Diagnostic et prise en charge de l'hypertension artérielle chez l'enfant

Pediatric hypertension (HTN) is often asymptomatic and warrants systematic annual blood pressure (BP) measurement in children and adolescents ≥ 3 years of age, with appropriate cuff size. From 1 to 17 years of age, normal values of systolic and diastolic BP depend on age, height, and sex. BP is elevated when between the 90th and 95th percentile, or when ranging from 120/80 mmHg to 129/80 mmHg in adolescents. HTN is confirmed when BP is at or above the 95th percentile or above 130/80 mmHg in adolescents. Elevated BP in childhood is correlated with HTN in early adulthood and with increased cardiovascular risk. Screening and diagnosis of elevated BP or HTN in children is a key challenge. The prevalence of essential HTN increases with higher rates of children and adolescents who are overweight or obese. In prepubescent children, the cause of HTN is often secondary, due to renal and/or renovascular disease, requiring complementary investigations. Echocardiography should be performed to assess cardiac target-organ damage (left ventricular hypertrophy) when considering pharmacologic treatment of HTN. Treatment of elevated BP and HTN, as well as their prevention, is based on lifestyle recommendations, including the control of overweight and obesity. Pharmacological therapy should be initiated when patients experience symptomatic HTN, hypertensive target-organ damage, secondary HTN, or type 1 or 2 diabetes mellitus at the time of presentation.