Up To Date in the diagnosis and treatment of high blood pressure in Pediatrics. Recommendations from the Nephrology Branch of the Chilean Society of Pediatrics

Abstract

Blood pressure (BP) is a vital sign routinely obtained in adult physical examination. This is not the case in children; therefore, high blood pressure in children is frequently not diagnosed. It should be measured with adequate equipment according to age and height of the child, considering that BP values increase under physiological conditions. Arterial hypertension is defined in percentiles for age, gender and height. Three categories can be established: normal BP, pre-hypertension and hypertension. Clinical studies have determined that the younger the child, the probability of secondary hypertension increases, usually of renal origin. Genetic and metabolic risk factors have been identified intrauterine; this "fetal programming" is related later in life with the onset of high blood pressure. Arterial hypertension evolves without symptoms for long periods of time, making more relevant a complete physical examination that includes BP. The hypertensive patient must be approached by age, clinical history, physical examination and BP values, followed by a laboratory work-up. Complementary studies including BP ambulatory monitoring are being used with increasing frequency in the pediatric population, allowing a big number of BP readings during diary activities of the child. Arterial hypertension treatment in pediatrics begins with the prevention of known risk factors, encouraging a change of lifestyle for the child and his/her family. Drug treatment must be reserved after secondary causes have been corrected and lifestyle modifications did not work out. Pharmacological treatment must be indicated individually, its efficacy monitored and potential adverse effects assessed. Still at an experimental stage, antihypertensive vaccination modifying the renin-angiotensin system is being studied.