Hypertension

Question 1

What are the normal systolic blood pressure markers for 1-5yo’s, 6-10yo’s and those older than 10?

Answer 1

1-5yo less than 110mm/Hg
6-10yo less than 120mm/Hg
Over 10’s less than 140mm/Hg

Question 2

What is important to bear in mind when interpreting the blood pressure of a sick child?

Answer 2

Children are very good at compensating. A drop in BP is a pre-terminal change and should be very worrying.

Question 3

Define hypertension in children?

Answer 3

Hypertension is defined as blood pressure above the 95th centile for height, age and sex.

Question 4

What are the common causes of hypertension in children?

Answer 4

It is often due to underlying cardiac, renal or endocrine disorders.

• Renal parenchymal disease
• Renovascular disease
• Endocrine causes (hyperthyroid/congenital adrenal hyperplasia/cushings)
• Coarctation of the aorta

As age increases it is more likely that there will be no identifiable cause aka essential hypertension.

Question 5

In neonates how might HTN present?

Answer 5

May be assymptomatic but may cause:

• Failure to thrive
• Convulsion
• Irritability or lethargy
• Respiratory distress
• Congestive cardiac failure

Question 6

In older children how might HTN present?

Answer 6

Usually asymptomatic but may present with:

• Headache
• Blurred vision
• Fatigue
• Epistaxis

Question 7

What specific signs and conditions should be look for to be ruled out in HTN in children?

Answer 7

Cardiac exam: Coarctation

Cafe au last spots: Neurofibromatosis type 1 can cause catecholamine secreting tumours

Abdominal mass: Wilms tumour