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Renal 3 > Pediatrics: HTN > Flashcards

Pediatrics: HTN Flashcards

1
Q

When do you begin BP screening?

A

At 3 (when you stop measuring head size, start doing BP)

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2
Q

What is normal BP determined by?

A

Age and gender as compared to the nomogram determined by the national heart, lung, and blood institute (last updated in 1996)

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3
Q

What is blood pressure?

A

CO * PVR

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4
Q

What normal BP for peds?

A

Systolic and diastolic uner 90% for age, height, and gender

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5
Q

What is pre-HTN for peds?

A

Average systolic and/or average diastolic BP between 90-95 percentiles for age, height, and gender

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6
Q

What is HTN in peds?

A

Average systolic and/or diastolic BP greater than or equal to the 95th % for age, height, and gender with measurements on at least 3 separate occasions

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7
Q

What 4 things are required for HTN Dx?

A
  1. Exclude errors of measurement
  2. Ensure proper interpretation
  3. In the same location
  4. Consistent method
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8
Q

What is stage 1 HTN?

A

95-99% for age, hieght, and gender

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9
Q

What is stage 2 HTN?

A

Greater than 99% + 5mmHg for age, height, and gender

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10
Q

What are 4 errors of measurement?

A
  1. Use of inappropriate cuff sizes
  2. Poor auscultation technique
  3. Use of unvalidated/uncalibrated monitorying device
  4. Improper use of nomogram (harriet-Lane Handbook)
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11
Q

What are 4 errors in ensuring proper BP interpretation

A
  1. Improper use of nomogram
  2. Use of improper nomogram
  3. Lack of use of nomogram
    (Nomograms available in the Harriet Lane Handbook
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12
Q

What is the prevalence of pediatric HTN in the US?

A

Under 1%

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13
Q

What % of HTN children require medication?

A

Under 0.1%

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14
Q

What % of HTN children are symptomatic?

A

Less than 0.1%

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15
Q

In the US, what ethnic groups does pediatric HTN affect most?

A
  1. Mexican American

2. Non-hispanic black children

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16
Q

What are 4 RF for pediatric HTN?

A
  1. Ethnicity
  2. Gender
  3. Family history
  4. BMI
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17
Q

What is the classification based on for peds HTN?

A

ETIOLOGY

  1. Primary/essential
  2. Seconday
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18
Q

What % of peds HTN is primary?

A

10%

Primary is no identifiable cause…Dx of exclusion

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19
Q

Is primary peds HTN familial?

A

YES

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20
Q

What is the most common cause of HTN in adolescence?

A

Primary

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21
Q

What % of peds HTN is secondary?

A

90%

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22
Q

What are the 2 most common reasons for secondary HTN (remember, secondary HTN has an identifiable cause)?

A
  1. 70-80% renal
  2. 10% cardiac and endocrine
    - Meds
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23
Q

What are the possible etiologies for neonate HTN?

A
  • Coarctation of the Aorta
  • Renal Artery Thromboembolism
  • Renal Artery Stenosis
  • Congenital Renal Abnormalities
  • Hyperthyroidism
  • Neoplasia
  • Iatrogenic
  • CNS causes
  • Bronchopulmonary Dysplasia
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24
Q

What are the possible etiologies for HTN in infants to 6 years?

A
  • Renal Parenchymal Disease
  • Coarctation of the Aorta
  • Renal Artery Stenosis
  • Neoplasia
  • Iatrogenic
25
Q

What are the possible etiologies for HTN in 6-10 years?

A
  • Renal Parenchymal Disease
  • Renal Artery Stenosis
  • Endocrinopathy
  • Obesity
  • Neoplasia
26
Q

What are the possible etiologies for HTN in adolescence?

A
  1. Renal parenchymal disease
  2. Endocrinopathy
  3. Obesity
  4. Meds/drugs
27
Q

What is the number 1 cause of secondary HTN in children?

A

Renal- Generally reflux nephropathy secondary to undiagnosed vesicoureteral reflux

28
Q

What history is important to get for pediatric HTN?

A
  1. Family history of HTN
  2. Family history of endocrinologic disorders
  3. Trauma
  4. Medication use
29
Q

What medications might contribute to pediatric HTN?

A
  • Corticosteroids
  • OCPs
  • Alcohol
  • Nicotine
  • NSAIDS
  • Lead/toxins
  • Illicit drug use
30
Q

What are special consideration in ROS for ped HTN?

A
  • Epistaxis
  • Headache
  • Blurry vision
  • Weight gain or loss
  • Flushing
  • Chest pain
  • History of urinary tract infections
  • Neonatal history
31
Q

What should be part of the PE for pediatric HTN?

A
  • Body habitus, growth curves, BMI: Adrenal dysfunction or growth failure secondary to renal dysfunction
  • Dysmorphisms
  • Integumentary exam for neurocutaneous stigmata: Neurofibromatosis
  • Moon facies, Buffalo hump: Cushing
  • Fundoscopic exam
  • Proptosis
  • Cardiovascular exam for murmurs, rubs, gallops, femoral/peripheral pulses (F/U with echo)
  • Abdominal exam for masses, bruits, hepatosplenomegaly
  • Genitalia for virilization or ambiguity (adrenal dysfunction)
  • Neurologic exam for any deficits
32
Q

For workup of ped HTN, what should all patients have?

