From the Guidelines
Pediatric hypertension is primarily caused by a combination of factors including underlying kidney diseases, endocrine disorders, cardiovascular abnormalities, and increasingly, obesity, with the strongest risk factor being elevated body mass index, as noted in the 2013 USPSTF recommendation statement 1. The causes of pediatric hypertension can be categorized into several key areas, including:
- Underlying kidney diseases such as glomerulonephritis, renal artery stenosis, and polycystic kidney disease
- Endocrine disorders like hyperthyroidism, Cushing syndrome, and pheochromocytoma
- Cardiovascular abnormalities, including coarctation of the aorta
- Lifestyle factors, particularly obesity, poor diet high in sodium, physical inactivity, and stress, which have become leading contributors to primary hypertension in children
- Certain medications like corticosteroids, decongestants, and some ADHD medications that can raise blood pressure
- Genetic factors, with family history increasing risk
- Sleep disorders, particularly obstructive sleep apnea, associated with hypertension in children
According to the 2017 clinical practice guideline for the management of high blood pressure in children and adolescents, the definition of hypertension in children is based on the 95th percentile on age-related BP distribution curves, and the guideline provides a framework for diagnosis, evaluation, and management of hypertension in children and adolescents 1. The 2013 USPSTF recommendation statement also highlights the importance of considering the potential preventable burden of hypertension in children and adolescents, including the increasing prevalence of hypertension in children and adolescents, possibly driven by childhood obesity 1. Additionally, the 2013 study on screening for primary hypertension in children and adolescents notes that secondary hypertension is relatively rare and is more likely to occur in younger children, while primary hypertension is more common in older children and adolescents 1.
In terms of management, identifying the underlying cause of pediatric hypertension is essential, and treatment typically addresses the underlying cause while implementing lifestyle modifications and, when necessary, appropriate antihypertensive medications, as recommended by the 2017 clinical practice guideline 1. This may require comprehensive evaluation including blood tests, urine analysis, imaging studies, and sometimes specialized endocrine testing. Overall, the management of pediatric hypertension requires a comprehensive approach that takes into account the underlying causes, lifestyle factors, and potential complications, with the goal of reducing the risk of cardiovascular disease and improving quality of life.
From the FDA Drug Label
Pediatric Patients: In a clinical study involving 115 hypertensive pediatric patients 6 to 16 years of age, patients who weighed < 50 kg received either 0.625 mg, 2.5 mg or 20 mg of lisinopril once daily and patients who weighed > 50 kg received either 1. 25 mg, 5 mg, or 40 mg of lisinopril once daily. The FDA drug label does not answer the question.
From the Research
Causes of Pediatric Hypertension
The causes of pediatric hypertension can be classified into primary and secondary hypertension.
- Primary hypertension is a multifactorial disease, and its pathophysiology is not fully elucidated 2.
- Secondary hypertension is caused by underlying medical conditions.
Risk Factors
Several risk factors are associated with an increased prevalence of elevated blood pressure and hypertension in children, including:
- Family history of hypertension 3, 2
- Obesity 3, 2, 4, 5, 6
- Minority race/ethnicity 3
- Physical inactivity 3
- High dietary intake of sodium 3, 2
- Poor sleep quality 3
- Sedentary lifestyle 2
- Prematurity and low birth weight 2
- Prenatal and postnatal exposures 2
- Socioeconomic status 2
- Ethnicity 2
- Family structure 2
Lifestyle Changes
Lifestyle changes, such as adhering to the Dietary Approaches to Stop Hypertension diet, are a central component of effectively reducing blood pressure and have been shown to reduce target organ damage 3.
Pharmacologic Treatment
Pharmacologic treatment using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers is an effective and safe method for reducing blood pressure among children with uncontrolled blood pressure after implementing lifestyle changes 3.