Hypertension in children vevey february 2010

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short review of HTN management, in the light of two cases

Transcript of Hypertension in children vevey february 2010

  • 1. Hypertension in children F. Cachat Pediatrics and Pediatric Nephrology Vevey and Lausanne Switzerland

2. Disease prevalencein childhood

  • Congenital heart disease 1%
  • Epilepsy 3-5%
  • ADHD 3-5%
  • Hypertension 4-5%
  • Asthma 7%
  • Obesity 18-25%

3. HTN is a major killer in adulthood Some HTN originates in childhood Many children with HTN during infancy will still have HTN as adults (blood pressure tracking) 4. PLAN

  • Definition
  • Case presentation
  • Physiology of hypertension in children(some aspects)
  • Evaluation of the child with hypertension(some aspects)
  • Management of the child with hypertension(some aspects)
  • Conclusion

5. Definitions 6.

  • Update on the 1996 and 1987 Task Force Report on High Blood Pressure in Children and Adolescents:
    • 60000 healthy children
    • M/F: 50/50
    • White: 56%, African-American: 29%, Spanish: 9%, Asian: 3%, Others: 3%

Definitions 7. Definitions 8. Classification of Hypertension in Children andAdolescents SBP or DBP Percentile Normal P99referral diet yes + 5 mmHg physical activity 64. Pharmacologic management

  • Pharmacological approach will allow to control:
    • hormonal aspect of BP ( IEC or ARBs )
    • Vascular reactivity (arterial and venous) ( calcium channel blockers or peripheral -blockers )
    • Cardiac output ( -blockers )
    • SNC sympathetic activity ( central -agonists )

65. 66. Why to treat, does it make a difference?

  • Outcome difficult to assess in children:
      • Rare complications during childhood
      • Classic complications (stroke, heart failure, blindness) occur (very) late
      • Notable exception of children with CKD and HTN:

67. Mortality in children with CKD Death rate per 100,000 0 10 100 1000 10000 0-14 15-19 20-30 Age (years) Adapted from Parekh et al, J Pediatr, 2002 Dialysis Transplant General Population

  • Black
  • White

68. CrCl < 75ml/min/1.73m 2 HTN: >95 th % (Task Force) Normotensive: n=1987 (52%) Hypertensive: n=1874 (48%) Endpoint: CrCl by 10 ml/min/1.73m 2 Renal replacement therapy P