Hypertension in children: new trends and challenges

Abstract

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.

Associations among blood pressure, salt consumption and body weight status of students from south-western Ontario

“…Interestingly, Rocchini et al (51) reported lower mean arterial BP among obese boys (but not among normal weight boys) in a low-Na intervention. Several review papers (52)(53)(54) convey that reducing salt intake from the diet will lower BP, regardless of gender, age or ethnicity. The Na intake in the present study was high (e.g.…”

Assessment of arterial stiffness from ambulatory blood pressure monitoring in children with diabetes mellitus type-1 (DMT1)

“…22 Therefore, early detection and treatment of increased arterial stiffness may prevent future development of structural vascular changes. 23 Arterial stiffness can be directly measured by PWV. 4,5,24 However, PWV measurement requires a specific device, a quiet patient and good normative values.…”

Influence of High Glycemic Index and Glycemic Load Diets on Blood Pressure During Adolescence

“…Thus, our findings have important health implications for 2 key reasons: elevated BP over the longer term in adolescents could ultimately lead to end-stage organ damage, which could increase the risk of future cardiovascular morbidity and mortality, 36 and, in a normotensive adult population, a 2-mm Hg reduction of systolic BP has been estimated to potentially reduce stroke mortality by 10% and ischemic heart disease by 7%. 37 Moreover, these associations did not appear to be modified by the presence of obesity and/or a family history of hypertension, therefore suggesting that modifications in the carbohydrate quantity and quality of the diet would likely have beneficial vascular effects in adolescents, regardless of weight status or genetic predisposition.…”