Symptomatic hypertension in children is usually secondary and of renal origin. Most often, this is due to renal parenchymal disease. Coarctation of the aorta is another important cause in children. Other causes are rare (Box 18.13).
Box 18.13 Causes of hypertension
Renin-dependent
• Renal parenchymal disease
• Renovascular, e.g. renal artery stenosis
• Renal tumours
Coarctation of the aorta
Catecholamine excess
• Phaeochromocytoma
• Neuroblastoma
Endocrine causes
• Congenital adrenal hyperplasia
• Cushing's syndrome or corticosteroid therapy
Essential hypertension
Presentation includes vomiting, headaches, facial palsy, hypertensive retinopathy, convulsions or proteinuria. Failure to thrive and cardiac failure are the most common features in infants. Phaeochromocytoma may cause paroxysmal palpitations and sweating.
Some causes are correctable, e.g. nephrectomy for unilateral scarring, angioplasty for renal artery stenosis, surgical repair of coarctation of the aorta, resection of a phaeochromocytoma, but in most cases medical treatment is necessary with antihypertensive drugs.
Early detection of hypertension is important. Any child with a renal abnormality should have their blood pressure checked annually throughout life. Children with a family history of essential hypertension should be encouraged to restrict their salt intake, avoid obesity and have their blood pressure checked regularly.
