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1、Childhood and Adolescent HypertensionJames H. Moller, M.D.James H. Moller, M.D.Professor and former Head of PediatricsProfessor and former Head of PediatricsUniversity of Minnesota University of Minnesota Minneapolis Minnesota, 55455Minneapolis Minnesota, 55455molle002umn.edumolle002umn.eduChildhood
2、 and Adolescent HypertensionCardiovascular Disease PreventionChildhood and Adolescent HypertensionTrends during past 50 years-Trends during past 50 years-1958-mostly “secondary”1958-mostly “secondary”Primary considered rare.Primary considered rare.2008-mostly “primary”,2008-mostly “primary”,Secondar
3、y to obesity and lack of physical activitySecondary to obesity and lack of physical activityChildhood and Adolescent Hypertensionn nTypes of Cardiovascular preventionn nPrimordial-Prevention of development of cardiovascular risk factors.n nPrimary-Control cardiovascular risk factors once they are pr
4、esent.n nSecondary-Reduction of risk factors once a cardiovascular event has occurred.Childhood and Adolescent Hypertensionn nPDAY and Bogalusa Studiesn nFatty streaks in coronary arteries and aorta occur early in life.n nMore advanced fibrous plaques in adolescents and young adults.Childhood and Ad
5、olescent Hypertensionn nPDAY and Bogalusa Studiesn nRisk factors of high body mass index, high blood pressure, dyslipidemia strongly associated with extent of arterial lesions.n nPresence of multiple risk factors associated with higher risk of atherosclerotic lesions.Childhood and Adolescent Hyperte
6、nsionn nLong-term study of children first seen from 1922 to1935.n nOf adolescents with BMI greater than 75% relative risk of death from coronary heart disease is 2.3.n nAlso higher morbidity from coronary artery disease. Childhood and Adolescent Hypertensionn nClustering of Cardiovascular Risk Facto
7、rsClustering of Cardiovascular Risk Factorsn nStroke associated with obesity and Stroke associated with obesity and hypertensionhypertensionn nObese children often have some degree of Obese children often have some degree of insulin resistanceinsulin resistancen nInsulin resistance syndrome occurs i
8、n Insulin resistance syndrome occurs in children with truncal obesity, high children with truncal obesity, high triglycerides, low LDL-C, hyperinsulinemiatriglycerides, low LDL-C, hyperinsulinemiaChildhood and Adolescent Hypertensionn nEvaluation of Children and Adolescentsn nHistory about physical
9、activity, food choices, smoking, sleep disorders.n nFamily history of early (under 55 years) of cardiovascular events or disease.Childhood and Adolescent Hypertensionn nEvaluation of Children and Adolescentsn nCareful and repeated measurement of blood pressuren nMeasure height and weight-compare to
10、growth chartsn nMeasure abdominal circumferencen nCalculate body mass index (BMI)n nBMI=weight (kg)/height(M)squaredChildhood and Adolescent Hypertensionn nBlood Pressure MeasurementBlood Pressure Measurementn nAll children over 3 years old in medical All children over 3 years old in medical setting
11、 should have blood pressure setting should have blood pressure measured.measured.n nAuscultation preferred measurement Auscultation preferred measurement method.method.n nUse appropriate sized blood pressure cuff.Use appropriate sized blood pressure cuff.n nElevated blood pressure measurement Elevat
12、ed blood pressure measurement must be confirmed by repeat readingsmust be confirmed by repeat readingsChildhood and Adolescent Hypertensionn nDefinition of Pre-hypertensionn nSystolic or diastolic blood pressure between 90% and 95% for gender, age and height on at least 3 occasions.n nBlood pressure
13、 above 120/80 on at least 3 occasions.Childhood and Adolescent Hypertensionn nDefinition of Hypertensionn nsystolic or diastole pressure above 95% for gender, age and height on at least 3 occasions.Childhood and Adolescent Hypertensionn nManagement of Normal BPn nBP less than 90%.n nMeasure BP on ne
