Novelty in hypertension in children and adolescents: focus on hypertension during the first year of life, use and interpretation of ambulatory blood pressure monitoring, role of physical activity in prevention and treatment, simple carbohydrates and uric acid as risk factors

Abstract

The present article intends to provide an update of the article “Focus on prevention, diagnosis and treatment of hypertension in children and adolescents” published in 2013 (Spagnolo et al., Ital J Pediatr 39:20, 2013) in this journal. This revision is justified by the fact that during the last years there have been several new scientific contributions to the problem of hypertension in pediatric age and during adolescence. Nevertheless, for what regards some aspects of the previous article, the newly acquired information did not require substantial changes to what was already published, both from a cultural and from a clinical point of view. We felt, however, the necessity to rewrite and/or to extend other parts in the light of the most recent scientific publications. More specifically, we updated and extended the chapters on the diagnosis and management of hypertension in newborns and unweaned babies, on the use and interpretation of ambulatory blood pressure monitoring, and on the usefulness of and indications for physical activity. Furthermore, we added an entirely new section on the role that simple carbohydrates (fructose in particular) and uric acid may play in the pathogenesis of hypertension in pediatric age.

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“…Primary hypertension represents a growing problem in children and adolescence. Recent novelties in the field of prevention, diagnosis and treatment of hypertension in children were considered by Strambi et al [ 24 ]. Authors emphasized that the definition of normal blood pressure values in neonates are lacking [ 25 ].…”

“…However, it is advisable to use results of the study by Dionne et al [ 26 ] that provided blood pressure values corresponding to different percentiles at 15 days of age according to gestational age. In pediatric age, diagnosis of hypertension is based on repeated office measurements exceeding reference values [ 24 ]. Ambulatory blood pressure monitoring can be useful in children older than 10 years of age to clarify critical issues, such as hypertension during hypersensitivity reaction [ 27 ]), white coat hypertension, masked hypertension, treatment efficacy, nocturnal drop [ 24 ].…”

“…In pediatric age, diagnosis of hypertension is based on repeated office measurements exceeding reference values [ 24 ]. Ambulatory blood pressure monitoring can be useful in children older than 10 years of age to clarify critical issues, such as hypertension during hypersensitivity reaction [ 27 ]), white coat hypertension, masked hypertension, treatment efficacy, nocturnal drop [ 24 ]. Strambi et al [ 24 ] considered also another key point that is the positive effect of physical exercise on prevention of primary hypertension by reducing overweight, inferior quality of sleep and by maintaining sodium homeostasis [ 28 ].…”

“…Ambulatory blood pressure monitoring can be useful in children older than 10 years of age to clarify critical issues, such as hypertension during hypersensitivity reaction [ 27 ]), white coat hypertension, masked hypertension, treatment efficacy, nocturnal drop [ 24 ]. Strambi et al [ 24 ] considered also another key point that is the positive effect of physical exercise on prevention of primary hypertension by reducing overweight, inferior quality of sleep and by maintaining sodium homeostasis [ 28 ]. However, they [ 24 ] reported a list of isometric and intensive sports that are not recommended in case of stage 2 hypertension not pharmacologically controlled.…”

“…Strambi et al [ 24 ] considered also another key point that is the positive effect of physical exercise on prevention of primary hypertension by reducing overweight, inferior quality of sleep and by maintaining sodium homeostasis [ 28 ]. However, they [ 24 ] reported a list of isometric and intensive sports that are not recommended in case of stage 2 hypertension not pharmacologically controlled. It must be also considered that diagnosis of hypertension should not be neglected in athletic adolescents [ 29 ].…”