10.3 Hypertension in Children Flashcards
HTN more common in kids these days?
yes more primary due to childhood obesity and poor diet
where on kids measure BP?
upper right preferable with mercury sphygmo
for age >12, if BP >120/80 then considered?
prehypertensive regardless
how to confirm child is hypertensive?
- SBP >95th percentile + 5mmHg for age, gender, height
- confirmed with 3 or more occasions with mean
two kinds of hypertension
- primary/essential 95%
- secondary 5%
secondary hypertension in kids, usually cause?
- renal
- renovascular disease
- more common than adults
most common renal disease you’ll see causing secondary hypertension?
post-strep glomerulonephritis
evaluation of hypertensive child, where to begin?
- thorough history
- exam
- appearance cushing/obese (cafeau lait, neurofibromas)
- height, weight
- upper and lower limb BP measurements
- CVS exam
- abdo for bruits, renal
- full neuro
- 24hr BP
Ix for childhood hypertension
UEC FBE Urine Plasma renin activity Thyroid Catecholamines Cholesterol/insulin/metabolic syndrome
imaging for childhood hypertension?
CXR/ECG ECHO renal U/S doppler renal artery DMSA scan for kidneys MRA/CTA/arteriogram
childhood hypertension non-pharma therapy?
- lifestyle
- weight reduction
pharma therapy childhood hypertension?
atenolol/metoprolol *amlodipine (mainstay) ACEi, ARB Diuretics(HCTZ) Central alpha blockers (clonidine)
ACEi and ARBs contraindicated when?
- in pregnancy
- make sure adolescent girls don’t fall pregnant
- in age 3-6 months
obesity what happens to body?
- increase renal angiotension system
- increase sympathetic overdrive
- salt and water retention
how to treat obesity physiological changes?
- salt restriction
- lifestyle
- ACE inhibitor
