Evaluation of hypertension in children and adolescents
- Tej K Mattoo, MD, DCH, FRCP
Tej K Mattoo, MD, DCH, FRCP
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Wayne State University School of Medicine
It has become clear that hypertension (HTN) begins in childhood and adolescence, and that it contributes to the early development of cardiovascular disease (CVD). The supporting data include clinical studies that demonstrate cardiovascular structural and functional changes in children with HTN, and autopsy studies that have shown an association of blood pressure (BP) with atherosclerotic changes in the aorta and heart in children and young adults. (See "Definition and diagnosis of hypertension in children and adolescents" and "Risk factors and development of atherosclerosis in childhood", section on 'Hypertension'.)
In hypertensive adults, multiple randomized trials have shown that reduction of BP by antihypertensive therapy reduces cardiovascular morbidity and mortality. The magnitude of the benefit increases with the severity of the HTN. (See "Hypertension: Who should be treated?".)
Based upon these observations, identifying children with HTN and successfully treating their HTN should have an important impact on long-term outcomes of CVD. One of the most important components of the successful management of childhood HTN is determining whether or not there is an underlying cause that is amenable to treatment.
The evaluation of children with HTN will be reviewed here. The epidemiology, etiology, diagnosis, and treatment of childhood hypertension are discussed separately. (See "Epidemiology, risk factors, and etiology of hypertension in children and adolescents" and "Definition and diagnosis of hypertension in children and adolescents" and "Ambulatory (outpatient) treatment of hypertension in children and adolescents".)
In addition, the evaluation for hypertensive emergency is presented elsewhere. (See "Approach to hypertensive emergencies and urgencies in children".)
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- Primary versus secondary hypertension
- Comorbid risk factors and diseases
- INITIAL EVALUATION
- History and physical examination
- - Secondary versus primary hypertension
- - CVD risk factors
- - Physical findings of end-organ damage
- Laboratory evaluation and imaging
- FURTHER EVALUATION
- Primary hypertension
- Secondary hypertension
- - Renal imaging
- - Plasma renin and aldosterone activity
- - Plasma and urine catecholamines
- - Renovascular imaging
- Our approach
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS