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Hypertension in children from a nephrological perspective — are there any differences between younger children and adolescents?
Affiliations- Students Scientific Association at the Department of Pediatric Nephrology, Wrocław
- Chair and Department of Pediatric Nephrology, Wrocław Medical University, Wrocław
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Abstract
Background. Hypertension (HTN) affects about 5% of children. Renal diseases are the major cause of HTN in
pediatric patients, but the incidence of primary HTN is increasing. The aim of the study was to analyze the potential
differences between etiology of HTN, type of renal disease leading to HTN, clinical picture, laboratory test results
or family history, with reference to patients’ age.
Material and methods. Medical records of 112 patients (27 children < 11 years and 85 adolescents > 11 years),
diagnosed with hypertension in the Department of Pediatric Nephrology, were analyzed. Family history, aetiology
of HTN, clinical course and laboratory results were compared, regarding the patients’ age.
Results. HTN secondary to renal disease prevailed over the primary one in younger children. Major causes of renal
HTN differed with age. In children under 11 anomalies in the urinary tract were dominant, in teenagers — glomerulopathies. In adolescents, the incidence of primary HTN was higher than in the younger patients and became
comparable to that of secondary HTN. Patients with primary HTN, irrespective of their age, had higher BMI and
more frequent positive family history of HTN. Clinical symptoms, except for headaches prevalent in adolescents,
did not depend on age.
Conclusions. In paediatric patients, hypertension secondary to renal diseases is more frequent than the primary
one. The incidence of primary HTN is increasing with age and occurs in adolescents more often than in younger
children. The clinical course is usually asymptomatic and may delay the diagnosis, especially in the youngest patients.
Abstract
Background. Hypertension (HTN) affects about 5% of children. Renal diseases are the major cause of HTN in
pediatric patients, but the incidence of primary HTN is increasing. The aim of the study was to analyze the potential
differences between etiology of HTN, type of renal disease leading to HTN, clinical picture, laboratory test results
or family history, with reference to patients’ age.
Material and methods. Medical records of 112 patients (27 children < 11 years and 85 adolescents > 11 years),
diagnosed with hypertension in the Department of Pediatric Nephrology, were analyzed. Family history, aetiology
of HTN, clinical course and laboratory results were compared, regarding the patients’ age.
Results. HTN secondary to renal disease prevailed over the primary one in younger children. Major causes of renal
HTN differed with age. In children under 11 anomalies in the urinary tract were dominant, in teenagers — glomerulopathies. In adolescents, the incidence of primary HTN was higher than in the younger patients and became
comparable to that of secondary HTN. Patients with primary HTN, irrespective of their age, had higher BMI and
more frequent positive family history of HTN. Clinical symptoms, except for headaches prevalent in adolescents,
did not depend on age.
Conclusions. In paediatric patients, hypertension secondary to renal diseases is more frequent than the primary
one. The incidence of primary HTN is increasing with age and occurs in adolescents more often than in younger
children. The clinical course is usually asymptomatic and may delay the diagnosis, especially in the youngest patients.
Keywords
primary hypertension; kidney disease; obesity
About this articleTitle
Hypertension in children from a nephrological perspective — are there any differences between younger children and adolescents?
Journal
Issue
Article type
Original paper
Pages
179-184
Published online
2018-10-08
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1153
Article views/downloads
807
DOI
Bibliographic record
Arterial Hypertension 2018;22(4):179-184.
Keywords
primary hypertension
kidney disease
obesity
Authors
Karol Marschollek
Paweł Marschollek
Anna Ciszewska
Julia Rasała
Danuta Zwolińska
Kinga Musiał
References (23)- Lurbe E, Agabiti-Rosei E, Cruickshank JK, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016; 34(10): 1887–1920.
- Chen X, Wang Y. Tracking of Blood Pressure From Childhood to Adulthood: A Systematic Review and Meta-Regression Analysis. Circulation. 2008; 117(25): 3171–3180.
