20 Arterial Hypertension



10.1055/b-0035-121515

20 Arterial Hypertension



20.1.1 Basics



Definition


Arterial hypertension is defined as an increase in systolic and/or diastolic blood pressure over the gender-specific 95th percentile for the age or size of the patient (Table 20.1). At least three independent measurements are needed.


























































































































































Table 20.1 Normal values for 24-hour long-term blood pressure measurement in children and adolescents in relation to gender and height (Soergel et al. 1997)101

Mean values for boys (mmHg)



Daytime


Nighttime


24 hours


Height (cm)


50th percentile


95th percentile


50th percentile


95th percentile


50th percentile


95th percentile


120


112/73


123/85


95/55


104/63


105/65


113/72


130


113/73


125/85


96/55


107/65


105/65


117/75


140


114/73


127/85


97/55


110/67


107/65


121/77


150


115/73


129/85


99/56


113/67


109/66


124/78


160


118/73


132/85


102/56


116/67


112/66


126/78


170


121/73


135/85


104/56


119/67


115/67


128/77


180


124/73


137/85


107/56


122/67


120/67


130/77


Mean values for girls (mmHg)



Daytime


Nighttime


24 hours


Height (cm)


50th percentile


95th percentile


50th percentile


95th percentile


50th percentile


95th percentile


120


111/72


120/84


96/55


107/66


103/65


113/73


130


112/72


124/84


97/55


109/66


105/66


117/75


140


114/72


127/84


98/55


111/66


108/66


120/76


150


115/73


129/84


99/55


112/66


110/66


122/76


160


116/73


131/84


100/55


113/66


111/66


124/76


170


118/74


131/84


101/55


113/66


112/66


124/76


180


120/74


131/84


103/55


114/66


113/66


124/76


The following formulas can be used as a rule of thumb for the upper blood pressure limits:




  • Children age 1 to 10 years:




    • Systolic blood pressure (mmHg): 100 + (age in years × 2)



    • Diastolic blood pressure (mmHg): 60 + (age in years × 2)



  • Children and adolescents age 11 to 17 years:




    • Systolic blood pressure (mmHg): 100 + (age in years × 2)



    • Diastolic blood pressure (mmHg): 70 + (age in years)



Epidemiology


The incidence of arterial hypertension in children and adolescents in Germany is at present 1 to 3% but increasing.



Classification and Etiology


Arterial hypertension is classified as primary (essential) hypertension or secondary hypertension. Secondary hypertension is due to a treatable cause.



Primary (Essential) Hypertension

The cause of essential hypertension is unknown. It is assumed that there are multiple factors, among them genetic predisposition, environmental factors, lifestyle, and ethnic origin. Studies in the United States show that essential hypertension is on the increase, even in children and adolescents. Many of these patients are obese and have a positive family history of hypertension. This form of hypertension is often associated with lipid metabolism disorders and impaired glucose tolerance (metabolic syndrome), especially in overweight patients.



Secondary Hypertension



  • Renal disease: Kidney diseases constitute around 90% of secondary hypertension:




    • Renovascular diseases: Renovascular disease is found in about half of neonates with hypertension. Examples:




      • Congenital renal artery stenosis



      • Complex anomaly of the entire aorta (mid-aortic syndrome)



      • Renal artery stenosis due to a fibromuscular dysplasia (association with neurofibromatosis type I)



      • Renal vascular thrombosis (especially after umbilical vessel catheters)



      • After kidney transplantation



    • Renal parenchymal diseases: Renal parenchymal diseases are the most common causes of secondary hypertension in infants and school-age children. Examples:




      • Focal segmental glomerulosclerosis



      • Mesangial proliferative glomerulonephritis



      • Membranoproliferative glomerulonephritis



      • Rapid progressive glomerulonephritis



      • IgA nephritis



      • Diabetic nephropathy



      • HIV nephropathy



      • Renal parenchymal scarring and reflux nephropathy



      • Vasculitis (systemic lupus erythematosus, Wegener granulomatosis, polyangiitis)



      • Hemolytic uremic syndrome



      • Polycystic kidney disease (in autosomal recessive forms, severe hypertension is often already present at birth)



      • Alport syndrome



      • Renal hypoplasia/dysplasia



      • Metabolic diseases (cystinosis, oxalosis)



  • Cardiovascular diseases:




    • Coarctation of the aorta—leading symptom: increased blood pressure in the upper limbs, decreased blood pressure in the lower limbs. (Even after surgery or interventional catheterization, hypertension often persists in the upper limbs.)



    • Rarely:




      • Hypoplastic aortic arch



      • Mid-aortic syndrome



      • Takayasu arteritis



      • Aortic aneurysm



      • Stenosis of the carotid artery



      • After Kawasaki disease



  • Endocrine diseases:




    • Cushing syndrome, steroid treatment



    • Adrenogenital syndrome



    • Pheochromocytoma (rare in childhood, usually associated with neurofibromatosis type I)



    • Neuroblastoma (however, usually no hypertension present)



    • Hyperthyroid crisis



    • Hyperaldosteronism, Liddle syndrome (hypokalemia, alkalosis)



  • Neurogenic diseases:




    • Intracranial pressure (brain tumors, trauma)



    • CNS inflammation (Guillain–Barré syndrome, encephalitis)



  • Drugs and toxic causes:




    • Drugs: steroids, cyclosporine A, sympathomimetics, caffeine



    • Excessive consumption of liquorice



    • Mercury poisoning



  • Other causes:


Jun 13, 2020 | Posted by in CARDIOLOGY | Comments Off on 20 Arterial Hypertension
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