Pediatric hypertension: an updated review
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REVIEW
Open Access
Pediatric hypertension: an updated review Mohd Ashraf1*, Mohd Irshad2 and Nazir Ahmed Parry3
Abstract Globally hypertension in adults is among the leading preventable cause of premature death, where a graded association from the childhood hypertension is well recognised. With the concurrent rise in obesity and pediatric hypertension (HTN) during the past decade in developed countries, a parallel trend is emerging in developing countries that has a potential for exponential rise in cardiovascular, cerebrovascular and renal tragedies. A cumulative incidence of pediatric HTN in China and India is 50–70 and 23% respectively, is quite disturbing. New guidelines for the detection, evaluation and management of hypertension in children and adolescents published in 2017, where a jump in prevalence of pediatric HTN is observed, rings a call to address this under-attended burning problem; for which a review in pediatric hypertension and its management is warranted. Keywords: Blood pressure, Children, Guidelines, Hypertension, Prevalence
Introduction Blood pressure (BP), is the pressure of the blood exerted on the arterial walls, produced by the contraction of the left ventricle against the resistance offered by arteries and arterioles that is required for the optimal body functioning, however, persistent high blood pressure (hypertension) is a global health issue. Globally, hypertension (HTN) is found to be major risk factor accounting for 10.2 million deaths and 208 million disability adjusted life years [1]. Evidence based exiting data published for both pediatrics and adults, has projected a graded association between increased blood pressure (BP) and risk of cardiovascular disease, end-stage renal disease, along with mortality [2–4]. Meta-analysis of more than 61 prospective studies from 1 million adults, showed that the risk of cardiovascular disease increased beginning at systolic BP levels less than 115 mmHg and diastolic BP levels less than 75 mmHg [5]. Considering 115/75 mmHg a normal BP for an adolescent corresponding to his/her age, height and sex; nevertheless, a consistent linear upward trend of this * Correspondence: [email protected] 1 Department of Pediatrics, Govt Medical College, Srinagar, Jammu and Kashmir 190010, India Full list of author information is available at the end of the article
BP level forms the basis of adult HTN a leading cause of high cardiovascular, nervous system and kidney related morbidity and mortality.
Prevalence
Globally the prevalence of hypertension is increasing and more than 1 billion people are hypertensive, and the increasing trends are witnessed more in low-income and middle-income countries [6, 7]. In our country (India), there is a steady increase in HTN prevalence from > 1% in 1960’s [8], 5–7% in 1990’s [9], and in 2013 it was 29.8% [10]. During last 10 years in USA, HTN has risen to 5% in adolescents; elevated BP (combination of prehypertension and HTN) increased up to 12.6% in girls and 19.2% in boys [11]; while using the fourth report on the di
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