Pediatric hypertension: An update on a burning problem

A large number of adults worldwide suffer from essen-tial hypertension, and because blood pressures(BPs) tend to remain within the same percentiles throughout life, it has been postulated that hypertensive pressures can be tracked from childhood to adulthood. Thus, chil-dren with higher BPs are more likely to become hyper-tensive adults. These "pre-hypertensive" subjects can be identified by measuring arterial BP at a young age, and compared with age, gender and height-specific references. The majority of studies report that 1 to 5% of children and adolescents are hypertensive, defined as a BP > 95th percentile, with higher prevalence rates reported for some isolated geographic areas. However, the actual prevalence of hypertension in children and adolescents remains to be fully elucidated. In addition to these young "pre-hypertensive" subjects, there are also children and adolescents with a normal-high BP(90th-95th percentile). Early intervention may help pre-vent the development of essential hypertension as they age. An initial attempt should be made to lower their BP by non-pharmacologic measures, such as weight re-duction, aerobic physical exercise, and lowered sodium intake. A pharmacological treatment is usually needed should these measures fail to lower BP. The majority of antihypertensive drugs are not formulated for pediatricpatients, and have thus not been investigated in great detail. The purpose of this review is to provide an up-date concerning juvenile hypertension, and highlight recent developments in epidemiology, diagnostic meth-ods, and relevant therapies.