Hypertension, or high blood pressure, is a common problem in adults, but it is not infrequently seen in children. The symptoms of hypertension are often absent, like in adults, and the high blood pressure is often detected during a routine school or medical visit.  In children, there is not a specific “hypertensive value”, but rather blood pressure measurements based upon age, sex and height, and repeat measurements of blood pressure using the appropriate cuff size (2/3 of the upper arm) before confirming the problem.

Contrary to adults, where no underlying cause is often found (“essential hypertension”), in children, a cause for the hypertension needs to be looked for. The most common causes include heart (coaretation of the aorta), kidney (poor development), obstruction, stress, inflammation, and infections, or endocrine problems). Therefore, a complete evaluation that includes blood and radiologic tests is required to exclude the treatable causes of hypertension.

Upon completion of the work-up, if no cause is elicited, especially in the presence of a family history of hypertension, “essential hypertension” is diagnosed.

In recent years, there have been new advances in the treatment of hypertension in children. Some medicines previously used in adults have gained acceptance for safe use with children. The treatment approach in children is different than in adults and expertise is required for the management of hypertension. This is the reason why most children with hypertension are referred to pediatric nephrologists. Based upon the underlying condition leading to the hypertension, the pediatric nephrologist will decide what family of hypertensive drugs is most appropriate for the child. For example, in the presence of progressive renal disease a drug called “ACE-inhibitor” would be more appropriate since it not only reduces the blood pressure but only exerts a renal protective effect and can delay progression of renal disease. In the athletic child, heart rate reducing drugs might not be appropriate and the anti-hypertensive regimen needs to be tailored to the needs of the patient.

Persistence of untreated hypertension, especially when it starts in childhood, can have devastating health consequences including heart failure, eye problems and renal damage. A comprehensive health care team approach is crucial for the successful management of the hypertension, especially in adolescents where non-adherence issues can arise due to the absence of symptoms. The use of long-acting drugs (once a day rather than two or three times a day) and comprehensive approach (physician, nurse, dietician, social worker) contributes to a more successful approach to management of hypertension in children.

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