Primary Hypertension and Secondary Hypertension in Children - A Single-Center Experience

Objective: Arterial hypertension (AH) occurs in the developmental age in about 4% of patients. There is controversy regarding the prevalence of primary hypertension (PH) and secondary hypertension (SH) in children. The study aimed to characterize the hypertensive patients hospitalized in one pediatric nephrology center. Design and method: In 657 patients hospitalized between 2018 and 2022 with suspicion of hypertension, we diagnosed AH in 441 patients. We assessed the following: etiology of AH, age at diagnosis, current age, blood pressure (Z-score), and anthropometric and biochemical parameters. Results: In the study group of 441 patients, there were 282 boys and 159 girls. The age of diagnosis was 11.2±5.0, and the current age was 12.5±4.7 years. The causes of AH were: PH in 279 (63.3%), SH in 162 (36.7%): renal - 109, drug-induced - 35, renovascular - 10, hormonal - 3, aortic coarctation - 2, other - 3. Patients with PH were older (14.2±3.4 vs. 9.6±5.1 years, p=10 years of age, out of 321 patients with AH, 245 (76.3%) had PH. PH was statistically more frequent in boys than in girls (PH - 198 boys, 81 girls, SH - 84 boys, 78 girls, p=0.001). The diagnosis of PH was associated with a higher height Z-score (OR 1.49, 95CI: 1.16-1.91), higher BMI Z-score (OR 1.41, 95CI: 1.12-1.78), and older age (OR 1.33, 95CI: 1.24-1.44). Conclusions: 1. Currently, primary hypertension may be the most common etiology of hypertension in children. 2. Higher height, higher BMI, and older age rather than blood pressure values suggest a diagnosis of primary hypertension.