Physiology and treatment of hypertension

Childhood hypertension (HT) is an increasing problem brought about by the epidemic of obesity. This is particularly true in adolescents, where currently Primary HT (PHT) is more common than secondary HT (SHT). The pathophysiology of PHT is complex and involves the interplay of genetic, congenital and environmental factors. It is important that every child with HT has a thorough evaluation so that any secondary cause of HT is identified and managed appropriately. There is increasing role for ABPM in the diagnosis and management of HT. Non-pharmacological therapy should be commenced on all children with hypertension and also those with high normal BP. The decision to initiate antihypertensive therapy should not be based on BP readings alone but should consider the presence or absence of end organ damage and other risk factors such as obesity, kidney disease and family history. Long term studies detailing the outcome of childhood HT and treatment are lacking. Since adult studies have demonstrated that treatment of hypertension leads to improved cardiovascular outcomes, it is imperative that HT is promptly diagnosed and appropriate treatment is commenced to prevent progression of end organ damage.