Childhood Hypertension: A Review

Prevalence of hypertension in children has increased significantly in recent times, in part related to the epidemic of childhood obesity. Identification and treatment of hypertension in childhood is likely to favorably impact on cardiovascular disease in adulthood. Identification of hypertensive children continues to be problematic because of incomplete blood pressure screening during routine pediatric clinical visits. The blood pressure norms are based on age, gender and height specific values in contradistinction to adults where a single value suffices. Childhood hypertension is either primary or secondary and is categorized as prehypertension (between 90th to 95th percentile), stage 1 (95th to 99th percentile plus 5 mmHg) and stage 2 (≥ 99th percentile plus 5 mmHg) hypertension. Ambulatory blood pressure monitoring is useful in confirming the diagnosis and in helping diagnose white coat and masked hypertension. Once diagnosed as definitive hypertension, the causes of secondary hypertension should be determined and appropriately treated. In children with primary hypertension, a combination of life-style changes (diet and exercise) and drug therapy should be instituted depending upon the stage of the hypertension. Continued follow-up to ensure compliance with treatment regimen and to monitor blood pressure control is mandatory.