rss
Arch Dis Child 81:452-455 doi:10.1136/adc.81.5.452
  • Current topic

Investigation of hypertension and the recognition of monogenic hypertension

  1. David V Milford
  1. Department of Nephrology, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
  1. Dr Milford. email:david.milford{at}bhamchildrens.wmids.nhs.uk

    Hypertension in childhood is rare and is more likely to be secondary to a medical disorder in the very young and in those with severe hypertension. Essential hypertension is rarely diagnosed in children less than 5 years of age but is diagnosed with increasing frequency from the age of 10 years. These observations justify the aggressive investigation of preschool children with persistent hypertension (blood pressure > 97th centile for height1) and school aged children with severe hypertension, because of the high probability of making a diagnosis.

    Key messages

    • Aggressive investigation of preschool children with persistent hypertension, and school aged children with severe hypertension is justified because of the high probability of making a diagnosis

    • When the aetiology is not evident from the history or examination, investigations should be directed to a renal or cardiac cause

    • The finding of abnormal potassium concentrations (low or high), alkalosis, suppressed renin, and low aldosterone should prompt the consideration of one of the rarer causes of hypertension

    • A better understanding of the physiological mechanisms operating in monogenic hypertension might provide a clue to the cause of essential hypertension and aid in the identification of individuals at risk of developing hypertension in later life

    The assessment of a child with hypertension should begin with a careful medical history, family medical history, and a thorough physical examination, which might provide clues to the diagnosis. When the aetiology is not evident, investigations should be directed to a renal or cardiac cause. Appropriate investigations include a full blood count, plasma electrolytes and creatinine, urine analysis, and the measurement of urinary protein excretion, which is most conveniently undertaken by measuring the ratio of urinary protein to creatinine in an early morning urine sample.2 Because renal disease results in the release of renin and angiotensin II with vasoconstriction and aldosterone …