2: Pediatric HTN

Question 1

When should BP screening start with peds?

Answer 1

• Every 3+ year old every visit (One recommendation)
• VS Every 3+ year old once annually (and with concerns)
• Whenever clinical concern exists (HA, chest pain, renal dx, dehydration, new murmur, etc.)

Question 2

When should BP measurements be taken in children less than 3 yo?

Answer 2

• If clinical concern exists!
• Hx of prematurity or very low birth weight
• Congenital heart disease
• Recurrent UTI, hematuria, proteinuria, hx renal dzs, urologic disease
• Family hx of congenital renal disease
• Solid organ transplant
• Malignancy, bone marrow transplant
• Medications known to elevate BP
• Other disease processes known to elevate BP
• Evidence of increased ICP

Question 3

How do you take a proper BP in children?

Answer 3

• Child seated.
• Quiet x 5 minutes prior to measurement!
• No recent stimulant foods/drink.
• Seated with his or her back supported, feet on the floor and right arm supported, cubital fossa at heart level.
• Due to risk of coarctation of the aorta, check both arms.
• Cuff should cover 80-100% of arm. Too big better than too small.

Question 4

In children, what is considered pre-HTN?

Answer 4

120/80, regardless of age and height.

Question 5

What is needed to interpret BP in children?

Answer 5

• Age
• Gender
• Height (by %)

Question 6

What BP percentile is normal in children?

Answer 6

<90th percentile

Question 7

What BP percentile is pre-HTN in children?

Answer 7

90th-95th percentile

Question 8

What BP percentile is Stage 1 HTN in children?

Answer 8

95th-99th (+5)

Question 9

What BP percentile is Stage 2 HTN in children?

Answer 9

>99th percentile

Question 10

When do you treat HTN immediately in peds?

Answer 10

If stage 2 and symptomatic. Needs prompt referral.

Question 11

Hypertension diagnosed on or after the _____ abnormal reading.

Answer 11

Hypertension diagnosed on or after the 3rd abnormal reading.

Question 12

T/F Any abnormal reading needs to be repeated manually on the same day (both arms ideally).

Answer 12

True

Question 13

T/F HTN in children is secondary.

Answer 13

False. Hypertension in children in the past was always assumed to be secondary due to a renal cause, a tumor, coarctation of the aorta, etc. Overwhelming data shows that children are in fact, developing primary (essential) hypertension.

Question 14

Name causes of secondary HTN.

Answer 14

• Endocrine (hyperthyroidism, hyperaldosteronism, adrenal hyperplasia, Cushing’s syndrome, diabetes)
• Tumors (pheochromocytoma, neuroblastoma)
• Syndromes (Turner’s, Williams, Liddle)
• Obstructive sleep apnea
• Steroid use/abuse
• Illicit drug use
• Neurofibromatosis
• Tuberous sclerosis
• Systemic lupus
• Collagen-vascular disease
• Coarctation of the aorta
• Renal dx (polycystic kidney dx, Wilm’s or other renal tumor, renal artery stenosis, hydronephrosis, multicystic-dysplastic kidney)

Question 15

When is secondary HTN most common?

Answer 15

• Birth - 1 year (99%)
• 1 - 12 yo (70-85%)

Question 16

When is primary HTN most common?

Answer 16

12 - 18 yo (5-15%)

Question 17

Which would you expect to see as an end-result in pediatric HTN vs adult HTN?

• MI
• Stroke
• CV mortality
• Hypertensive encephalopathy

Answer 17

• Hypertensive encephalopathy
• The others are common end results in adult HTN

Question 18

Pediatric HTN can lead to hypertensive encephalopathy as illustrated by what?

Answer 18

• Seizures
• Stroke
• Heart Failure

Question 19

What is the target end organ damage in pediatric HTN?

Answer 19

• Chronic renal dx
• Left ventricular hypertrophy
• Retinal vascular abnormalities (no studies in children)

Question 20

Define pediatric HTN.

Answer 20

Pediatric hypertension is defined as an average of systolic or diastolic blood pressure measurements at or above the 95th percentile for the child’s age, gender, and height percentile.

Question 21

T/F The younger the age at diagnosis of HTN, the more likely the cause of HTN is secondary.

Answer 21

True

Question 22

Name the most common causes of HTN in children between 1 and 6 yo.

Answer 22

• Renal artery stenosis
• Parenchymal renal dx

Question 23

HTN in prepubertal children most commonly results from underlying _____.

Answer 23

HTN in prepubertal children most commonly results from underlying kidney disease.

Question 24

Clonidine is an antihypertensive medication that is frequently used in children with ADHD to assist with onset of sleep. Abrupt cessation can cause _____.

Answer 24

Clonidine is an antihypertensive medication that is frequently used in children with ADHD to assist with onset of sleep. Abrupt cessation can cause rebound HTN.