- Tirosh A, Afek A, Rudich A, et al. Progression of normotensive adolescents to hypertensive adults: a study of 26,980 teenagers. Hypertension. 2010; 56(2): 203–209.
- Żurowska A, Zwolińska D, Roszkowska-Blaim M, et al. Rekomendacje Polskiego Towarzystwa Nefrologii Dziecięcej (PTNFD) dotyczące postępowania z dzieckiem z podwyższonym ciśnieniem tętniczym. Forum Medycyny Rodzinnej. 2015; 9(5): 349–375.
- Widecka K. Nadciśnienie tętnicze u dzieci i młodzieży — coraz większy problem medyczny. Chor Serca Naczyń. 2004; 1(2): 89–96.
- Falkner B. Hypertension in children and adolescents: epidemiology and natural history. Pediatr Nephrol. 2010; 25(7): 1219–1224.
- Ogden CL, Flegal KM, Carroll MD, et al. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002; 288(14): 1723–1727.
- Sorof JM, Lai D, Turner J, et al. Overweight, Ethnicity, and the Prevalence of Hypertension in School-Aged Children. PEDIATRICS. 2004; 113(3): 475–482.
- Katona E, Zrínyi M, Komonyi E, et al. Epidemiological data of 15–18 year adolescents and the prevalence of hypertension in Debrecen. The Debrecen Hypertension Study. Orv Hetil. 2005; 146(3): 127–132.
- Baracco R, Kapur G, Mattoo T, et al. Prediction of primary vs secondary hypertension in children. J Clin Hypertens (Greenwich). 2012; 14(5): 316–321.
- Litwin M, Michałkiewicz J, Gackowska L. Primary hypertension in children and adolescents is an immuno-metabolic disease with hemodynamic consequences. Curr Hypertens Rep. 2013; 15(4): 331–339.
- Silva AC. Pathophysiology of Arterial Hypertension: Insights from Pediatric Studies. Current Pediatric Reviews. 2006; 2(3): 209–223.
- Gomes RS, Quirino IG, Pereira RM, et al. Primary versus secondary hypertension in children followed up at an outpatient tertiary unit. Pediatr Nephrol. 2011; 26(3): 441–447.
- DiPietro A, Kees-Folts D, DesHarnais S, et al. Primary hypertension at a single center: treatment, time to control, and extended follow-up. Pediatr Nephrol. 2009; 24(12): 2421–2428.
- Flynn JT, Alderman MH. Characteristics of children with primary hypertension seen at a referral center. Pediatr Nephrol. 2005; 20(7): 961–966.
- Gupta-Malhotra M, Banker A, Shete S, et al. Essential hypertension vs. secondary hypertension among children. Am J Hypertens. 2015; 28(1): 73–80.
- Flynn J, Zhang Y, Solar-Yohay S, et al. Clinical and demographic characteristics of children with hypertension. Hypertension. 2012; 60(4): 1047–1054.
- Flynn J. The changing face of pediatric hypertension in the era of the childhood obesity epidemic. Pediatr Nephrol. 2013; 28(7): 1059–1066.
- Kapur G, Ahmed M, Pan C, et al. Secondary hypertension in overweight and stage 1 hypertensive children: a Midwest Pediatric Nephrology Consortium report. J Clin Hypertens (Greenwich). 2010; 12(1): 34–39.
- Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA. 2007; 298(8): 874–879.
- Assadi F. The growing epidemic of hypertension among children and adolescents: a challenging road ahead. Pediatr Cardiol. 2012; 33(7): 1013–1020.
- Wyszyńska T, Cichocka E, Wieteska-Klimczak A, et al. A single pediatric center experience with 1025 children with hypertension. Acta Paediatr. 1992; 81(3): 244–246.
- Kota SK, Kota SK, Meher LK, et al. Clinical analysis of hypertension in children: an urban Indian study. Saudi J Kidney Dis Transpl. 2013; 24(4): 844–852.