14、xt regular medical visit.n nEncourage healthy food choices and physical activity.n nMedication-none.Childhood and Adolescent Hypertensionn nManagement of Pre-hypertensionn nBP-90%-95% or greater than 120/80n nMeasure BP again in 6 months.n nWeight management if obese.n nCounsel on food choices and p
15、hysical activityn nMedications-noneChildhood and Adolescent Hypertensionn nManagement of Hypertensionn nBP 95%-99%n nMeasure BP in 2 weeksn nManagement-food choices and physical activityn nMedication if persistent high BP, symptomatic, diabetes or secondary Childhood and Adolescent Hypertensionn nCl
16、ustering of Cardiovascular Risk Factorsn nMeasure fasting lipid profile and blood glucose and A1C level in pre-hypertensive obese children, all children over 95% blood pressureChildhood and Adolescent Hypertensionn nManagement of Elevated Blood Pressure. Medicationn nIndication-secondary hypertensio
17、n, insufficient response to life style modification.n nMedication-initially a single drug.n nGoal-reduction of blood pressure below 90%.Childhood and Adolescent Hypertensionn nManagement of Elevated Blood Pressure in Management of Elevated Blood Pressure in Children.Children.n nMost patients with hi
18、gh BP-treatment is Most patients with high BP-treatment is life-long.life-long.n nLong-term consequences of untreated Long-term consequences of untreated hypertension in children-unknown.hypertension in children-unknown.n nLong-term consequences of medication Long-term consequences of medication eff
19、ects in children-unknown.effects in children-unknown.n nTherefore, definitive indication is needed Therefore, definitive indication is needed before beginning medication.before beginning medication.Childhood and Adolescent Hypertensionn nManagement of Elevated Blood Pressure in Children.n nMedicatio
20、nn nDiuretics and beta-blockers in children have a long history of safety and efficacy.n nRemain appropriate for use in children and adolescents.Childhood and Adolescent Hypertensionn nAdult blood pressure correlates with:n nchildhood blood pressure, n nbody size, n nChange in ponderosity between ch
21、ildhood and adulthood.Childhood and Adolescent Hypertensionn nIn childhood, the magnitude of change in blood pressure related to amount of ponderosity gain or loss and does not depend on initial blood pressure.n nThus, for obese children weight loss may be effective method for reducing blood pressur
22、e.Changes in BMI and Systolic BP in Changes in BMI and Systolic BP in Minneapolis School Children Between 1986 & 1996Minneapolis School Children Between 1986 & 19961986199618.51919.52020.52121.5Male Femalekg/m2BMIP.0001P.0001102104106108MaleFemalemm HgSystolic BPP.0001P=.0002Childhood and Adolescent
23、 Hypertensionn nChinas division of KFC, Pizza Hut, and Taco Bell profits increased 33% last year.n nKFC-2,500 restaurants in 450 cities.n nKFC projects 14,000 restaurants in China-more than number of McDonalds restaurants in the US.Childhood and Adolescent Hypertensionn n5-2-1-0 Principlen n5 fresh
24、fruits or vegetables/dayn n2 hour limit of screen time/dayn n1 hour physical activity/ dayn n0 sweetened drinks (sodas)/dayChildhood and Adolescent Hypertension The Fourth Report on the Diagnosis, The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Evaluation, and Treatment of High
25、 Blood Pressure in children and Blood Pressure in children and Adolescents.Adolescents.Pediatrics 2004;114;555-576Pediatrics 2004;114;555-576Childhood and Adolescent HypertensionAmerican Heart Association Guidelines American Heart Association Guidelines for Primary Prevention of for Primary Preventi
26、on of Atherosclerotic Cardiovascular Disease Atherosclerotic Cardiovascular Disease Beginning in Childhood.Beginning in Childhood.Circulation 2003:107:1562-1566Circulation 2003:107:1562-1566Childhood and adolescent HypertensionCardiovascular Health in Children. A Statement Cardiovascular Health in C
27、hildren. A Statement for Health Professionals from Committee on for Health Professionals from Committee on atherosclerosis, Hypertension and Obesity in the atherosclerosis, Hypertension and Obesity in the Young.Young.American Heart AssociationAmerican Heart AssociationCirculation 2006: 106:143-160Circulation 2006: 106:143-160
