Aggiornamento
L'ipertensione arteriosa in età pediatrica: dall'inquadramento diagnostico alla terapia
NHBMANAGEMENT OF HYPERTENSION IN CHILDREN AND ADOLESCENTS: FROM DIAGNOSIS TO TREATMENT
ANGELA DE CUNTO1, MASSIMO MASCHIO1, MARCO PENNESI1, ALESSANDRA BENETTONI2
1Clinica Pediatrica, IRCCS “Burlo Garofolo”, Trieste
2Servizio di Cardiologia, IRCCS “Burlo Garofolo”, Trieste
Aprile 2008 - pagg. 226 -234
Abstract
The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy,
and evidence of the early development of atherosclerosis in children would make identification
and treatment of hypertension an important focus of physicians caring for children.
Secondary hypertension is more common in preadolescent children, with most cases caused
by renal disease. Primary or essential hypertension is an emerging condition in adolescents
and has multiple risk factors, including obesity and a family history of hypertension.
Evaluation involves a thorough history and physical examination, laboratory tests, and
specialized studies. Lifestyle modifications are advised for all patients and can be tried solely
for those with blood pressures between the 95th and 99th percentiles. Drug therapy
is indicated in children with blood pressures greater than the 99th percentile, secondary
hypertension, coexisting diabetes, left ventricular hypertrophy, or those who fail a trial of
non pharmacologic treatment.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
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2. Hanevold C, Waller J, Daniels S, Portman R, Sorof J, International Pediatric Hypertension Association. The effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics 2004;113:328-33.
3. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogulusa Heart Study. N Engl J Med 1998;338:1650-6.
4. National High Blood Pressure Education Program Working Group. The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114 (suppl):555-76.
5. US. Preventive Services Task Force. Screening for high blood pressure: recommendations and rationale. Rockville, Md.: Agency for Healthcare Research and Quality, 2003. Accessed online February 2, 2006, at: http:// www.ahrq.gov/clinic/3rduspstf/highbloodsc /hibloodrr.htm.
6. Robinson RF, Batisky DL, Hayes JR, Nahata MC, Mahan JD. Significance of heritability in primary and secondary pediatric hypertension. Am J Hypertens 2005;18:917-21.
7. Raccomandazioni sull’ipertensione arteriosa in età pediatrica: il progetto CHILD. Linee guida Ital Heart J 2004; Suppl vol. 5.
8. Butani L, Morgesten BZ. Are pitfalls of oscillometric blood pressure measurements preventable in children? Pediatr Nephrol 2003;18:313-8.
9. Flynn JT. Evaluation and management of hypertension in childhood. Prog Pediatr Cardiol 2001;12:177-88.
10. Goodman E, Daniels SR, Morrison JA, Huang B, Dolan LM. Contrasting prevalence of and demographic disparities in the World Health Organization and National Cholesterol Education Program Adult Treatment Panel III definitions of metabolic syndrome among adolescents. J Pediatr 2004;145:445-51.
11. Bartosh SM, Aronson AJ. Childhood hypertension. An update on etiology, diagnosis, and treatment. Pediatr Clin North Am 1999; 46:235-52.
12. Enright PL, Goodwin JL, Sherrill DL, Quan JR, Quan SF. Blood pressure elevation associated with sleep-related breathing disorder in a community sample of white and Hispanic children: the Tucson Children’s Assessment of Sleep Apnea study. Arch Pediatr Adolesc Med 2003;157:901-4.
13. Zintzaras E, Kaditis AG. Sleep-disordered breathing and blood pressure in children: a meta-analysis. Arch Pediatr Adolesc Med 2007;161(2):172-8.
14. Sinaiko AR, Steinberger J, Moran A, Prineas RJ, Jacobs DR Jr. Relation of insulin resistance to blood pressure in childhood. J Hypertens 2002;20:509-17.
15. Williams CL, Hayman LL, Daniels SR, et al. Cardiovascular health promotion in the schools: a statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2002;106:143-60.
16. Simons-Morton DG, Hunsberger SA, Van Horn L, et al. Nutrient intake and blood pressure in the Dietary Intervention Study in Children. Hypertension 1997;29:930-6.
