SpringerLink
Log in

Evaluation of Hypertension in Pediatric Patients

  • Chapter
  • First Online:
Pediatric Hypertension

Part of the book series: Clinical Hypertension and Vascular Diseases ((CHVD))

Abstract

The management of hypertension in the pediatric population begins with a thorough diagnostic evaluation which can be tailored to the individual patient based on age, symptoms, and severity of hypertension. We outline four phases of evaluation which are integral to the optimal management of hypertension in children. The first phase seeks to answer whether the patient is truly hypertensive in the nonmedical setting. This can be confirmed with either ambulatory blood pressure monitoring or self-monitored blood pressure monitoring. Once it is determined that the patient is truly hypertensive, the second phase provides screening for etiology of hypertension, hypertensive end-organ damage, and comorbidities. The third phase of evaluation defines the underlying abnormality which could be causing the hypertension, and the fourth phase determines the significance and remediability of the abnormality. By systematically using the four phases outlined in this chapter, the clinician can conduct a thorough evaluation of the hypertensive patient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
EUR 29.95
Price includes VAT (Germany)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
EUR 234.33
Price includes VAT (Germany)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Falkner BE. Treatment of hypertensive children and adolescents. In: Isso JL, Black HR, editors. Hypertension primer. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2003. p. 494–7.

    Google Scholar 

  2. US Department of Health and Human Services. National Institutes of Health. National Heart, Lung, Blood Institute. The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. NIH Publication No. 05–5267 May 2005 1–42.

    Google Scholar 

  3. Lande MB, Flynn JT. Treatment of hypertension in children and adolescents. Pediatr Nephrol. 2009;24:1939–49.

    Article  PubMed  Google Scholar 

  4. The ESCAPE Trial Group. Strict blood-pressure control and progression of renal failure in children. N Engl J Med. 2009;361(17):1639–50.

    Article  Google Scholar 

  5. Kavey R-E, Allada V, Daniels SR, Hayman LL, McCrindle BW, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science. Circulation. 2006;114:2710–38.

    Article  PubMed  Google Scholar 

  6. Falkner B. Hypertension in children and adolescents: epidemiology and natural history. Pediatr Nephrol. 2009. doi:10.1007/s00467-009-1200-3.

    PubMed  Google Scholar 

  7. Julius S, Nesbitt SD, Egan BM, Weber MA, Michelson EL, Kaciroti N, et al. Feasibility of treating prehypertension with an angiotensin-receptor blocker for the trial of preventing hypertension (TROPHY) study investigators. N Engl J Med. 2006;354:1685–97.

    Article  CAS  PubMed  Google Scholar 

  8. Amoore JN. Oscillometric sphygmomanometers: a critical appraisal of current technology. Blood Press Monit. 2012 Apr;17(2):80–8.

    Article  PubMed  Google Scholar 

  9. Chio SS, Urbina EM, Lapointe J, Tsai J, Berenson GS. Korotkoff sound versus oscillometric cuff sphygmomanometers: comparison between auscultatory and DynaPulse blood pressure measurements. J Am Soc Hypertens. 2011;5(1):12–20. Epub 2011 Jan 26. PubMed PMID: 21269907.

    Article  PubMed  Google Scholar 

  10. Landgraf J, Wishner SH, Kloner RA. Comparison of automated oscillometric versus auscultatory blood pressure measurement. Am J Cardiol. 2010 Aug 1;106(3):386–8. Epub 2010 May 22.

    Article  PubMed  Google Scholar 

  11. Park MK, Menard SW, Yuan C. Comparison of auscultatory and oscillometric blood pressures. Arch Pediatr Adolesc Med. 2001;155:50–3.

    CAS  PubMed  Google Scholar 

  12. Lurbe E, Torro I, Alvarez V, Nawrot T, Paya R, Redon J, Staessen J. Prevalence, persistence and clinical significance of masked hypertension in youth. Hypertension. 2005;45:493–8.