A
  • Urinalysis
  • Urine culture
  • Serum electrolytes, BUN, creatinine, calcium, uric acid, cholesterol/lipid panel
  • CBC
  • Echocardiogram
  • Renal ultrasound
33
Q

What are some other evaluations that may need to be done for pediatric HTN based on history and physical examination?

A
  • VCUG
  • DMSA Renal Scan
  • Urine for Catecholamines and Metanephrines
  • Plasma Renin Activity
  • Aldosterone levels
  • Renal Angiogram
  • Renal Vein Renin Sampling
  • MIBG Scan
  • Renal Biopsy
34
Q

What are 3 treatment goals for pediatric HTN?

A
  1. Identify those with secondary HTN and refer appropriately
  2. Identify comorbidities and address them (like increased weight)
  3. Identify patients requiring medication
35
Q

What should be done for asymptomatic significant HTN (>95%)?

A
  1. Nonpharmacologic intervention: Lifestyle changes

2. Consider medication if no improvement over several weeks

36
Q

What should be done for significant HTN with end organ damage (abnormal kidney function, ocular exam, ect.)?

A

Pharmacologic and nonpharmacologic interventions

37
Q

What should be done for symptomatic HTN (malignant)?

A

Emergency intervention

38
Q

What is the main goal in treatment of pediatric HTN?

A

Gradual reduction of BP to avoid symptoms of decreased perfusion (don’t go too fast)

39
Q

What are long term goals of ped HTN treatment?

A
  1. Achieve BP below the 90% for age, height, and gender
  2. Prevent further end organ damage
  3. Reduce the CV risk
40
Q

What are some nonpharmacologic interventions for ped HTN?

A
  • Weight reduction
  • Sodium restriction (under 2g a day) –> NATURAL FOODS)
  • Exercise
  • Avoidance of alcohol
  • Avoidance of attributable medications
  • Avoidance of tobacco use / passive smoke exposure
41
Q

If your patients bp was 90-95% or 120/80 on 3 occasions what do you do and when do you re-evaluate?

A
  • Lifestyle modifications

- 6 month re-check

42
Q

If your patients BP was greater than 95% on 3 occasions what do you do?

A

Begin evaluation for secondary causes

*You need 3 high BP values unless in malignant HTN range

43
Q

What does the choice of medication and route depend on?

A
  • Age of patient: School age versus teen
  • Etiology of HTN
  • Severity of HTN
  • Volume status of patient: Physically active, perhaps dehydrated and a diuretic would be bad
  • Presence of associated heart failure
  • Presence of renal impairment
  • Presence of compromised cerebrovascular blood flow
44
Q

What is the most common drug given for pediatric HTN?

A

Hydrochlorothiazide

45
Q

What is the one major concern when prescribing hydrochlorothiazide?

A

VOLUME STATUS
-If your patient is athletic or outside a lot you worry about volume depletion and dehydration wtih a diuretic…besides this, this works well

46
Q

What is the second most common drug given for pediatric HTN?

A

ACEi

47
Q

What are the 6 categories of drugs that can be given for pediatric HTN?

A
  1. Hydrochlorothiazide
  2. ACEi
  3. CCB
  4. BB
  5. Diuretic
  6. Nitroprusside
48
Q

What should be done at regular-follow for patients with pediatric HTN?

A
  • Measure and assess adequacy of control
  • Evaluate for end organ damage
  • Examine for previously undetected etiologies/syndromes
  • Counsel of importance of BP control
  • Educate about lifestyle, diet, exercise, etc.
49
Q

What are the NHBPEP guidlines for pre-HTN in kids?

A

Lifestyle changes

50
Q

What are the NHBPEP guidelines for pre-HTN and comorbidity in kids?

A

Lifestyle and pharmacologic

51
Q

What are the NHBPEP guidelines for stage 1 asymptomatic HTN in kids?

A

Lifestyle initially, then add pharmacologic if unsuccessful with lifestyle

52
Q

What are the NHBPEP guidelines for stage 1 with CVD, symptoms or end organ damage and stage 2 HTN in kids?

A

Lifestyle and pharmacologic

53
Q

What is the choice of medication for primary HTN without end-organ damage?

A

Hydrochlorothiazide

54
Q

What is the choice of medication for HTN and chronic kidney disease or HTN and diabetes mellitus?

A

ACEi/ARB

55
Q

When do you just observe HTN in infants

A

When systolic BP is 95th to 99th %

56
Q

When do you initiate pharmacologic therapy in infants?

A

When BP is greater than 99%, in those with symptoms, or end-organ involvement

57
Q

What are general thoughts on drugs for HTN in infants?

A
  1. Avoid ACEi in less than 44 weeks to prevent damage to developing renal structures
  2. Avoid BB in lung disease
58
Q

What is the duration of therapy for infant HTN dependent on?

A

THE CAUSE

Renal 3 (17 decks)

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