2: Pediatric HTN Flashcards
When should BP screening start with peds?
- 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.)
When should BP measurements be taken in children less than 3 yo?
- 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
How do you take a proper BP in children?
- 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.
In children, what is considered pre-HTN?
120/80, regardless of age and height.
What is needed to interpret BP in children?
- Age
- Gender
- Height (by %)
What BP percentile is normal in children?
<90th percentile
What BP percentile is pre-HTN in children?
90th-95th percentile
What BP percentile is Stage 1 HTN in children?
95th-99th (+5)
What BP percentile is Stage 2 HTN in children?
>99th percentile
When do you treat HTN immediately in peds?
If stage 2 and symptomatic. Needs prompt referral.
Hypertension diagnosed on or after the _____ abnormal reading.
Hypertension diagnosed on or after the 3rd abnormal reading.
T/F Any abnormal reading needs to be repeated manually on the same day (both arms ideally).
True
T/F HTN in children is secondary.
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.
Name causes of secondary HTN.
- 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)
When is secondary HTN most common?
- Birth - 1 year (99%)
- 1 - 12 yo (70-85%)
When is primary HTN most common?
12 - 18 yo (5-15%)
Which would you expect to see as an end-result in pediatric HTN vs adult HTN?
- MI
- Stroke
- CV mortality
- Hypertensive encephalopathy
- Hypertensive encephalopathy
- The others are common end results in adult HTN
Pediatric HTN can lead to hypertensive encephalopathy as illustrated by what?
- Seizures
- Stroke
- Heart Failure
What is the target end organ damage in pediatric HTN?
- Chronic renal dx
- Left ventricular hypertrophy
- Retinal vascular abnormalities (no studies in children)
Define pediatric HTN.
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.
T/F The younger the age at diagnosis of HTN, the more likely the cause of HTN is secondary.
True
Name the most common causes of HTN in children between 1 and 6 yo.
- Renal artery stenosis
- Parenchymal renal dx
HTN in prepubertal children most commonly results from underlying _____.
HTN in prepubertal children most commonly results from underlying kidney disease.
Clonidine is an antihypertensive medication that is frequently used in children with ADHD to assist with onset of sleep. Abrupt cessation can cause _____.
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.
