Hypertension in children and adolescents: Definition, pathophysiology, risk factors, and long-term sequelae

Background: Awareness of hypertension as an adult public health issue has i ncreased dramatically during the past 3 decades, leading to substantial dec reases in morbidity and mortality related to stroke and coronary artery dis ease. Awareness of blood pressure issues in the pediatric population also h as increased, leading to conceptual changes in the diagnosis and treatment of childhood hypertension. The current focus has shifted to early identific ation of mild to moderate hypertension in asymptomatic, otherwise healthy c hildren and adolescents. Objective: The purpose of this article was to define hypertension in the pe diatric population and describe the secondary causes of childhood hypertens ion, risk factors and potential pathophysiology of essential hypertension i n childhood, and the long-term sequelae for individuals with hypertension i dentified during childhood. Methods: Information regarding pediatric hypertension was identified throug h a MEDLINE(R) search of the literature from 1985 to 2000. Results: Definitions of pediatric hypertension have been carefully refined over the past 30 years, and normative data are available for children and a dolescents, based on age, sex, and height. Childhood hypertension may be id entified during evaluation of an acutely ill child, but is increasingly ide ntified during routine blood pressure screening, particularly in adolescent s. Although, historically, most pediatric hypertension was believed to be s econdary in origin (related to an identifiable underlying disorder), recent data suggest that almost 90% of hypertensive adolescents have essential hy pertension. The proposed factors that may be involved in the pathophysiolog y of essential hypertension include familial and genetic influences, race, and salt sensitivity. Although an essential hypertension gene has not yet b een identified, several monogenic forms of hypertension have been described , which may account for a minority of individuals with presumed essential h ypertension. In addition, a number of candidate genes that may be involved in the complex genetic susceptibility to hypertension have been described. There is growing evidence concerning adverse long-term consequences of hype rtension identified in childhood and adolescence, including increased incid ence of cardiovascular and coronary heart disease. Conclusions: Based on the generally accepted concept that essential hyper t ension begins in childhood, early optimization of blood pressure control in childhood may reduce an individual's lifetime risk of cardiovascular morbi dity and mortality. In addition, aggressive treatment of cardiovascular ris k factors during childhood and adolescence may have a major impact on the p revalence of adult cardiovascular disease.