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Primary hypertension and special aspects of hypertension in older children and adolescents.

Ellis D, Miyashita Y - Adolesc Health Med Ther (2011)

Bottom Line: While it is essential to exclude numerous causes of secondary hypertension in every child, these disorders are not discussed in this review.Rather, the aim of this review is to familiarize pediatricians with casual and ambulatory blood pressure measurement, epidemiology, pathophysiology, and management of several common conditions that play a role in the development of hypertension in children and adolescents.Lastly, because pediatricians are increasingly confronted with special issues concerning the management of the hypertensive athlete, this topic is also addressed.

View Article: PubMed Central - PubMed

Affiliation: Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, PA, USA.

ABSTRACT
The prevalence of hypertension has increased at an accelerated rate in older children and adolescents. This has raised great concern about premature development of cardiovascular disease, which has major long-term health and financial implications. While obesity and sedentary habits largely explain this phenomenon, there are other social and cultural influences that may unmask genetic susceptibility to hypertension in the pediatric population. While it is essential to exclude numerous causes of secondary hypertension in every child, these disorders are not discussed in this review. Rather, the aim of this review is to familiarize pediatricians with casual and ambulatory blood pressure measurement, epidemiology, pathophysiology, and management of several common conditions that play a role in the development of hypertension in children and adolescents. Besides primary hypertension and obesity-related hypertension, emphasis is given to epidemiology, measurement of blood pressure, including ambulatory blood pressure monitoring, hypertension associated with drug use, teenage pregnancy, and video and computer games. Lastly, because pediatricians are increasingly confronted with special issues concerning the management of the hypertensive athlete, this topic is also addressed.

No MeSH data available.


Related in: MedlinePlus

Mechanism of salt-sensitive hypertension. Under normal conditions, there is a balance between renal perfusion pressure (about 100 mmHg) and sodium excretion (about 100–120 mmol/day). The increment in arterial pressure is a physiological response directed to promote an increase in urine sodium and water excretion required to bring expanded extracellular fluid volume to normal. Maintenance of hemodynamic homeostasis requires higher blood pressure if the pressure natriuresis mechanism is impaired (shifted to the right and less steep). Copyright© 2007. Elsevier. Adapted with permission from Rodriguez-Iturbe B, Romero F, Johnson RJ. Pathophysiological mechanisms of salt-dependent hypertension. Am J Kidney Dis. 2007;4:655–672.61Abbreviation: UNaV, urinary sodium excretion.
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f1-ahmt-2-045: Mechanism of salt-sensitive hypertension. Under normal conditions, there is a balance between renal perfusion pressure (about 100 mmHg) and sodium excretion (about 100–120 mmol/day). The increment in arterial pressure is a physiological response directed to promote an increase in urine sodium and water excretion required to bring expanded extracellular fluid volume to normal. Maintenance of hemodynamic homeostasis requires higher blood pressure if the pressure natriuresis mechanism is impaired (shifted to the right and less steep). Copyright© 2007. Elsevier. Adapted with permission from Rodriguez-Iturbe B, Romero F, Johnson RJ. Pathophysiological mechanisms of salt-dependent hypertension. Am J Kidney Dis. 2007;4:655–672.61Abbreviation: UNaV, urinary sodium excretion.

Mentions: North American children have a high intake of salt, derived mainly from processed food rather than salt added to food by the individual. Sodium restriction is of particular benefit in African-Americans with salt-sensitive hypertension. Figure 1 shows the mechanisms implicated in salt-sensitive hypertension.61 Individuals with this disorder have an inheritable impairment in sodium excretion at any level of renal perfusion pressure. This impairment in “pressure natriuresis”, combined with an acquired taste for salt leading to ever increasing salt intake, eventually leads to sustained hypertension.


Primary hypertension and special aspects of hypertension in older children and adolescents.

Ellis D, Miyashita Y - Adolesc Health Med Ther (2011)

Mechanism of salt-sensitive hypertension. Under normal conditions, there is a balance between renal perfusion pressure (about 100 mmHg) and sodium excretion (about 100–120 mmol/day). The increment in arterial pressure is a physiological response directed to promote an increase in urine sodium and water excretion required to bring expanded extracellular fluid volume to normal. Maintenance of hemodynamic homeostasis requires higher blood pressure if the pressure natriuresis mechanism is impaired (shifted to the right and less steep). Copyright© 2007. Elsevier. Adapted with permission from Rodriguez-Iturbe B, Romero F, Johnson RJ. Pathophysiological mechanisms of salt-dependent hypertension. Am J Kidney Dis. 2007;4:655–672.61Abbreviation: UNaV, urinary sodium excretion.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3926767&req=5

f1-ahmt-2-045: Mechanism of salt-sensitive hypertension. Under normal conditions, there is a balance between renal perfusion pressure (about 100 mmHg) and sodium excretion (about 100–120 mmol/day). The increment in arterial pressure is a physiological response directed to promote an increase in urine sodium and water excretion required to bring expanded extracellular fluid volume to normal. Maintenance of hemodynamic homeostasis requires higher blood pressure if the pressure natriuresis mechanism is impaired (shifted to the right and less steep). Copyright© 2007. Elsevier. Adapted with permission from Rodriguez-Iturbe B, Romero F, Johnson RJ. Pathophysiological mechanisms of salt-dependent hypertension. Am J Kidney Dis. 2007;4:655–672.61Abbreviation: UNaV, urinary sodium excretion.
Mentions: North American children have a high intake of salt, derived mainly from processed food rather than salt added to food by the individual. Sodium restriction is of particular benefit in African-Americans with salt-sensitive hypertension. Figure 1 shows the mechanisms implicated in salt-sensitive hypertension.61 Individuals with this disorder have an inheritable impairment in sodium excretion at any level of renal perfusion pressure. This impairment in “pressure natriuresis”, combined with an acquired taste for salt leading to ever increasing salt intake, eventually leads to sustained hypertension.

Bottom Line: While it is essential to exclude numerous causes of secondary hypertension in every child, these disorders are not discussed in this review.Rather, the aim of this review is to familiarize pediatricians with casual and ambulatory blood pressure measurement, epidemiology, pathophysiology, and management of several common conditions that play a role in the development of hypertension in children and adolescents.Lastly, because pediatricians are increasingly confronted with special issues concerning the management of the hypertensive athlete, this topic is also addressed.

View Article: PubMed Central - PubMed

Affiliation: Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, PA, USA.

ABSTRACT
The prevalence of hypertension has increased at an accelerated rate in older children and adolescents. This has raised great concern about premature development of cardiovascular disease, which has major long-term health and financial implications. While obesity and sedentary habits largely explain this phenomenon, there are other social and cultural influences that may unmask genetic susceptibility to hypertension in the pediatric population. While it is essential to exclude numerous causes of secondary hypertension in every child, these disorders are not discussed in this review. Rather, the aim of this review is to familiarize pediatricians with casual and ambulatory blood pressure measurement, epidemiology, pathophysiology, and management of several common conditions that play a role in the development of hypertension in children and adolescents. Besides primary hypertension and obesity-related hypertension, emphasis is given to epidemiology, measurement of blood pressure, including ambulatory blood pressure monitoring, hypertension associated with drug use, teenage pregnancy, and video and computer games. Lastly, because pediatricians are increasingly confronted with special issues concerning the management of the hypertensive athlete, this topic is also addressed.

No MeSH data available.


Related in: MedlinePlus