What are the causes of hypertension in a child?

From the Guidelines

Hypertension in children is primarily caused by underlying medical conditions, with secondary hypertension being more common in younger children and primary hypertension more prevalent in adolescents. The causes of hypertension in children can be multifaceted, involving various underlying medical conditions. According to 1, the prevalence of hypertension in children and adolescents is 1% to 5%, with obese children having a higher prevalence of approximately 11%. In school-aged children, secondary hypertension accounts for 70% to 85% of cases, whereas in adolescents, 85% to 95% of cases are primary hypertension. Some of the key causes include:

• Renal disease, such as glomerulonephritis, polycystic kidney disease, and renal artery stenosis
• Endocrine disorders like Cushing's syndrome, hyperthyroidism, and pheochromocytoma
• Cardiovascular conditions, particularly coarctation of the aorta
• Certain medications like corticosteroids, oral contraceptives, and some decongestants
• Genetic factors, with some children inheriting a predisposition to hypertension
• In adolescents, obesity, sedentary lifestyle, and high sodium intake are becoming increasingly common contributors
• Sleep disorders, particularly obstructive sleep apnea
• Neurological conditions affecting brain regulation of blood pressure and certain congenital abnormalities It is essential to identify the underlying cause of hypertension in children to determine the most effective treatment approach, as noted in 1, which emphasizes the need for evidence on the effectiveness of pharmacologic and lifestyle interventions to achieve sustained reductions in blood pressure and longer-term modification of adult hypertension and cardiovascular risk in children with primary hypertension.

From the Research

Causes of Hypertension in Children

The causes of hypertension in children can be classified into primary and secondary hypertension.

• Primary hypertension is associated with factors such as:
  • Obesity 2, 3, 4
  • Family history of hypertension 2, 5
  • Sedentary lifestyle 3, 4
  • Poor diet, including high sodium intake 2, 4
  • Minority race/ethnicity 2
  • Poor sleep quality 2
• Secondary hypertension is caused by underlying medical conditions, such as:
  • Congenital heart disease 5
  • Kawasaki disease 5
  • Chronic kidney disease 5
  • Other cardiovascular risk factors, including diabetes and dyslipidemia 5

Risk Factors

Several risk factors are associated with an increased prevalence of hypertension in children, including:

• Genetic factors 4
• Environmental factors, such as socioeconomic status and ethnicity 4
• Prematurity and low birth weight 4
• Prenatal and postnatal exposures 4

Classification and Diagnosis

Hypertension in children can be diagnosed using various methods, including:

• Ambulatory blood pressure monitoring (ABPM) 3
• Multiple office blood pressure measurement (mOBPM) 3
• The American Academy of Pediatrics (AAP) 2017 guidelines recommend measuring blood pressure every year from the age of three 3, 6