Hypertension Flashcards
What is the stage 1 BP and stage 2 BP in pediatric
1: >95th to <95th + 5mmhg OR 130\80
2: >95th + 5mmhg OR 139\89
Define pediatric HTN
More than 95%th for age, gender, and height on 3 seperate occasions (systolic + diastolic)
Define prehypertensive state in pediatric age group
90th to 95th
BUT if it’s found to be >120\80 it should be considered even if below the 90th percentile
What is the normal BP and elevated BP in pediatric
Normal: <90th percentile
Elevated: >90th to <95th OR 120\80
Early diagnosis of HTN in pediatric is associated with
Coronary artery disease in the future
Who should be measured for BP in the pediatric age group
- Any one 3 years and older
- any one <3 years + risk factors
In child <3 years, what are the risk factors that yield importance to have BP measured?
- very low birth weight
- premature
- NICU stay
- conginital heart disease
- UTI, hematuria, proteinurea, renal disease (known\family hx)
- organ transplant
- malignancy
- drugs
- systemic illness
- increase ICP
How much is the width of the cuff from the arm circumfrance?
40%
How much is the length of the cuff from the arm circumfrance?
40%
Where to measure the arm the circumfrance
Mid-portion of the arm
How to measure BP?
- no stimulants for 24 hours
- quiet environment for 5 minutes
- back and feet supported
- right arm placed at level of heart
- empty bladder
When is ambulatory most beneficiall
To diagnose:
- white coat HTN
- drug induced hypotension
- drug resistant hypertension
What is the risk of cvd in masked vs presistant HTN?
Same
What is the most common causes of htn in pediatrics?
Secondary (renal parynchymal) then renal vascular
Name secondary causes for htn in pediatric
- coarctation of aorta
- renovascular
- renal parenchyma
- endocrine (cushing, adrenal hyperplasia, hypercalcemia, hyperaldosteronism, pheochromocytoma)
- renal tumors
What are the investigations to order in all patient with HTN?
Urinalysis - chemistry panel (urea, creatinine, nitrogen, electrolyte) - lipid profile - renal US
What are the indications for renal ultrasound for patient with htn?
- <6 years
- Abnormal urinalysis
- Abnormal renal function
What test to preform in obese patients who you suspect HTN
AST, ALT, and Hgb1ac
Name examples of target organ damage
Microalbumineuria - proteinurea - hypertensive retinopathy - LVH - increased carotid artery intima media thhickness - decreased vascular compliance
What is the most common target organ damage in htn
LVH, must do echocardiogram and repeat 6-12 months
What is the risk of obese children to have elevated SBP and DBP?
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Name syndrome associated with hypertension
- turner (coarctation of aorta)
- williams
What findings do you expect to see in physical examinations in pediatric with hypertension
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What are the dermatological changes you expect to see in pediatric hypertension?
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What are the symptoms of hypertension in pediatric
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What are clues in history for primary
HTN
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What are clues in history for secondary
HTN
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medications that might increase BP in pediatric age group:
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What are the lab workups you’d like to order if you suspect stage 1 HTN?
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What are the imaging to order in pediatric HTN?
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What imaging to order if you suspect pyelonephritis?
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What is the first step in treating HTN?
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What is the long term outcome of HTN?
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What is DASH?
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How much does DASH diet decrease DBP and SBP?
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What is the role of srceen time in hTN?
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What is the salt restriction grams in pediatric?
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