1 / 23

Good Morning Everyone!

Good Morning Everyone!. Monday, July 25 th , 2011. Hypertension in Childhood. Diagnostic Evaluation COST Confirm the diagnosis Organize a diagnostic approach Determine the Severity of the HTN Treat the HTN effectively. Confirm the Diagnosis.

jasper
Download Presentation

Good Morning Everyone!

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Good Morning Everyone! Monday, July 25th, 2011

  2. Hypertension in Childhood • Diagnostic Evaluation • COST • Confirm the diagnosis • Organize a diagnostic approach • Determine the Severity of the HTN • Treat the HTN effectively

  3. Confirm the Diagnosis • Suspect when the BP reading is high for the height, age, and sex of the child • Confirmed when a high reading is obtained at three or more separate office visits about 1 week apart

  4. Confirm the Diagnosis • Ensure proper BP cuff size • Bladder should encircle the arm by at least 80%

  5. *

  6. Organize a Diagnostic Approach • MONSTER • Medications • Obesity • Neonatal history • Symptoms or signs • Trends in the family • Endocrine or renal

  7. **Remember, amphetamines, corticosteroids, contraceptives, cyclosporine, OTC allergy and cold medicine and licorice can cause HTN

  8. BMI > 95% • 3 to 5 times more likely to have hypertension • Can have obstructive sleep apnea syndrome (OSAS) • Causes significantly higher diastolic BPs

  9. Organize a Diagnostic Approach • Evaluation is guided by history and physical • Biochemical and imaging studies are used to address three primary organ systems: endocrine, renal, and cardiovascular

  10. Suggested Eval for Children with HTN

  11. Uric Acid • High uric acid is associated with high BP readings in childhood that may persist into adulthood (Bogalusa Heart Study) • Strong relationship between uric acid and essential HTN (found in 89%, but only 30% with secondary HTN, none with white-coat HTN)

  12. Determine the Severity • Combo of magnitude of BP elevation and presence of LVH on echo are proof of sustained HTN • Cardiac hypertrophy is major indication for therapy • Finding of LVH suggests risk for future CV disease

  13. Treatment* • Nonpharmacologic treatment • Lifestyle modifications or environmental changes must be implemented or at least attempted! • Reducing sodium intake • Physical activity • If significant essential or severe HTN, avoid weight lifting, body building, and strength training • Restriction based on the possibility of catastrophic event

  14. Treatment • Goal is normalization or near-normalization of BP based on age, sex, and height using a drug regimen that causes minimal adverse effects • Consider starting with one drug and maximizing dose before adding a second agent

  15. Treatment • First-line • ACE inhibitors (ex: Captopril, Enalpril) • SE = renal impairment, hyperkalemia, neutropenia, anemia, dry cough, angioedema • Angiotensin receptor blockers • SE = renal impairment, hyperkalemia, neutropenia, anemia • Calcium channel blockers (ex: Nifedipine, Isradipine) • SE = peripheral edema, dizziness, nausea, headache, flushing, weakness

  16. Treatment • Second-line therapy • Beta-blockers • Central alpha agonists (Clonidine) • Vasodilators (Hydralazine, Minoxidil) • Diuretics

  17. QUIZ Answers • 1. • E. Schedule 2 subsequent visits to measure BP • 2. • A. Echocardiography • 3. • B. Hyperkalemia • 4. • D. Perform renal ultrasonography

  18. Have a great day! Noon conference is Inpatient ID with Dr. Begue

More Related