    Article  CAS  PubMed  Google Scholar 

  13. Hansen TW, Kikuya M, Thijs L, Björklund-Bodegard K, Kuznetsova T, Ohkubo T, et al. Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7030 individuals. J Hypertens. 2007;25:1554–64.

    Article  CAS  PubMed  Google Scholar 

  14. Eguchi K, Pickering TG, Hoshide S, Ishikawa J, Ishikawa S, Schwartz JE, et al. Ambulatory blood pressure is a better marker than clinic blood pressure in predicting cardiovascular events in patients with/without type 2 diabetes. Am J Hypertens. 2008;21: 443–50.

    Article  PubMed  Google Scholar 

  15. Gueyffier F, Cornu C, Bossard N, Mercier C, Poncelet P, Sebaoun A, et al. Prognostic importance of ambulatory arterial pressure monitoring in France. Initial results of the OCTAVE II study. Arch Mal Coeur Vaiss. 1999;92:1151–7.

    CAS  PubMed  Google Scholar 

  16. Swartz SJ, Srivaths PR, Croix B, Feig DI. Cost-effectiveness of ambulatory blood pressure monitoring in the initial evaluation of hypertension in children. Pediatrics. 2008;122:1177–81.

    Article  PubMed  Google Scholar 

  17. Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, et al. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens. 2009;27:1719–42.

    Article  CAS  PubMed  Google Scholar 

  18. Urbina E, Alpert B, Flynn J, Hayman L, Gregory A, et al. Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment. A scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertension. 2009;52: 433–51.

    Article  Google Scholar 

  19. Clement DL, De Buyzere ML, De Bacquer DA, Fagard RH, Gheeraert PJ, Missault LH, Braun JJ, Six RO, Van Der Niepen P, O’Brien E, Office versus Ambulatory Pressure Study Investigators. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med. 2002;348:2407–15.

    Article  Google Scholar 

  20. Amin R, Somers VK, McConnell K, Willging P, Myer C, Sherman M, et al. Activity-adjusted 24-hour ambulatory blood pressure and cardiac remodeling in children with sleep disordered breathing. Hypertension. 2008;51:84–91.

    Article  CAS  PubMed  Google Scholar 

  21. Karavanaki K, Kazianis G, Konstantopoulos I, Tsouvalas E, Karayianni C. Early signs of left ventricular dysfunction in adolescents with type 1 diabetes mellitus: the importance of impaired circadian modulation of blood pressure and heart rate. J Endocrinol Invest. 2008;31:289–96.

    CAS  PubMed  Google Scholar 

  22. McNiece KL, Gupta-Malhotra M, Samuels J, Bell C, Garcia K, Poffengbarger T, et al. Left ventricular hypertrophy in hypertensive adolescents: analysis of risk by 2004 National High Blood Pressure Education Program Working Group staging criteria. Hypertension. 2007;50:392–5.

    Article  CAS  PubMed  Google Scholar 

  23. Covic A, Goldsmith DJA, Georgescu GC, Ackrill P. Relationships between blood pressure variability and left ventricular parameters in hemodialysis and renal transplant patients. Nephrology. 1998;4:87–94.

    Article  Google Scholar 

  24. Appel LJ, Robinson KA, Guallar E, Erlinger T, Masood SO, Jehn M, Fleisher LA, Bass EB. Utility of blood pressure monitoring outside of the clinic setting. Evidence/Technology assessment, No 63, U.S. Department of Health and Human Service, Agency for Healthcare Research and Quality, 2002. Available at http://www.ahrq.gov/downloads/pub/evidence/pdf/utbp/utbp.pdf

  25. Flynn JT. Differentiation between primary and secondary hypertension in children using ambulatory blood pressure monitoring. Pediatrics. 2002;110: 89–93.

