Q. My child aged 4 years was admitted in the hospital with convulsions recently. The doctor said that he had high blood pressure because of which he got a fit. Is it possible ?

A. It is possible to get convulsions due to high BP and this episode is called hypertensive encephalopathy which is due to increased intracranial pressure (increased pressure in the brain) or brain swelling due to high BP. Associated with convulsions the child may have paralysis of one side (hemiparesis), blindness and speech defect.

Q. Is hypertension common in children? I through it occurred only in adults ?

A. Hypertension through rare in children when compared with adults occurs in 1 - 2 % of school going children who look apparently healthy.

Q. What is normal blood pressure in children? When do you consider high BP ?

A. Normal blood pressure in children varies according to age, gender and height of a child. There are normal values of systolic and diastolic BP which are recorded in large number of school children and like growth charts, percentile charts of BP are available for different ages as per 3rd Task for blood pressure in children which is compiling data from USA and Europe. If 3 separate BP recordings of a child are above 95th centile for age, gender and height it is designated as hypertension or high BP.

Q. What are the causes of hypertension ?

A. Causes of Hypertension in children in 80 - 85% of cases are due to kidney diseases like glomerulonephritis, urinary tract infections or pyelonephritis, collagen vascular diseases such as lupus erythematosus, hemolytic uremic syndrome, renal tumors like Wilm's tumor, congenital anomalies such as polycystic kidney disease or hereditary causes such as Alport's syndrome. Renal artery stenosis or aortoarteritis are renovascular causes of hypertension. Less than 5% are due to endocrinal disorders such as Cushing's or adrenal hyperplasia and adrenal tumors i.e. pheochromocytoma or neuroblastoma.

Co-arctation of aorta and patent ductus arteriosus are in less than 3% hypertensives and rare cases of meningitis, encephalitis, brain tumors are CNS causes. Less than 1 - 2% hypertensive children are due to essential or primary hypertension in preadolescent age group.

Q. How do I know whether my child is suffering from high BP ?

A. Symptoms of hypertension are nonspecific in young children. Irritability, excessive crying, failure to gain weight, poor feeding, low-grade fever are the only symptoms in children younger than 2 - 3 years. Later on headache, vomiting, palpitations, giddiness, are present. In severe and acute cases, signs and symptoms of encephalopathy, cardiac failure, blindness or renal failure occur when it is called hypertensive crisis which requires hospitalization. BP recording is the only method by which hypertension is detected in children with vague symptoms.

Q. How do you investigate a case of hypertension ?

A. Investigations in a case of hypertension should start with urine examination, urine culture, renal function tests, and ultrasonography of kidneys because 80 - 85% cases are due to renal diseases. Special tests like tests for SLE, hormonal assay to rule out endocrinal causes, radionucleide studies, doppler studies and renal angiography/aortography to rule out adrenal, renovascular causes are invasive and expensive and should be done after common causes are ruled out.

Q. What is the treatment for hypertension? When is treatment required? How does one decide which antihypertensive to use ?

A. Treatment of hypertension is urgently required to control BP in hypertensive emergencies to prevent damage to brain, heart, kidney and retina.

In cases with chronic hypertension which is moderate or severe, oral medicines are used depending on the cause. Diuretics are used in renal diseases with sodium and water retention. b blockers and vasodilators like propranolol, hydralazine and recently even calcium channel blockers (nifedipine) and ACE inhibitors (enalapril) are used if hypertension is not controlled by diuretics, b blocker/vasodilator combinations. Initially single drug should be used and dose increased every 1 - 3 weeks and if after 2 - 3 weeks BP is still above 50th centile, new drug is added. Chronic hypertension may require treatment for years.

Mild to moderate hypertension with minimum symptoms may be controlled by non pharmacologic measures like weight reduction in obese children, diet control (low salt, high potassium, high calcium & magnesium and low fat diet), exercises - yoga, life style modification, reduction of stress etc.

Q. What is hypertensive crisis & how is it managed ?

A. Hypertensive crisis is when hypertension increases to be severe enough to cause CNS, CVS, kidney or retinal involvement and quick control of BP is required to save the child and prevent permanent damage to these organs. The aim is to lower BP to 2/3 of its peak level using rapidly acting drugs for 24 - 48 hrs like sublingual nifedipine, IV Sodium nitroprusside, IV Labetolol or hydralazine. Subsequently oral medications can be used to bring BP to normal levels by 1 - 3 weeks. Very rapid reduction can result in poor perfusion of brain, coronary arteries, kidney etc. Simultaneously investigations, to arrive at the cause of hypertension should be started so that treatment can be offered.

Q. What are the complications of high BP ?

A. Long term complications of hypertension are cerebrovascular stroke, cardiovascular damage resulting in left ventricular dysfunction/failure, renal failure and retinopathy or blindness.

Q. Would my child require to take medicine for high BP life long ?

A. Depending on the causes of hypertension and control of hypertension, the duration of drug treatment differs. Very few children with hypertension require life long treatment since Primary/Idiopathic/essential hypertension is rare in children. Familial hypertension can be recognized by BP recording of children whose parents suffer from high BP and non - pharmacologic therapy started at early stage.

Q. Does any particular diet help in the treatment of high BP ?

A. If high BP is due to essential hypertension with obesity- low salt, low fat, high fiber diet with high potassium, calcium and magnesium may help to reduce BP and also reduce the dose of drugs used for high BP.

Q. What is the chance of hypertension in other members of the family if my child has one ?

A. All children of hypertensive parents and all parents of hypertensive children should have BP recordings. Although mode of inheritance is not established, essential or primary hypertension is familial and environmental factors may play a role in developing high BP in susceptible individuals.

Q. How do you follow up a patient of hypertension? How is the patient to be monitored ?

A. Regular BP monitoring along with weight and height is the simple and easy method of following a patient with hypertension. Depending on the cause urinalysis, renal function tests etc may be needed during follow up.

Last created on 09-05-2001
Last submitted on 01-07-2006