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Good Morning Everyone!

Good Morning Everyone!. Monday, July 25 th , 2011. Hypertension in Childhood. Diagnostic Evaluation COST Confirm the diagnosis Organize a diagnostic approach Determine the Severity of the HTN Treat the HTN effectively. Confirm the Diagnosis.

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Good Morning Everyone!

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  1. Good Morning Everyone! Monday, July 25th, 2011

  2. Hypertension in Childhood • Diagnostic Evaluation • COST • Confirm the diagnosis • Organize a diagnostic approach • Determine the Severity of the HTN • Treat the HTN effectively

  3. Confirm the Diagnosis • Suspect when the BP reading is high for the height, age, and sex of the child • Confirmed when a high reading is obtained at three or more separate office visits about 1 week apart

  4. Confirm the Diagnosis • Ensure proper BP cuff size • Bladder should encircle the arm by at least 80%

  5. *

  6. Organize a Diagnostic Approach • MONSTER • Medications • Obesity • Neonatal history • Symptoms or signs • Trends in the family • Endocrine or renal

  7. **Remember, amphetamines, corticosteroids, contraceptives, cyclosporine, OTC allergy and cold medicine and licorice can cause HTN

  8. BMI > 95% • 3 to 5 times more likely to have hypertension • Can have obstructive sleep apnea syndrome (OSAS) • Causes significantly higher diastolic BPs

  9. Organize a Diagnostic Approach • Evaluation is guided by history and physical • Biochemical and imaging studies are used to address three primary organ systems: endocrine, renal, and cardiovascular

  10. Suggested Eval for Children with HTN

  11. Uric Acid • High uric acid is associated with high BP readings in childhood that may persist into adulthood (Bogalusa Heart Study) • Strong relationship between uric acid and essential HTN (found in 89%, but only 30% with secondary HTN, none with white-coat HTN)

  12. Determine the Severity • Combo of magnitude of BP elevation and presence of LVH on echo are proof of sustained HTN • Cardiac hypertrophy is major indication for therapy • Finding of LVH suggests risk for future CV disease

  13. Treatment* • Nonpharmacologic treatment • Lifestyle modifications or environmental changes must be implemented or at least attempted! • Reducing sodium intake • Physical activity • If significant essential or severe HTN, avoid weight lifting, body building, and strength training • Restriction based on the possibility of catastrophic event

  14. Treatment • Goal is normalization or near-normalization of BP based on age, sex, and height using a drug regimen that causes minimal adverse effects • Consider starting with one drug and maximizing dose before adding a second agent

  15. Treatment • First-line • ACE inhibitors (ex: Captopril, Enalpril) • SE = renal impairment, hyperkalemia, neutropenia, anemia, dry cough, angioedema • Angiotensin receptor blockers • SE = renal impairment, hyperkalemia, neutropenia, anemia • Calcium channel blockers (ex: Nifedipine, Isradipine) • SE = peripheral edema, dizziness, nausea, headache, flushing, weakness

  16. Treatment • Second-line therapy • Beta-blockers • Central alpha agonists (Clonidine) • Vasodilators (Hydralazine, Minoxidil) • Diuretics

  17. QUIZ Answers • 1. • E. Schedule 2 subsequent visits to measure BP • 2. • A. Echocardiography • 3. • B. Hyperkalemia • 4. • D. Perform renal ultrasonography

  18. Have a great day! Noon conference is Inpatient ID with Dr. Begue

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