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Hipertensión arterial sistémica en el niño y adolescente
Resumen
La pandemia de la obesidad en el niño y adolescente, el riesgo de desarrollar hipertrofia ventricular y la evidencia del desarrollo temprano de la aterosclerosis hacen necesaria una detección temprana y una intervención oportuna en la hipertensión de la niñez para reducir riesgos de salud a largo plazo; sin embargo, los datos epidemiológicos de apoyo a las cifras de referencia son escasos. La hipertensión secundaria es más común en niños preadolescentes y una buena proporción está en relación a enfermedad renal. La hipertensión arterial sistémica esencial es más común en adolescentes y tiene múltiples factores de riesgo asociados, incluyendo obesidad y antecedentes familiares. La evaluación clínica integral implica una historia cuidadosa y un examen físico completo, pruebas de laboratorio y estudios especiales. Los tratamientos no farmacológicos incluyen la reducción del peso, ejercicio y modificaciones dietéticas. Las recomendaciones para el tratamiento farmacológico se basan sobre todo en la hipertensión sintomática, la evidencia de daño a órganos blanco y la hipertensión arterial que no se reduce con las modificaciones de la forma de vida, o bien, la hipertensión arterial asociada con diabetes mellitus, en la que la búsqueda de microalbuminuria está justificada.
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