    Article  PubMed  Google Scholar 

  26. Wuhl E, Hadtstein C, Mehls O, Schaefer F, ESCAPE Trial Group. Home, clinic, and ambulatory blood pressure monitoring in children with chronic renal failure. Pediatr Res. 2004;55:492–7.

    Article  PubMed  Google Scholar 

  27. Stergious GS, Karpettas N, Kapoyiannis A, Stefandidi CJ, Vazeou A. Home blood pressure monitoring in children and adolescents: a systematic review. J Hypertens. 2009;27:1941–7.

    Article  Google Scholar 

  28. Lurbe E, Alvarez V, Redon J. Obesity, body fat distribution, and ambulatory blood pressure in children and adolescents. J Clin Hypertens. 2001;3:362–7.

    Article  CAS  Google Scholar 

  29. May AL, Kuklina EV, Yoon PW. Prevalence of cardiovascular disease risk factors among US adolescents, 1999–2008. Pediatrics. 2012;129(6):1035–41.

    Article  PubMed  Google Scholar 

  30. Prineas RJ, Ostchega Y, Carroll M, Dillon C, McDowell M. US demographic trends in mid-arm circumference and recommended blood pressure cuffs for children and adolescents: data from the National Health and Nutrition Examination Survey 1988–2004. Blood Press Monit. 2007;12(2):75–80.

    Article  PubMed  Google Scholar 

  31. Gimpel C, Wuhl E, Arbeiter K, Drozdz D, Trivelli A, Charbit M, et al. Superior consistency of ambulatory blood pressure monitoring in children: implications for clinical trials. J Hypertens. 2009 Aug;27(8): 1568–74.

    Article  CAS  PubMed  Google Scholar 

  32. Lurbe E, Toor I, Paya R, Alvarez V, Redon J. Masked hypertension in adolescents. Am J Hypertens. 2003;16:237A.

    Article  Google Scholar 

  33. Londe S. Causes of hypertension in the young. Pediatr Clin North Am. 1978;25(1):55–65.

    CAS  PubMed  Google Scholar 

  34. Luma GB, Spiotta RT. Hypertension in children and adolescents. Am Fam Physician. 2006;73: 1558–68.

    PubMed  Google Scholar 

  35. Schwartz GJ, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009;20:629–37.

    Article  PubMed  Google Scholar 

  36. Olin JW, Piedmonte MA, Young JR. The utility of duplex ultrasound scanning of the renal arteries for diagnosing significant renal artery stenosis. Ann Intern Med. 1995;122:833–8.

    Article  CAS  PubMed  Google Scholar 

  37. Brun P, Kchouk H, Mouchet B. Value of Doppler ultrasound for the diagnosis of renal artery stenosis in children. Pediatr Nephrol. 1997;11:27–30.

    Article  CAS  PubMed  Google Scholar 

  38. Toka HR, Luft FC. Monogenic forms of human hypertension. Semin Nephrol. 2002;22:81–8.

    Article  CAS  PubMed  Google Scholar 

  39. Daniels SR, Lipman MU, Berke JM. The prevalence of retinal vascular abnormalities in children and adolescents with essential hypertension. Am J Ophthalmol. 1991;111:205–8.

    CAS  PubMed  Google Scholar 

  40. Mitchell P, Cheung N, Dettuseth K, Taylor B, Rochitchira E, Wang JJ, et al. Blood pressure and retinal arteriolar narrowing in children. Hypertension. 2007;49:1156–62.

    Article  CAS  PubMed  Google Scholar 

  41. Daniels SR, Loggie JM, Khoury P, Kimball TR. Left ventricular geometry and severe left ventricular hypertrophy in children and adolescents with essential hypertension. Circulation. 1998;97:1907–11.

    Article  CAS  PubMed  Google Scholar 

  42. Sorof JM, Alexandrov AV, Cardwell G, Portman RJ. Carotid artery intimal-medial thickness and left ventricular hypertrophy in children with elevated blood pressure. Pediatrics. 2003;111:61–6.

