Pediatric approach to hypertension.

The prevalence of pediatric hypertension (HTN) has increased over the past several decades, bringing with it increased numbers of children with hypertensive sequelae such as left ventricular hypertrophy as well as greater numbers of hypertensive adults. This growing public health concern calls for vigilant screening, diagnosis, evaluation, and treatment of HTN in children. Although primary HTN has become more common in childhood and adolescence, it still should be considered a diagnosis of exclusion. As such, a diagnostic work-up should be conducted to rule out secondary causes of HTN for any child with a confirmed diagnosis of HTN. Important secondary causes of pediatric HTN include renal parenchymal, renovascular, and endocrine etiologies, and secondary HTN becomes more likely the younger the child is and the more severe the blood pressure elevation is at diagnosis. In addition, several genetic disorders have been identified in which one aberrant gene results in severe HTN, often early in life. All hypertensive children, regardless of the cause of their HTN, should be prescribed therapeutic lifestyle changes, and children with symptomatic, secondary, or severe HTN; HTN resistant to lifestyle changes; or children with evidence of end-organ damage also should be prescribed antihypertensive medications.