17. Kelley GA, Kelley KS, Tran ZV. The effects of exercise on resting blood pressure in children and adolescents: a meta-analysis of randomized controlled trials. Prev Cardiol 2003; 6:8-16.
18. Task Force on Blood Pressure Control in Children. Report of the Second Task Force on Blood Pressure Control in Children-1987. National Heart, Lung, and Blood Institute, Bethesda, Maryland. Pediatrics 1987;79:1-25.
19. Blumenthal S, Epps RP, Heavenrich R, et al. Report of the task force on blood pressure control in children. Pediatrics 1977;59:797- 820.
20. Wells T, Frame V, Soffer B, et al. A doubleblind, placebo-controlled, dose-response study of the effectiveness and safety of enalapril for children with hypertension. J Clin Pharmacol 2002;42:870-80.
21. Soffer B, Zhang Z, Miller K, Vogt BA, Shahinfar S. A double-blind, placebo-controlled, dose-response study of the effectiveness and safety of lisinopril for children with hypertension. Am J Hypertens 2003;16:795-800.
22. Sakarcan A, Tenney F, Wilson JT, et al. The pharmacokinetics of irbesartan in hypertensive children and adolescents. J Clin Pharmacol 2001;41:742-9.
23. Trachtman H, Frank R, Mahan JD, et al. Clinical trial of extended release felodipine in pediatric essential hypertension. Pediatr Nephrol 2003;18:548-53.
24. Sorof JM, Cargo P, Graepel J, et al. Betablocker/ thiazide combination for treatment of hypertensive children: a randomized doubleblind, placebo-controlled trial. Pediatr Nephrol 2002;17:345-50.
25. Adelman RD, Coppo R, Dillon MJ. The emergency management of severe hypertension. Pediatr Nephrol 2000;14:422-7.
26. Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet 2000;356:411-7.
27. Feldstein C. Management of hypertensive crises. Am J Ther 2007;14(2):135-9.
28. Fenves AZ, Ram CV. Drug treatment of hypertensive urgencies and emergencies. Semin Nephrol 2005;25:272-80.
29. Calvetta A, Martino S, von Vigier RO, Schmidtko J, Fossali E, Bianchetti MG. What goes up must immediately come down! Which indication for short-acting nifedipine in children with arterial hypertension? Pediatr Nephrol 2003;18:1-2.
30. Flynn JT. Safety of short-acting nifedipine in children with severe hypertension. Expert Opin Drug Saf 2003;2(2):133-9.
31. Yiu V, Orrbine E, Rosychuk RJ, et al. The safety and use of short-acting nifedipine in hospitalized hypertensive children. Pediatr Nephrol 2004;19:644-50.
2. Hanevold C, Waller J, Daniels S, Portman R, Sorof J, International Pediatric Hypertension Association. The effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics 2004;113:328-33.
3. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogulusa Heart Study. N Engl J Med 1998;338:1650-6.
4. National High Blood Pressure Education Program Working Group. The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114 (suppl):555-76.
5. US. Preventive Services Task Force. Screening for high blood pressure: recommendations and rationale. Rockville, Md.: Agency for Healthcare Research and Quality, 2003. Accessed online February 2, 2006, at: http:// www.ahrq.gov/clinic/3rduspstf/highbloodsc /hibloodrr.htm.
6. Robinson RF, Batisky DL, Hayes JR, Nahata MC, Mahan JD. Significance of heritability in primary and secondary pediatric hypertension. Am J Hypertens 2005;18:917-21.
7. Raccomandazioni sull’ipertensione arteriosa in età pediatrica: il progetto CHILD. Linee guida Ital Heart J 2004; Suppl vol. 5.
8. Butani L, Morgesten BZ. Are pitfalls of oscillometric blood pressure measurements preventable in children? Pediatr Nephrol 2003;18:313-8.
9. Flynn JT. Evaluation and management of hypertension in childhood. Prog Pediatr Cardiol 2001;12:177-88.
10. Goodman E, Daniels SR, Morrison JA, Huang B, Dolan LM. Contrasting prevalence of and demographic disparities in the World Health Organization and National Cholesterol Education Program Adult Treatment Panel III definitions of metabolic syndrome among adolescents. J Pediatr 2004;145:445-51.
