How to cite this article: Rosas-Peralta M, Medina-Concebida LE, Borrayo-Sánchez G, Madrid-Miller A, Ramírez-Arias E, Pérez-Rodríguez G. Hipertensión arterial sistémica en el niño y adolescente. Rev Med Inst Mex Seg Soc 2016;54 Supl 1:s52-66.
Martín Rosas-Peralta,a Luz Elena Medina-Concebida,b Gabriela Borrayo-Sánchez,c Alejandra Madrid-Miller,d Erick Ramírez-Arias,e Gilberto Pérez-Rodríguezf
aDivisión de Investigación en Salud
bServicio de Cardiología Pediátrica
dServicio de Terapia Posquirúrgica
eServicio de Urgencias
Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
Communication with: Martín Rosas-Peralta
The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. Evaluation involves a through history and physical examination, laboratory tests, and specialized studies. Management is multifaceted. Nonpharmacologic treatments include weight reduction, exercise, and dietary modifications. Although the evidence of first line therapy for hypertension is still controversial, the recommendations for pharmacologic treatment are based on symptomatic hypertension, evidence of end-organ damage, stage 2 of hypertension, or stage 1 of hypertension unresponsive to lifestyle modifications, and hypertension with diabetes mellitus where is the search for microalbuminuria justified.
Key words: Hypertension; Child;Adolescent; Obesity; Treatment
The European Society of Hypertension recently published its recommendations on the prevention, diagnosis, and treatment of hypertension in children and adolescents. Taking this contribution as a starting point, the Hypertension Study Group at the Hospital de Cardiología del Centro Médico Nacional Siglo XXI has done a reassessment of the recent literature on this topic. This review is not intended to be an exhaustive description of hypertension in the pediatric population, but is meant to provide pediatricians with practical and up-to-date indications in order to guide them in this often unappreciated problem.
This document focuses on primary hypertension, which represents a growing problem in children and adolescents. Subjects at high risk of hypertension are those who are overweight, underweight at birth, and those with a family history of hypertension. However, children who do not have these risk factors may also have elevated blood pressure levels. The diagnosis of hypertension or normal high blood pressure in children is made with repeated blood pressure measurements in the doctor’s office, showing higher than baseline values. Blood pressure should be checked at least once a year with the appropriate methods and instruments, and the values observed should be interpreted according to the latest nomograms adjusted for the gender, age, and height of the children. Currently, other available methods, such as ambulatory blood pressure measurement and home blood pressure measurement, are not properly validated for use as diagnostic tools. To diagnose primary hypertension it is necessary to exclude secondary forms. The probability of facing a secondary form of hypertension is inversely proportional to the child's age and directly proportional to blood pressure levels. Medical history, clinical data, and blood tests can guide the differential diagnosis of primary versus secondary forms. Prevention of hypertension is based on good lifestyle and nutrition. Treatment of primary hypertension in children is almost exclusively dietary and behavioral and includes: a) the reduction of excess weight, b) reduction of dietary sodium intake, c) increasing physical activity. Medication therapy is rarely needed and only in specific cases.
The concept of the importance of measuring blood pressure in children for pediatric health care has changed; considerable progress has been made in the detection, assessment, treatment, and prevention of hypertension (HT), and its importance as a cardiovascular risk factor in childhood.1 The definition of HT in this group has changed. Before statistics were designed for the normal distribution of blood pressure in children, adult blood pressure was usually used. It was in 1987 when the second working group of the US National High Blood Pressure Education Program presented a report standardizing the method for measuring blood pressure in children and teens.2 This served as a guide for diagnosis and treatment. In 1996, this report was updated with data collected between 1988 and 1991; new benchmarks were developed for blood pressure taking into account height and growth rate. Systolic blood pressure was determined by the onset of Korotkoff phase I. The definition of diastolic blood pressure was more controversial, since it was previously thought that it correlated best with Korotkoff phase IV; however, the American Heart Association established Korotkoff phase V as diastolic blood pressure at all ages. One of the most important developments over the past five years was the development of new blood pressure cutoffs adjusted for height, gender, and age, and published by the National Health and Nutrition Examination Survey (NHANES). These cutoffs included 50th, 90th, and 95th percent