High blood pressure (BP) or hypertension is a well known risk factor for developing heart attack, stroke, atrial fibrillation and renal failure. Although in the past hypertension was supposed to develop at middle age, it is now widely recognized that it begins early during childhood. As such, approximately 5-10% of children and adolescents are hypertensive. Unlike that previously reported, it is now widely accepted that primary hypertension is the most diffuse form of high BP encountered even in paediatric age, while secondary hypertension accounts just for a minority of the cases. There are significant differences between that outlined by the European Society of Hypertension (ESH), the European Society of Cardiology (ESC), and the last statement by the American Academy of Pediatrics (AAP) concerning the BP cut-offs to identify young hypertensive individuals. Not only that, but the AAP have also excluded obese children in the new normative data. This is undoubtedly a matter of concern. Conversely, both the AAP and ESH/ESC agree that medical therapy should be reserved just for nonresponders to measures like weight loss/salt intake reduction/increase in aerobic exercise. Secondary hypertension often occurs in aortic coarctation or chronic renal disease patients. The former can develop hypertension despite early effective repair. This is associated with significant morbidity and is arguably the most important adverse outcome in about 30% of these subjects. Also, syndromic patients, for example those with Williams syndrome, may suffer from a generalized aortopathy, which triggers increased arterial stiffness and hypertension. This review summarizes the state-of-the-art situation regarding primary and secondary paediatric hypertension.
Keyphrases
- blood pressure
- hypertensive patients
- heart rate
- atrial fibrillation
- weight loss
- healthcare
- emergency department
- intensive care unit
- heart failure
- aortic valve
- body mass index
- coronary artery
- adipose tissue
- ejection fraction
- cardiac surgery
- coronary artery disease
- venous thromboembolism
- machine learning
- big data
- arterial hypertension
- roux en y gastric bypass
- catheter ablation
- high grade
- bariatric surgery
- acute coronary syndrome
- subarachnoid hemorrhage
- low grade
- blood brain barrier
- pulmonary hypertension
- left atrial appendage
- patient reported
- pulmonary arterial hypertension
- left atrial
- direct oral anticoagulants