Makindo Medical Notes

Hypertension in children is uncommon compared to adults, but when it occurs, it is often due to a secondary cause 🧪. Early recognition is vital because untreated hypertension in childhood can lead to long-term complications such as kidney damage, stroke, and heart disease 💔.

🔎 Causes

• 🧬 Renal: Chronic kidney disease, renal artery stenosis, polycystic kidney disease.
• 🧪 Endocrine: Hyperaldosteronism (Conn’s), phaeochromocytoma, Cushing’s syndrome, congenital adrenal hyperplasia.
• ❤️ Cardiovascular: Coarctation of the aorta, congenital heart defects.
• 🧠 Neurological: Raised intracranial pressure (tumour, trauma, hydrocephalus), autonomic dysreflexia.
• ⚖️ Obesity-related: Primary hypertension linked to obesity, insulin resistance, and metabolic syndrome.

🩺 Clinical Presentation

• ⚡ Headaches, visual disturbance, seizures (neurological involvement).
• 💧 Oedema, haematuria, flank pain (renal disease).
• 💓 Palpitations, sweating, episodic headaches (pheochromocytoma).
• 💪 Growth retardation, fatigue, poor exercise tolerance.
• 🚸 Often asymptomatic — high BP may be found incidentally during routine checks.

🧪 Investigations

• 🧾 BP in all 4 limbs (to check for coarctation).
• 🧪 Urinalysis, U&E, creatinine for renal function.
• 🖥️ Renal ultrasound, Doppler studies, CT/MRI as indicated.
• 🧬 Hormonal assays (aldosterone, renin, cortisol, catecholamines).
• 👀 Fundoscopy for papilloedema.

💊 Management

• 🎯 Treat the underlying cause (e.g., surgery for coarctation, tumour removal, renal interventions).
• 💉 Antihypertensive medications — ACE inhibitors, ARBs, beta-blockers, calcium-channel blockers.
• 🥦 Lifestyle modifications — healthy diet, weight reduction, regular exercise.
• 👨‍👩‍👧 Family education and follow-up to ensure adherence and early detection of complications.

📌 Key Clinical Pearls

• 👶 Always think of secondary hypertension in a child.
• 📈 Ambulatory BP monitoring can rule out “white coat hypertension.”
• 🩺 Children with unexplained growth delay, renal disease, or persistent headaches should have their blood pressure checked.
• 💡 Early recognition and management prevent long-term cardiovascular and renal damage.