Hypertension in Pediatric population

Normal below 90th%
Prehypertension between 90-95% or above 120/80
Stage 1 between 95 and 99%
Stage 2 above 99% +5mm Hg

Primary vs Secondary Hypertension
Primary - obesity, postpubertal, family history, mild/stage 1 hypertension, lack of associated symptoms (e.g. sweating, palpitations, tachycardia, ^ creatinine, etc)

Secondary Hypertension causes
•	Renal parenchymal
o	Glomerulonephritis
o	Renal parenchymal scarring (pyelo)
o	PKD
o	CRF
•	Renovascular
o	Fibromuscular dysplasia
o	Umbilical a. catheterization
•	Renal tubular
o	Monogenic causes:
o	Liddle's (ENaC)
o	Gordon's (WNK1 and WNK4)
•	Endocrinologic
o	Catecholamine excess
o	Corticosteroid excess
	Iatrogenic
	CAH
o	Thyroid
o	Hypercalcemia
•	Cardiac
o	Coarctation
•	Drugs and Toxins

Hypertensive urgency and emergency are both hypertensive crises - immediately medical treatment/evaluation
Urgency - no end organ damage. oral redosing but usually does not require hospitalization for immediate management of hypertension
Emergency - end organ damage

Screening for hypertensive emergency
Headache (urgency)
Seizures
Changes in mental status
Focal neurological deficits
Visual disturbances
Cardiovascular complaints indicative of heart failure
 

Lab workup
BUN, Creatinine, electrolytes and UA - check for underlying renal disease
CBC - anemia as part of other chronic diseases
Fasting glucose and lipids
EKG  for LVH

Workup for secondary causes
Renal imaging
Renin/Aldosterone
	High renin - reninoma? Fibromuscular dysplasia?
	High aldosterone - aldosteronoma? CAH? - ambiguous genitalia
	Both low - other causes?
Plasma and urine metanephrines - episodic?
	Pheochromocytoma
	Neuroblastoma

Echo? Renal biopsy? 99mtc-dimercaptosuccinic acid scan for parenchymal scarring