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 evaluation of children with HTN will be reviewed here. The epidemiology, etiology, diagnosis, and treatment of childhood HTN 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 "Nonemergent 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".)
For children in the United States, the 2017 American Academy of Pediatrics (AAP) guidelines for screening and managing high blood pressure for children and adolescents definitions are used to categorize blood pressure for two different age groups (table 1) . BP percentiles are based upon gender, age, and height (table 2 and table 3). (See "Definition and diagnosis of hypertension in children and adolescents".) Childhood HTN is also divided into two categories depending upon whether or not an underlying cause can be identified (table 4):
●Primary HTN – No identifiable cause is found.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- INITIAL EVALUATION
- History and physical examination
- - Symptomatic hypertension
- - Secondary versus primary hypertension
- - Risk factors for CVD and hypertension
- - Physical findings of end-organ damage
- Laboratory evaluation and renal imaging
- - Obese children
- FURTHER EVALUATION
- Detection of end-organ damage
- - LV hypertrophy and echocardiography
- - Unproven vascular assessment and CVD outcome
- Primary hypertension
- Secondary hypertension
- - Plasma renin and aldosterone activity
- - Plasma and urine catecholamines
- - Renal imaging
- - Renovascular imaging
- - Sleep study evaluation
- - Drug screening
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- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS