Open Access Highly Accessed Review

Focus on prevention, diagnosis and treatment of hypertension in children and adolescents

Amedeo Spagnolo1, Marco Giussani2, Amalia Maria Ambruzzi3, Mario Bianchetti4, Silvio Maringhini5, Maria Chiara Matteucci6, Ettore Menghetti7, Patrizia Salice8, Loredana Simionato9, Mirella Strambi10, Raffaele Virdis11 and Simonetta Genovesi12*

Author Affiliations

1 ISFOL, Istituto per gli Affari Sociali, Rome, Italy

2 Pediatra di Famiglia, Progetto PAB (Pressione Arteriosa Bambino), Milan, Italy

3 Pediatra-nutrizionista, Ospedale Pediatrico Bambino Gesù, Rome, Italy

4 Department of Pediatrics, Mendrisio and Bellinzona Hospitals, Switzerland, and University of Bern, Switzerland, Bern, Switzerland

5 Unità Operativa Complessa Nefrologia Pediatrica, Ospedale dei Bambini “G. Di Cristina” A.R.N.A. S. “Civico, Di Cristina e Benefratelli”, Palermo, Italy

6 Divisione di Nefrologia Pediatrica Ospedale Pediatrico Bambino Gesù, IRCCS, Società Italiana di Nefrologia Pediatrica, Rome, Italy

7 Pediatra-nutrizionista, Università”La Sapienza”, Rome, Italy

8 Cardiologia Pediatrica UO Cardiologia Fondazione Policlinico Ca Granda IRCCS, Progetto CHild, Milan, Italy

9 Pediatra di Famiglia, Progetto CHild, Milan, Italy

10 Dipartimento di Pediatria, Ostetricia e Medicina della Riproduzione, Università di Siena, Siena, Italy

11 Dipartimento Età Evolutiva, Clinica Pediatrica, Università di Parma, Parma, Italy

12 Clinica Nefrologica e Dipartimento di Medicina Clinica e Prevenzione Università di Milano Bicocca. Progetto PAB (Pressione Arteriosa Bambino), Società Italiana Ipertensione Arteriosa, Milan, Italy

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Italian Journal of Pediatrics 2013, 39:20  doi:10.1186/1824-7288-39-20

Published: 19 March 2013

Abstract

The European Society of Hypertension has recently published its recommendations on prevention, diagnosis and treatment of high blood pressure in children and adolescents. Taking this contribution as a starting point the Study Group of Hypertension of the Italian Society of Pediatrics together with the Italian Society of Hypertension has conducted a reappraisal of the most recent literature on this subject. The present review does not claim to be an exhaustive description of hypertension in the pediatric population but intends to provide Pediatricians with practical and updated indications in order to guide them in this often unappreciated problem.

This document pays particular attention to the primary hypertension which represents a growing problem in children and adolescents. Subjects at elevated risk of hypertension are those overweight, with low birth weight and presenting a family history of hypertension. However, also children who do not present these risk factors may have elevated blood pressure levels. In pediatric age diagnosis of hypertension or high normal blood pressure is made with repeated office blood pressure measurements that show values exceeding the reference values. Blood pressure should be monitored at least once a year with adequate methods and instrumentation and the observed values have to be interpreted according to the most updated nomograms that are adjusted for children’s gender, age and height. Currently other available methods such as ambulatory blood pressure monitoring and home blood pressure measurement are not yet adequately validated for use as diagnostic instruments. 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 may guide the differential diagnosis of primary versus secondary forms. The prevention of high blood pressure is based on correct lifestyle and nutrition, starting from childhood age. The treatment of primary hypertension in children is almost exclusively dietary/behavioral and includes: a) reduction of overweight whenever present b) reduction of dietary sodium intake c) increase in physical activity. Pharmacological therapy will be needed rarely and only in specific cases.

Keywords:
Blood pressure; Children; Hypertension; Obesity; Overweight; Prevention; Physical activity; Salt intake