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Hypertension In Children Of High Blood Pressure

Hypertension:

Hypertension (HTN) or high blood pressure, sometimes arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. Blood pressure involves two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed (diastole) between beats. Normal blood pressure is at or below 120/80 mmHg. High blood pressure is said to be present if it is persistently at or above 140/90 mmHg.

Hypertension is classified as either primary (essential) hypertension or secondary hypertension; about 90–95% of cases are categorized as “primary hypertension” which means high blood pressure with no obvious underlying medical cause.The remaining 5–10% of cases (secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart or endocrine system.

Hypertension is a major risk factor for stroke, myocardial infarction (heart attacks), heart failure, aneurysms of the arteries (e.g. aortic aneurysm), peripheral arterial disease and is a cause of chronic kidney disease. Even moderate elevation of arterial blood pressure is associated with a shortened life expectancy. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, although drug treatment is often necessary in patients for whom lifestyle changes prove ineffective or insufficient.

Classification:

In people aged 18 years or older hypertension is defined as a systolic and/or a diastolic blood pressure measurement consistently higher than an accepted normal value (currently 139 mmHg systolic, 89 mmHg diastolic: see table Classification (JNC7)). Lower thresholds are used (135 mmHg systolic or 85 mmHg diastolic) if measurements are derived from 24-hour ambulatory or home monitoring.The presence of other cardiovascular risk factors is taken into account when decisions are made regarding drug treatment. Recent international hypertension guidelines have also created categories below the hypertensive range to indicate a continuum of risk with higher blood pressures in the normal range. JNC7 (2003) uses the term prehypertension for blood pressure in the range 120-139 mmHg systolic and/or 80-89 mmHg diastolic, while ESH-ESC Guidelines (2007)[4] and BHS IV (2004) use optimal, normal and high normal categories to subdivide pressures below 140 mmHg systolic and 90 mmHg diastolic. Hypertension is also sub-classified: JNC7 distinguishes hypertension stage I, hypertension stage II, and isolated systolic hypertension. Isolated systolic hypertension refers to elevated systolic pressure with normal diastolic pressure and is common in the elderly. The ESH-ESC Guidelines (2007)[4] and BHS IV (2004), additionally define a third stage (stage III hypertension) for people with systolic blood pressure exceeding 179 mmHg or a diastolic pressure over 109 mmHg. Hypertension is classified as “resistant” if medications do not reduce blood pressure to normal levels.

Signs and symptoms:

Hypertension is rarely accompanied by any symptoms, and its identification is usually through screening, or when seeking healthcare for an unrelated problem. A proportion of people with high blood pressure reports headaches (particularly at the back of the head and in the morning), as well as lightheadedness, vertigo, tinnitus (buzzing or hissing in the ears), altered vision or fainting episodes.

On physical examination, hypertension may be suspected on the basis of the presence of hypertensive retinopathy detected by examination of the optic fundi using ophthalmoscopy Classically, the severity of the hypertensive retinopathy changes is graded from grade I–IV, although the milder types may be difficult to distinguish from each other.Ophthalmoscopy findings may also indicate how long a person has been hypertensive.

Secondary hypertension:

Some additional signs and symptoms may suggest secondary hypertension, i.e. hypertension due to some identifiable cause such as kidney diseases or endocrine diseases. For example, truncal obesity, glucose intolerance, moon facies, a “buffalo hump” and purple striae suggest Cushing’s syndrome. Thyroid disease and acromegaly can also cause hypertension and have characteristic symptoms and signs. An abdominal bruit may be an indicator of renal artery stenosis, while decreased blood pressure in the lower extremities and/or delayed or absent femoral arterial pulses may indicate aortic coarctation. Labile or paroxysmal hypertension accompanied by headache, palpitations, pallor, and perspiration should prompt suspicions of pheochromocytoma.

Hypertensive crises:

Severely elevated blood pressure (systolic over 180 or diastolic over 110 sometime termed malignant or accelerated hypertension) is referred to as a “hypertensive crisis”, as blood pressures above these levels are known to confer a high risk of complications. People with blood pressures in this range may have no symptoms, but are more likely to report headaches and dizziness.Other symptoms accompanying a hypertensive crisis may include visual deterioration or breathlessness due to heart failure or a general feeling of malaise due to renal failure. Most people with a hypertensive crisis are known to have elevated blood pressure, but additional triggers may have led to a sudden rise.

A “hypertensive emergency”, previously “malignant hypertension”, is diagnosed when there is evidence of direct damage to one or more organs as a result of the severely elevated blood presure. This may include hypertensive encephalopathy, caused by brain swelling and dysfunction, and characterised by headaches and an altered level of consciousness (confusion or drowsiness). Retinal papilloedema and/or fundal hemorrhages and exudates are another sign of target organ damage. Chest pain may indicate heart muscle damage (which may progress to myocardial infarction) or sometimes aortic dissection, the tearing of the inner wall of the aorta. Breathlessness, cough, and the expectoration of blood-stained sputum are characteristic signs of pulmonary edema, the swelling of lung tissue due to left ventricular failure an inability of the left ventricle of the heart to adequately pump blood from the lungs into the arterial system.Rapid deterioration of kidney function (acute kidney injury) and microangiopathic hemolytic anemia (destruction of blood cells) may also occur.In these situations, rapid reduction of the blood pressure is mandated to stop ongoing organ damage.In contrast there is no evidence that blood pressure needs to be lowered rapidly in hypertensive urgencies where there is no evidence of target organ damage and over aggressive reduction of blood pressure is not without risks Use of oral medications to lower the BP gradually over 24 to 48 h is advocated in hypertensive urgencies.

In pregnancy:

Hypertension occurs in approximately 8-10% of pregnancies . Most women with hypertension in pregnancy have pre-existing primary hypertension, but high blood pressure in pregnancy may be the first sign of pre-eclampsia, a serious condition of the second half of pregnancy and puerperium. Pre-eclampsia is characterised by increased blood pressure and the presence of protein in the urine. It occurs in about 5% of pregnancies and is responsible for approximately 16% of all maternal deaths. Pre-eclampsia also doubles the risk of perinatal mortality. Usually there are no symptoms in pre-eclampsia and it is detected by routine screening. When symptoms of pre-eclampsia occur the most common are headache, visual disturbance (often “flashing lights”), vomiting, epigastric pain, and edema. Pre-eclampsia can occasionally progress to a life-threatening condition called eclampsia, which is a hypertensive emergency and has several serious complications including vision loss, cerebral edema,seizures or convulsions, renal failure, pulmonary edema, and disseminated intravascular coagulation

In neonates, infants and children

Failure to thrive, seizures, irritability, lack of energy, and difficulty breathing can be associated with hypertension in neonates and young infants. In older infants and children, hypertension can cause headache, unexplained irritability, fatigue, failure to thrive, blurred vision, nosebleeds, and facial paralysis.

What is the treatment for children with high blood pressure?

As in adults, HBP in children is typically managed with lifestyle changes, including:

•      Family Biking Outdoors Enjoying a heart-healthy diet
•      Participating in regular physical activity
•      Managing weight

Children and teens should also be taught the dangers of tobacco use and protected from secondhand smoke. While cigarettes aren’t directly related to high blood pressure, they do cause a number of health risks. Parents should set a good example by not smoking and educating their children about the hazards of smoking.

The doctor may also prescribe medication if an appropriate diet and regular physical activity don’t bring the high blood pressure under control.

Give your kids the best possible start by helping them develop heart-healthy habits early.