Hypertension
Hypertension: Excerpt from In A Page: Pediatric Signs and Symptoms
Hypertension is defined as the average (several measurements over time) systolic or diastolic blood pressure greater than the 95th percentile for age, gender, and height. Severe hypertension occurs when these values are greater than the 99th percentile. Patients with blood pressures between the 90th and 95th percentiles are considered borderline.
Differential Diagnosis
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“White coat” hypertension: Transient, related to anxiety
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Essential hypertension (most common cause in adolescents)
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Obesity
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Drugs: Amphetamines, cocaine, PCP, nicotine, corticosteroids, oral contraceptives, antidepressants, sympathomimetics (including eye and nose drops), decongestants, β-agonists, theophylline, NSAIDs, ephedra, etc.
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Pain/distress
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Trauma: Pain, increased ICP, or spinal cord injury
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Surgery: Transient hypertension secondary to pain or specific procedures such as ductus arteriosus ligation or coarctation repair, renal or urinary tract surgery
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Seizures
- Renal etiologies
–Chronic renal parenchymal disease: Most common in preadolescents (chronic renal insufficiency, reflux nephropathy, chronic glomerulonephritis, PCKD)
–Acute renal disease: Poststreptococcal glomerulonephritis, nephritis, renal failure
–Renal artery stenosis: From fibromuscular dysplasia or by external compression from tumor or hematoma
–Congenital ureteropelvic junction obstruction
–Renal ischemic events secondary to umbilical catheters (thrombosis/embolus)
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Endocrine disorders: CAH, Cushing syndrome, hypo-/hyperthyroidism, hyperparathyroidism, primary hyperaldosteronism, pheochromocytoma
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Sleep apnea
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Volume overload
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Hemolytic uremic syndrome
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Pregnancy
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Bronchopulmonary dysplasia
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Hypercalcemia
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Williams syndrome (multiple vascular stenosis, autoimmune vasculitis with large vessel involvement)
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Coarctation of the aorta
Workup and Diagnosis
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History
–Associated symptoms
–Birth history, PMH, review of systems
–Medications (including patient's own, those around the
house, and alternative medications/herbs)
–Social history including substance use, sleep patterns
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Physical exam
–Complete physical exam with special attention to eyes, abdomen, and neurologic systems
–Complete cardiac exam: Evaluate cardiovascular stability (four-extremity BP, pulse, perfusion, mental status, tachypnea) as well as heart sounds, murmurs, distal pulses
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Labs
–CBC, electrolytes, BUN, creatinine, calcium
–Urinalysis (blood, protein, calcium, creatinine,
creatinine clearance)
–Consider urine toxicology screen
–ASO titer if poststreptococcal glomerulonephritis is
suspected
–Thyroid function studies if history is consistent with thyroid dysfunction
- Studies
–Consider sleep study to rule out sleep apnea
–Consider echo for coarctation of aorta
–Consider renal ultrasound, DMSA, renin levels
–Captopril scan or renal angiography for renal etiology
Treatment
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Treat the underlying disease when possible
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Stop smoking and illicit drug use
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Avoid the offending drug when possible
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Limit competitive sports and highly static exercises in patients with severe hypertension only until their BP is controlled and there is no evidence of end organ damage
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Salt restriction (4–5 g/day), weight loss, and exercise are part of most regimens
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Essential hypertension can usually be resolved with weight loss, moderate exercise, and dietary modifications
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For other etiologies, many medications are used to control
blood pressure
–IV: Nicardipine, sodium nitroprusside, labetalol
–Oral: Captopril, enalapril, lisinopril, amlodipine,
nifedipine extended release, propranolol, clonidine, hydralazine
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
More About Pheochromocytoma
More Medical Textbooks Online about Pheochromocytoma
Review other book chapters online related to Pheochromocytoma:
Medical Books Excerpts
- Hypertension
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Hypertension
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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» Next page: HYPERTENSION (Differential Diagnosis in Primary Care)
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