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Etiology, clinical features, and diagnosis of neonatal hypertension

Joseph T Flynn, MD, MS
Section Editors
Joseph A Garcia-Prats, MD
Tej K Mattoo, MD, DCH, FRCP
Deputy Editor
Melanie S Kim, MD


Hypertension can be detected in 1 to 2.5 percent of all neonates (both term and preterm infants) admitted to neonatal intensive care units (NICUs). The clinician needs to be knowledgeable about normative blood pressure (BP) values, the optimal method to measure BP in newborns, the underlying etiologies, and clinical manifestations, in order to identify and treat neonatal hypertension.

The definition, etiology, clinical features, and diagnostic evaluation of neonatal hypertension will be reviewed here. Treatment of hypertension in infants is discussed separately. (See "Management of hypertension in infants".)


Hypertension — Neonatal hypertension is defined as persistent systolic and/or diastolic blood pressure (BP) that exceeds the 95th percentile for postmenstrual (sometimes referred to as postconceptional) age (figure 1 and table 1). However, it is challenging to define normal neonatal BP as there is a lack of normative BP in this age group. In addition, there are a number of factors that affect normal BP values during the neonatal period (defined as the first 28 days of life). As a result, it has been difficult to develop a standardized definition of hypertension for clinical use in this age group.

Normal BP — It is challenging to establish normative values for neonatal BP, especially in preterm infants, because of the effects of gestational age and maturation on BP values. BP values increase following birth, with greater rates of increase seen in preterm infants compared with term infants (see "Etiology, clinical manifestations, evaluation, and management of low blood pressure in extremely preterm infants", section on 'Physiological changes in BP'). In addition, the lack of large scale, prospective, multicenter studies of neonatal BP, further complicates the problem of defining normative BP data for neonates, especially preterm and ill term infants.

Nevertheless, based on a review of these data, a reference table of normal BP values at or after two weeks of age in infants between 26 and 44 weeks postconceptional age has been published (table 1) [1]. This table, which is based on the best available data through 2010, can be used clinically to identify infants with hypertension, defined as persistent BP elevation greater than the 95th percentile. These infants require further evaluation and/or treatment. (See 'Evaluation' below and "Management of hypertension in infants".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 05, 2017.
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