    Article  PubMed  Google Scholar 

  43. McConnell K, Somers VKL, Kimball T, Daniels S, VanDyke R, Fenchel M, et al. Baroreflex gain in children with obstructive sleep apnea. Am J Respir Crit Care Med. 2009;180:42–8.

    Article  PubMed  Google Scholar 

  44. McGlothan KR, Wyatt RJ, Ault BH, Hastings MC, Rogers T, DiSessa T, et al. Predominance of nocturnal hypertension in pediatric renal allograft recipients. Pediatr Transplant. 2006;10:558–64.

    Article  PubMed  Google Scholar 

  45. Lurbe E, Redon J, Kesani A, et al. Increase in nocturnal blood pressure and progression to microalbuminuria in type I diabetes. N Engl J Med. 2002;347: 797–805.

    Article  CAS  PubMed  Google Scholar 

  46. Glushien AS, Mansuy MM, Littman DS. Pheochromocytoma: its relationship to neurocutaneous syndromes. Am J Med. 1953;14:318–27.

    Article  CAS  PubMed  Google Scholar 

  47. Alpert BS, Bain HH, Balfe JW. Role of the renin-angiotensin-aldosterone system in hypertensive children with coarctation of the aorta. Am J Cardiol. 1979;43:828–31.

    Article  CAS  PubMed  Google Scholar 

  48. Becker AE, Becker MJ, Edward JE. Anomalies associated with coarctation of aorta. Circulation. 1979;41: 1067–9.

    Article  Google Scholar 

  49. Morriss M, McNamara D. Coarctation of the aorta. In: Garson A, Bricker J, McNamara D, editors. Science and practice of pediatric cardiology. Philadelphia: Lea & Febiger; 1990. p. 1353–65.

    Google Scholar 

  50. Wiggelinkhuizen J, Cremin BJ. Takayasu arteritis and renovascular hypertension in childhood. Pediatrics. 1978;62:209–17.

    CAS  PubMed  Google Scholar 

  51. Vehaskari M. Heritable forms of hypertension. Pediatr Nephrol. 2009;24:1929–37.

    Article  PubMed  Google Scholar 

  52. Martinez-Aguayo A, Fardell C. Genetics of hypertensive syndrome. Horm Res. 2009;71:253–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology and Hypertension, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 3.121, 77030, Houston, TX, USA

    Joyce P. Samuel M.D. & Rita D. Swinford M.D.

  2. Global Clinical Research, Bristol-Myers Squibb, Pediatric Center of Excellence, Route 206 & Provinceline Road, 08543, Princeton, NJ, USA

    Ronald J. Portman M.D.

Authors
  1. Joyce P. Samuel M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rita D. Swinford M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ronald J. Portman M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rita D. Swinford M.D. .

Editor information

Editors and Affiliations

  1. University of Washington, Division of Pediatrics, Seattle Children's Hospital, Sand Point Way NE. 4800, Seattle, 98105, Washington, USA

    Joseph T. Flynn

  2. Harvard Medical School, Pediatric Nephrology Unit, MassGeneral Hospital for Children at MGH, Fruit St. 55, Boston, 02114, Massachusetts, USA

    Julie R. Ingelfinger

  3. Global Clinical Research, Bristol-Myers Squibb, Route 206 & Provinceline Road, Princeton, 08543, New Jersey, USA

    Ronald J. Portman

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Samuel, J.P., Swinford, R.D., Portman, R.J. (2013). Evaluation of Hypertension in Pediatric Patients. In: Flynn, J., Ingelfinger, J., Portman, R. (eds) Pediatric Hypertension. Clinical Hypertension and Vascular Diseases. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-490-6_32

Download citation

  • DOI: https://doi.org/10.1007/978-1-62703-490-6_32

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-62703-489-0

  • Online ISBN: 978-1-62703-490-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation