pediatrics
Hypertension in Children
Etiology of Hypertension in Children
Hypertension may be Primary (no known cause, a diagnosis of exclusion) Secondary (caused by another disorder, eg, kidney disease) After age 6, primary hypertension is by far the dominant etiology, and this is even more true for adolescents. Before age 6, secondary hypertension is more common, and this is more true for children under the age of 3. By definition, the cause of primary hypertension is not known, which is why it is a diagnosis of exclusion. However, it is known to be more common among children who Are overweight or obese (most important risk factor for primary hypertension) Have a family history of hypertension Are male Are Mexican-American or non-Hispanic black (in the US) Have a sedentary lifestyle Have unhealthy dietary habits (eg, high salt and calorie intake) Had various intrauterine factors (eg, resulting in low birth weight, Preterm Infants , or Have social risk factors (eg, Overview of Child Maltreatment , family and/or interpersonal violence, food and/or housing insecurity—the number, duration, and severity of these factors have a cumulative effect) Secondary hypertension has an identifiable cause; the hypertension may be reversible if the cause is resolved. Themost common causesof secondary hypertension in children are Renal parenchymal disease (eg, Membranoproliferative Glomerulonephritis , Renovascular disease (eg, Renal Artery Stenosis and Occlusion , Cardiovascular disease (eg, Coarctation of the Aorta , Endocrine disease (eg, Pheochromocytoma , Other causesof secondary hypertension include Sleep-disordered breathing Neurologic causes (eg, increased intracranial pressure) Drugs (eg, glucocorticoids, anabolic steroids, stimulants, oral contraceptives,nicotine,caffeine, certain illicit drugs) Psychologic stress or pain Miscellaneous causes (eg, Neuroblastoma , Orthopedic-related hypertension is related to traction or casting of a lower extremity, usually after a femur fracture. This type of hypertension is thought to be caused by pressure on the femoral nerve. 