HYPERTENSION IN CHILDREN AND ADOLESCENTS

Question 1

What is hypertension in children

Answer 1

Hypertension in children is defined as an average systolic and/or diastolic blood pressure that is greater or equal to the 95th percentile for gender, age and height on 3 or more occasions taken in the right arm

Question 2

Appropriate cuff size to measure BP in children and adolescents

Answer 2

Should cover 2/3 of the length of the arm (between shoulder and arm) and encircling the whole arm

Question 3

Abnormal BP in children between 2 to 5

Answer 3

> 110/70

Question 4

Abnormal BP in children between 6 to 12 years

Answer 4

> 115/76

Question 5

Abnormal BP in adolescents

Answer 5

> 128/82

Question 6

causes of hypertension in children and adolescents

Answer 6

1. Renal- Chronic pyelonephritis, hydronephrosis
2. Vascular- coarctation of the aorta, renal artery stenosis
3. Endocrine- phaeochromocytoma, Cushing’s syndrome, adrenal disorders
4. Obesity
5. Primary hypertension

Question 8

Target BP in children and adolescents

Answer 8

< 95th percentile for age,
gender and height in the absence of end organ-damage and to < 90thpercentile if end organ damage present

Question 9

Treatment objectives for hypertension in children and adolescents

Answer 9

To reduce blood pressure (BP) to a target of < 95th percentile for age,
gender and height in the absence of end organ-damage (to < 90th percentile if end organ damage present)
To prevent complications
To manage underlying secondary cause
To encourage weight reduction in obese and overweight children

Question 10

Non-pharmacological interventions for hypertension in children and adolescents

Answer 10

weight control
regular exercise
low fat intake
low sodium diet
regular fruit and vegetable intake

Question 11

Drugs for pharmacological treatment of hypertension in children and adolescents

Answer 11

ACEi- Enalapril
Diuretics- Bendroflumethiazide
Beta blockers- propranolol, atenolol
CCBs- nifedipine, amlodipine
Vasodilators- hydralazine
ARBs- Losartan

Question 12

Losartan dose in children

Answer 12

Losartan, oral,
Children
Initial dose; 0.7 mg /kg daily (max. 50 mg)
Maintenance dose; 1.4 mg /kg daily (max. 100 mg)

Question 13

Hydralazine dose in children

Answer 13

Hydralazine, oral,
Children
12-18 years; 25 mg 12 hourly increased to usual max. 50-
100 mg 12 hourly
1 month-12 years; 250-500 microgram/kg 8-12 hourly increased
as necessary to max. 7.5 mg/kg daily (not exceeding 200 mg)

Neonate
250-500 microgram/kg 8-12 hourly increased as necessary to max.
2-3 mg/kg every 8 hours
IV, 250-500 microgram/kg diluted in 10 ml normal saline given over
20 minutes, then 100-200 microgram/kg 4-6 hourly (max 3 mg/kg
in 24 hours)

Question 14

Nifedipine dose in children

Answer 14

Children
12-18 years; 5-20 mg 8 hourly
1 month-12 years; 200-300 microgram/kg 8 hourly (max. 100
mg daily)

Question 15

Amlodipine dose in children

Answer 15

Amlodipine, oral,
Children
12-18 years; 5-10 mg daily
1 month-12 years; 100-400 microgram/kg daily (max. 10 mg
daily)

Question 16

Propranolol dose in children

Answer 16

Propranolol, oral,
Children
12-18 years; 80-160 mg 12 hourly
1 month-12 years; 250 microgram-1 mg/kg 8 hourly
Neonate; 250 microgram/kg 8 hourly

Question 17

Atenolol dose in children

Answer 17

Atenolol, oral,
Children
0.5-1 mg/kg daily (max. 2 mg/kg daily)

Question 18

Bendroflumethiazide dose in children

Answer 18

Bendroflumethiazide, oral,
Children
12-18 years; 2.5 mg daily
2-12 years; 50-100 microgram/kg daily
1 month-2 years; 50-100 microgram/kg daily

Question 19

Enalapril dose in children

Answer 19

Enalapril, oral,
Children
12-18 years; initially 2.5 mg daily (increased to max. 10-
20 mg daily in 1-2 divided doses)
1 month-12 years; initially 100 micrograms per kg daily (increased
to max. 1 mg/kg daily in 1-2 divided doses)
Neonate
10 microgram/kg daily (increased to max. 500 microgram/kg daily in
1-3 divided doses)