11. Bartosh SM, Aronson AJ. Childhood hypertension. An update on etiology, diagnosis, and treatment. Pediatr Clin North Am 1999; 46:235-52.
12. Enright PL, Goodwin JL, Sherrill DL, Quan JR, Quan SF. Blood pressure elevation associated with sleep-related breathing disorder in a community sample of white and Hispanic children: the Tucson Children’s Assessment of Sleep Apnea study. Arch Pediatr Adolesc Med 2003;157:901-4.
13. Zintzaras E, Kaditis AG. Sleep-disordered breathing and blood pressure in children: a meta-analysis. Arch Pediatr Adolesc Med 2007;161(2):172-8.
14. Sinaiko AR, Steinberger J, Moran A, Prineas RJ, Jacobs DR Jr. Relation of insulin resistance to blood pressure in childhood. J Hypertens 2002;20:509-17.
15. Williams CL, Hayman LL, Daniels SR, et al. Cardiovascular health promotion in the schools: a statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2002;106:143-60.
16. Simons-Morton DG, Hunsberger SA, Van Horn L, et al. Nutrient intake and blood pressure in the Dietary Intervention Study in Children. Hypertension 1997;29:930-6.
17. Kelley GA, Kelley KS, Tran ZV. The effects of exercise on resting blood pressure in children and adolescents: a meta-analysis of randomized controlled trials. Prev Cardiol 2003; 6:8-16.
18. Task Force on Blood Pressure Control in Children. Report of the Second Task Force on Blood Pressure Control in Children-1987. National Heart, Lung, and Blood Institute, Bethesda, Maryland. Pediatrics 1987;79:1-25.
19. Blumenthal S, Epps RP, Heavenrich R, et al. Report of the task force on blood pressure control in children. Pediatrics 1977;59:797- 820.
20. Wells T, Frame V, Soffer B, et al. A doubleblind, placebo-controlled, dose-response study of the effectiveness and safety of enalapril for children with hypertension. J Clin Pharmacol 2002;42:870-80.
21. Soffer B, Zhang Z, Miller K, Vogt BA, Shahinfar S. A double-blind, placebo-controlled, dose-response study of the effectiveness and safety of lisinopril for children with hypertension. Am J Hypertens 2003;16:795-800.
22. Sakarcan A, Tenney F, Wilson JT, et al. The pharmacokinetics of irbesartan in hypertensive children and adolescents. J Clin Pharmacol 2001;41:742-9.
23. Trachtman H, Frank R, Mahan JD, et al. Clinical trial of extended release felodipine in pediatric essential hypertension. Pediatr Nephrol 2003;18:548-53.
24. Sorof JM, Cargo P, Graepel J, et al. Betablocker/ thiazide combination for treatment of hypertensive children: a randomized doubleblind, placebo-controlled trial. Pediatr Nephrol 2002;17:345-50.
25. Adelman RD, Coppo R, Dillon MJ. The emergency management of severe hypertension. Pediatr Nephrol 2000;14:422-7.
26. Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet 2000;356:411-7.
27. Feldstein C. Management of hypertensive crises. Am J Ther 2007;14(2):135-9.
28. Fenves AZ, Ram CV. Drug treatment of hypertensive urgencies and emergencies. Semin Nephrol 2005;25:272-80.
29. Calvetta A, Martino S, von Vigier RO, Schmidtko J, Fossali E, Bianchetti MG. What goes up must immediately come down! Which indication for short-acting nifedipine in children with arterial hypertension? Pediatr Nephrol 2003;18:1-2.
30. Flynn JT. Safety of short-acting nifedipine in children with severe hypertension. Expert Opin Drug Saf 2003;2(2):133-9.
31. Yiu V, Orrbine E, Rosychuk RJ, et al. The safety and use of short-acting nifedipine in hospitalized hypertensive children. Pediatr Nephrol 2004;19:644-50.
Corrispondenza: pennesi@burlo.trieste.it