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Investigation and management of hypertension in children

A personal perspective


The prevalence of hypertension in children is of the order of 1%–3%. Of these children, 10% will have severe hypertension and in the majority the increased blood pressure will be secondary to renal disease. Nephrologically orientated investigation is therefore important. The most helpful investigations are: peripheral plasmarenin activity,99mTc dimercaptosuccinic acid (DMSA) scan, main and segmental renal vein renin measurements and renal angiography plus123I metaiodobenzyl guanidine (MIBG) scan in suspected phaeochromocytoma. Drug treatment of accelerated hypertension is most successfully undertaken by intravenous labetalol or sodium nitroprusside; sustained moderate-to-severe hypertension by a beta-blocker plus a vasodilator or an angiotensin-converting enzyme inhibitor with or without a diuretic; mild hypertension by diet, diuretic and if necessary by more powerful hypotensives. Surgical treatment by revascularization or nephrectomy and percutaneous transluminal angioplasty can be successful. Utilizing the current range of investigational and therapeutic tools the aetiology and appropriate management of hypertension can be effectively and safely undertaken in the majority of hypertensive children.

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Recommended further reading

  1. Giovannelli G, New MI, Gorini S (eds) (1981) Hypertension in children and adolescents. Raven Press, New York

  2. Ingelfinger JR (1982) Pediatric hypertension. In: Markowitz M (ed) Major problems in clinical pediatrics series, vol XXIV W. B. Saunders. Philadelphia

  3. Dillon MJ (1984) Modern management of hypertension. In: Meadow SR (ed) Recent advances in paediatrics, No. 7. Churchill Livingstone Edinburgh, pp 35–55

  4. Portman RJ, Robson AM (1984) Controversies in pediatric hypertension. In: Tune BM, Mendoza SA (eds) Pediatric nephrology. [In: Brenner BM, Stein JH (eds) Contemporary issues in nephrology vol 12]. Churchill Livingstone, New York, pp 265–296

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Dillon, M.J. Investigation and management of hypertension in children. Pediatr Nephrol 1, 59–68 (1987).

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Key words

  • Hypertension
  • Renin
  • Radionuclide imaging
  • Angiography
  • Antihypertensives
  • Revascularization
  • Angioplasty