HTA

Question 1

Definition of BP categories and stages

Answer 1

Normal BP: <90th percentile
Elevated BP: > 90th percentile to < 95th percentile
Stage 1 HTA: > 95th percentile to < 95th percentile + 12mmhg
Stage 2: >95th percentil + 12mmhg or > 140/90

Question 2

When to measure BP

Answer 2

Measure annually starting at 3 years old in ambulatory setting.

Children how should have BP measured at every health encounter:
- obesity
- Renal disease
- Diabetes
- COarct
- medication known to increase BP

Question 3

Medication known to increase BP

Answer 3

• Decongestants
• caffeine
• AINS
• produits naturels
• Stimulants
• Hormonal contraception
• Steroids
• tricyclic antidepressants
• Amphetamines
• cocaine

Question 4

Children under 3 that should have BP measured

Answer 4

• History of prematurity (<32 weeks)
• Small for gestational age
• Very low birth weight
• Other neonatal complications requiring intensive care or umbelical artery line
• Congenital heart disease (repaired or not)
• Reccurent UTI, hematuria or proteinuria
• Known renal disease or urologic malformations
• Family history of congenital renal disease
• solid organ transplant
• Malignancy or bone marrow transplant
• treatment with drugs known to raise BP
• Systemic illnesses (NF1, Tuberosis sclerosis, sickle cell disease)
• HTIC

Question 5

Elevated BP screening tests

Answer 5

In all patients:
- Urinalysis
- Chemistry panel : Electrolytes, BUN, creat
- Lipid profile
- Renal ultrasound for patients < 6 years old or those with abnormal urinalysis or renal function

In obese patients:
- HbA1c
- Aspartate transaminase or Alanine transaminase (screen for fatty liver)
- Fasting lipid panel (screen for dyslipidemia)

Other optional tests:
- Fasting serum glucose
- TSH
- Drug screen
- Sleep study
- CBC

Question 6

Primary hypertension

Answer 6

Enfants >6ans + positive family history + obésité ou surpoids

they also have no physical exam findings

Question 7

Causes secondary hypertension

Answer 7

1- Renal or renovascular
2- Cardiac cause including Coarct
3- Endocrine HTN
a. Cathecholamine excess
b. Mineralocroticoid excess
c. Congenital adrenal hyperplasia
d. familial hyperaldosteronism
e. Glucocorticoid excess
f. hyperthyroidism
g. hyperparathyroidism
4- Genetic causes
5- Environmental exposure: Lead, cadmium, mercury, phthalates
6- Neurofibromatosis
7- Medication related

Question 8

Anamnèse

Answer 8

1- histoire perinatale
2- Histoire nutritionnelle
3- histoire d’Activité physique
4- histoire psychosociale
5- histoire familiale

Question 9

Examen physique

Answer 9

• Height
• Weight
• BMI
• pouls fémoraux
  examen physique complet

Question 10

examens Dx pertinents à considérer

Answer 10

• Echocardiogram
• echo rénal + doppler
• Angio IRM
• CT scan
• Uric acid
• Microalbuminuria

Question 11

traitements

Answer 11

• Changements des habitudes de vie
• Diete DASH
• activité physique
• gestion du stress
• traitement pharmacologique PRN

Question 12

comorbidités

Answer 12

• dyslipidémie
• SAOS
• Cognitive impairement