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Hypertension In Children

Arterial blood pressure above the 95th percentile with reference to age and sex Q.


Essential hypertension is uncommon in children (5-10%)


The Fourth US Task Force Report on Hypertension in children and adolescents and the Indian Society of Pedi­atric Nephrology recommend that hypertension be diag­nosed and staged as follows:


Pre-hypertension: Systolic or diastolic blood pressure 90th-95th percentile
Hypertension: Systolic or diastolic blood pressure >95th percentile
Stage I hypertension: Systolic or diastolic blood pressure between 95th percentile & 99th percentile +5 mm Hg
Stage II hypertension: Systolic or diastolic blood pressure > 99th percentile + 5 mm Hg

Table : Blood pressure measurement (auscultatory method, mm Hg)


Systolic pressure

Diastolic pressure

1-3 months

75 ± 5

50 ± 5

4 – 12 months

84 ± 5

65 ± 5

1-8 years

95 ± 5

65 ± 5

9-14 years

105 ± 5

65 ± 5


Most common cause is due to RENAL CAUSES (78%) *

  • Chronic glomerulonephritis
  • Chronic pyelonephritis
  • BP should be obtained in both arms and at least one leg.
  • Higher BP in arm compared to legs occurs in coarctation and obstructive aortitis
  • If the BP is not recordable in arms but elevated in legs. the diagnosis is obstructive aorto-arteritis
  • Renal artery stenosis and obstructive aorto-arteritis results in abdominal bruit
  • Wt loss, headache, palpitation flushing, sweating and postural hypotension indicate the possibility of pheochromocytoma

INV - Plasma rennin activity is a useful screening test. Increased level suggest renal etiology Q

Table: Causes of persistent hypertension


Intrinsic renal diseases

  1. Chronic glomerulonephritis        
  2. Reflux nephropathy
  3. Obstructive uropathy                  
  4. Congenital lesions (dysplastic, hypoplastic, polycystic kidneys)  


  1. Idiopathic (Takayasu) aortoarteritis      
  2. Renal artery stenosis

Essential hypertension


Coarctation of aorta



  1. Pheochromocytoma, Cushing disease
  2. Liddle syndrome, syndrome of mineralocorticoid excess, glucocorticoid remediable aldosteronism, congenital adrenal hyperplasia, neuroblastoma, primary hyperaldosteronism

Renal tllmors

  1. Wilm's tumor, nephroblastoma

Table : Causes of transient hypertension



Acute post streptococcal GN: Most common Q

Hemolytic uremic syndrome

Renal trauma

Henoch Schönlein purpura

Postrenal transplant

Renal vein thrombosis

Landry Guillain Barre syndrome


Corticosteroids, contraceptives intake


Familial dysautonomia

Acute intermittent porphyria

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