Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

Abstract

Presented recommendations are an extended and actualized version of paediatric recommendations of Polish Society of Hypertension published in 2015. Since then, new studies have appeared on this subject, introducing a new classification of hypertension, newly described principles of management in risk groups and methods of assessing hypertensive target organ damage. The presented updated recommendations included changes introduced in the 2016 European Society of Hypertension recommendations and Recommendations of Children's Memorial Health Institute in Warsaw. Recently published guidelines of American Academy of Pediatrics have been discussed. In the presented issue of guidelines, epidemiological information on the occurrence and incidence of hypertension in developmental age was added and classification of blood pressure values was updated. Subchapters on diagnosis and organ damage assessment, principles of diagnosis and treatment of hypertension in children with diabetes, chronic kidney disease and a subsection discussing diagnostic and therapeutic difficulties with setting blood pressure targets were revised. In addition, the principles of early diagnosis of arterial hypertension in post-hospital care in children born before 33 weeks of gestation published in 2018 as recommendations of the Polish Neonatal Society have been also taken into account.

Vitamin D in children with primary hypertension

“…In our study we found no significant relation between blood pressure measured both in office and in ABPM and vitamin D status. As blood pressure in paediatric population is dependent on anthropometric variables (especially height) [1,2,20] it is recommended to index measurements to normative values. When expressed as Z-score the relation was stronger but still did not reach statistical significance.…”

“…In all children hypertension was confirmed using Polish Society of Arterial Hypertension and Polish Society of Paediatric Nephrology guidelines [1,2]. Secondary forms of hypertension were excluded by medical history and physical examination and by means of additional tests: renal function tests (creatinine, urea), serum ions (sodium, potassium, and calcium), capillary blood gases, urinalysis, and abdominal ultrasonography with evaluation of kidneys, urinary tract, adrenal glands, and blood flow in renal arteries.…”

“…Secondary forms of hypertension were excluded by medical history and physical examination and by means of additional tests: renal function tests (creatinine, urea), serum ions (sodium, potassium, and calcium), capillary blood gases, urinalysis, and abdominal ultrasonography with evaluation of kidneys, urinary tract, adrenal glands, and blood flow in renal arteries. Detailed diagnostic tests for secondary forms of hypertension were performed in all children younger than 10 years and with grade II hypertension [1,2].…”

“…Arterial hypertension (AH) is found in 3-5% of children and adolescents. Primary hypertension (PH) is a dominant form of AH in teenagers and its prevalence in paediatric population is increasing due to outbreak of obesity and excessive salt intake [1,2].…”

Ambulatory blood pressure monitoring and subclinical inflammation in children with chronic kidney disease

“…The following clinical data were collected from all CKD patients: age [years]; gender, aetiology of CKD according to ESPN/ERA-EDTA (European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplantation Association) Registry (www.espn-reg.org/index.jsp); CKD stage according to KDIGO classification [11] based on estimated glomerular filtration rate (eGFR) derived by the modified Schwartz formula [12]; body mass [kg]; height [m] and body mass index (BMI) [kg/m 2 ] (Z-scores were calculated from national normative data [13]); hypertension diagnosed according to Polish Society of Hypertension guidelines [14]; and medications that might affect cardiovascular system. Overweight and obesity were defined according to World Health Organization definitions as BMI Z-score values > 1 and > 2, respectively.…”