Hypertension

Published on 23/06/2015 by admin

Filed under Emergency Medicine

Last modified 23/06/2015

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16.3 Hypertension

Introduction

In children, blood pressure (BP) is a continuous variable that is influenced by age, sex, body size, and genetic, circadian and environmental factors.

Hypertension is defined as BP that is consistently above the 95th percentile for age, gender and height (nomograms are available with these data and should be present in both the emergency department (ED) and paediatric wards) (Table 16.3.1).

Table 16.3.1 Upper limit of systolic blood pressure by age

Age Upper limit for normal systolic BP (95th percentile)   Males Females 1 month 104 102 2 months 109 106 3 months 111 108 4 months 110 109 6 months 110 110 1 year 110 110 2 years 110 110 3 years 111 110 4 years 112 111 5 years 113 112 6 years 115 114 7 years 117 116 8 years 118 117 9 years 120 119 10 years 122 121 11 years 124 123 12 years 127 125 13 years 129 128 14 years 130 129 15 years 133 130 16 years 136 131

Data obtained with permission from the National Heart, Lung and Blood Institute of the United States National Institutes of Health.

Severe hypertension is BP consistently above the 99th centile with signs of end-organ damage such as retinopathy, nephropathy or left ventricular hypertrophy.

Accelerated hypertension occurs with severe hypertension plus neurological signs and symptoms (hypertensive encephalopathy) and severe hypertensive retinopathy.

Prevalence of hypertension is around 1–3% of children (note that this is to some extent a statistical issue related to use of BP centiles in defining hypertension). The most common secondary cause of hypertension in children is renal disease, though with increasing age (and the pandemic of childhood obesity) essential hypertension assumes more significance.

Ideally, all children presenting to ED should have a BP measurement.

History and examination