What is New in the Diagnostics and Treatment of Arterial Hypertension in Children?

Overview

The recommendation for diagnostics and therapy of hypertension at the child age according to so called Fourth Report of the Working Group on High Blood Pressure in Children and Adolescents from 2004 bring certain changes in this area. In accord with the recommendations for adults a term prehypertension was introduced and defined as the mean systolic blood pressure or diastolic blood pressure equal to or higher than 90^th percentile but lower than 95^th percentile, or BP ≥120/80 mm Hg independently of the value of the relevant 90^th percentil, but lower than 95^th percentile. In the new tables of percentile values of BP, in addition to 90^th and 95^th percentile the 50^th and 99^th percentiles are also listed. The new recommendations also introduce classification of the severity of hypertension of the degree 1 and 2 in relation to that fact how far the BP values exceed the 99^th percentile. The recommendations for the extent and urgency of examination and therapy of patients with hypertension then depend on the severity of hypertension. The examination should be aimed at exclusion of secondary etiology of hypertension, evaluation of the target organ damage and to uncover other cardiovascular risk factors. Small children with 2^nd degree of hypertension should be examined in more detail than patients with 1^st degree of hypertension. Present modern technologies make it possible to examine by less invasive way than those in the past. The treatment of hypertension is based on non-pharmacological measures and in indicated cases also by antihypertensive drugs. The pharmacological therapy is indicated in a symptomatic hypertension, secondary hypertension, in demonstrated target organ damage and in persisting hypertension, which could not be influenced by lifestyle changes. The therapeutic goal is to reach values of BP below 95^th percentile and in patients with a chronic renal disease, diabetes and the signs of affected target organs the BP values below 90^th percentile for sex, age and height.

Key words:
hypertension, prehypertension, blood pressure measurement, classification of hypertension, ambulatory blood pressure monitoring, diagnostics of hypertension, therapy of hypertension