Çiğdem Yanar Ayanoğlu

Question 1

HTN?

Answer 1

_> 95th percentile for age,sex,height on _> 3 occasions
1-13 years
Stage 1 htn: >95th to <95th+ 12mmhg or 130-139/80-89
Stage 2: >95th+12 mmhg or >140/90
Whicever is Lower
Usually secondary htn, and prevelance <%1

Bp should be checked after 3 years
Below 3 years if: premature,congenital heart disease, renal disease, increased intracranial pressure, other htn assoc ilnesses, cancer,solid organ transplant, use of steroids

Question 2

Prehtn/elevated bp
White coat htn

Answer 2

_> 90th percentile, <95th
Or 120/80 to <95th

Question 3

Measurement

Answer 3

Auscultation with cuff,oscillometric(for mean), ambulatory bp monitoring(ABPM)( 24 hr)

Systolic: 1st korotkoff
Diastolic: 5th korotkoff
Bp: vascular resistance,cardiac output

Question 4

Primary htn causes

Answer 4

Multifactorial
Calcium sodium transport alterations, vascular smooth muscle reactivity, renin ang system, symphathetic nervous system overreactivity, insulin resistance, elevated uric acid, salt sensitive htn

Question 5

Secondary htn causes

Answer 5

Renal, renovascular : %90
Renal: glomerulonephritis,reflux or obstructive nephropathy,polycystic/dysplastic renal disease, hemolytic uremic syndrome
Renal, cardiovascular, endocrinopathies:
Renal tumor, lupus,acute tubular necrosis,pyelonephritis,transplant rejection,Coarctation of aorta, takayasu arteritis,vasculitis, av shunt,umbilicak artery catheterization, cushing,pheochromacytoma,hyperthyroidism, hyperparathyroidism,congenital adrenal hyperplasia, aldosteronism,lidle syndrome, intracranial mass,quadriplegia, corticosteroids, guillen barre syndrome

Question 6

Htn causes depending on age?

Answer 6

Premature infant: umbilical artery cathetherization/ renal artery thrombosis
Early childhood: renal disease,coarctation of aorta,endocrine disorders,medication
Older school aged: primary htn

Question 7

Htn symptoms

Answer 7

If any:
Headache,dizziness,visual change,epistaxis,seizure,anorexia
After stage 2:
Hypertensive encephalopathy(PRES): vomiting, elrvated temperature,ataxia,stupor,seixure

Cardiac failure,pulmanory edema,renal dysfunction,bell palsy

Hypertensive crisis: decreased vision, papilledema, encephalopathy, hf, renal dysfunction

Target organ injury: lv hypertrophy, carotid intima-media thickness, retinopathy,microslbuminuria

Question 8

Dgx

Answer 8

1.primary/secondary
2.comorbidities
3. End organ damage

History,pe(cushing,neurofibromatosis,hsp,willms tumor),famly history,growth parameters,4 extremities, urinaysis,electrolytes,bun,creatinine,cbc,urine culture,renal usg, if obese: fasting lipid/glucose

1.htn 2. Measure 4 extremities 3.urinalysis

4 ekstremiteden ölç:
1.upper lower difference: coarctation of aorta
2.if not,urinalysis abnormal: a)rbc: postinfectious/lupus nephritis b)wbc:reflux nephritis,uti
3.urinalysis normal: endocrine, renovascular,essential htn

Question 9

Drugs for htn in children

Answer 9

İndication for drugs: symptomatic htn, secondary htn. Target organ damage,persistent htn,diabetes

Symptomatic htn: cardiac/renal failure,retinopathy,encephalopathy,seizure

Ace-i, Arb, b-blockers, ca channel blockers, diuretics
B blockers or ca channel blockers: htn children with migraine headaches
Ace-i or arb:diabetes,microalbuminuria, proteinuric renal disease

Bp goal <95th but if ckd,diabetes, target organ damage: <90th

Drug choices:labetalol,nicardipine,sodium nitroprusside
Bp reduced %10 1sth hour,%15 next 3-12 hours

If renovascular prblm, renin angiotensin system drugs are contraindicated