Childhood HTN (hypertension) has become a widely investigated topic within the last decade due to its increasing prevalence. In the present review, we examine new developments and trends that have significantly contributed to aetiology, diagnosis, evaluation and management of childhood HTN. Many recent reports document an increasing prevalence of HTN, mainly essential HTN, in children worldwide. This is probably related to the increase of childhood obesity, although obesity is not the only factor. Evidence has been accumulating to suggest a rather complex interplay between obesity, uric acid level, dietary sodium intake, inflammation, inheritance and other factors, which lead to increased risk of developing HTN in childhood and adulthood. The detection and monitoring of HTN has significantly improved with the use of ABPM (ambulatory blood pressure monitoring), which allows not only for a more accurate classification and staging of HTN, but also for the calculation of more sophisticated parameters such as the AASI (ambulatory arterial stiffness index). Measurement of arterial stiffness enables assessment of arterial dysfunction, which may precede structural vascular changes evaluated by carotid intima media thickness. Sustained HTN eventually leads to end-organ damage [LVH (left ventricular hypertrophy), central nervous system], which in turn increases the risk of cardiovascular morbidity and mortality. New developments in childhood HTN, as outlined in the present review, will hopefully contribute to better screening and management of HTN in children.

Despite current guidelines, variability exists in the workup of hypertensive children due to physician preferences. The study evaluates primary vs secondary hypertension diagnosis from investigations routinely performed in hypertensive children. This retrospective study included children 5 to 19 years with primary and secondary hypertension. The proportions of abnormal laboratory and imaging tests were compared between primary and secondary hypertension groups. Risk factors for primary vs secondary hypertension were evaluated by logistic regression and likelihood function analysis. Patients with secondary hypertension were younger (5-12 years) and had a higher proportion of abnormal creatinine, renal ultrasound, and echocardiogram findings. There was no significant difference in abnormal results of thyroid function, urine catecholamines, plasma renin, and aldosterone. Abnormal renal ultrasound findings and age were predictors of secondary hypertension by regression and likelihood function analysis. Children aged 5 to 12 years with abnormal renal ultrasound findings and high diastolic blood pressures are at higher risk for secondary hypertension that requires detailed evaluation. J Clin Hypertens (Greenwich).

J Clin Hypertens (Greenwich). 2010;12:34–39. ©2009 Wiley Periodicals, Inc. According to the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, stage 1 hypertension is often primary in origin and associated with overweight. In contrast, stage 2 hypertension is more often secondary in origin and, hence, requires more extensive evaluation according to task force recommendations. The objective of this retrospective study was to evaluate whether the presence of stage 1 hypertension in overweight pediatric patients precludes workup for secondary hypertension (SH). This study included children (5–18 years) with hypertension (defined and staged per task force recommendations) referred to 4 pediatric nephrology centers in the Midwest region. Of the 246 referred patients, 166 patients with primary hypertension (PH) and SH were included for body mass index and hypertension stage analysis. The study revealed no significant differences in the mean age at diagnosis (PH, 13.1±3.1 years; SH, 12.4±3.8 years), distribution of overweight (PH, 89.4% BMI >85th percentile; SH, 80% BMI >85th percentile), and stage 1 (PH, 45%; SH, 40%) or 2 hypertensive (PH,55%; SH, 60%) children between PH vs SH. Overweight and presence of stage 1 hypertension should not preclude evaluation for SH.

Introduction: Multiple cephalometric analyses are used to diagnose vertical skeletal facial discrepancy. A multitude of times, these parameters show conflicting results, and a specific diagnosis is hard to reach. Objective: Hence, this study aimed to identify the skeletal analysis that performs best for the identification of vertical skeletal pattern in borderline cases. Methods: The sample consisted of 161 subjects (71 males and 90 females; mean age = 23.6 ± 4.6 years). Y-axis, Sella-Nasion to mandibular plane angle (SN.MP), maxillary plane to mandibular plane angle (MMA), Sella-Nasion to Gonion-Gnathion angle (SN.GoGn), Frankfort to mandibular plane angle (FMA), R-angle and facial height ratio (LAFH.TAFH) were used to evaluate vertical growth pattern on lateral cephalograms. The subjects were divided into three groups (hypodivergent, normodivergent and hyperdivergent groups), as indicated by the diagnostic results of the majority of parameters. Kappa statistics was applied to compare the diagnostic accuracy of various analyses. To further validate the results, sensitivity and positive predictive values (PPV) for each parameter were also calculated. Results: SN.GoGn showed a substantial interclass agreement (k = 0.850). In the hypodivergent group, MMA showed the highest sensitivity (0.934), whereas FMA showed the highest PPV (0.964). In the normodivergent group, FMA showed the highest sensitivity (0.909) and SN.GoGn had the highest PPV (0.903). SN.GoGn showed the highest sensitivity (0.980) and PPV (0.87) in the hyperdivergent group. Conclusions: SN.GoGn and FMA were found to be the most reliable indicators, whereas LAFH.TAFH is the least reliable indicator in assessing facial vertical growth pattern. Hence, the cephalometric analyses may be limited to fewer analyses of higher diagnostic performance.