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Investigation of Pediatric Hypertension: Use of a Tailored Protocol

Investigation of Pediatric Hypertension: Use of a Tailored Protocol Abstract • Using a comprehensive protocol, the efficacy of simple clinical data, including history, physical examination, and urinalysis, In the discrimination of essential or secondary hypertension was investigated by a review of 103 patients, aged 2 weeks to 18 years, consecutively referred for investigation. Essential hypertension (55/103 mm Hg) was the most common diagnosis, even in infancy, whereas various renal disorders formed the next most common diagnostic category (21/103 mm Hg). Family history and the presence of "fixed" vs "labile" hypertension were of no value in detecting secondary hypertension. Urinalysis was useful in detecting inflammatory renal lesions but not structural disorders of the kidney. This study emphasizes the need for thorough investigation, including renal imaging, of asymptomatic hypertensive children and suggests a useful protocol to achieve this end. (AJDC 1987;141:1205-1209) References 1. Loggie JMM, Horan MJ, Hohn AR, et a[ill] Juvenile hypertension: Highlights of a worksho[ill] J Pediatr 1984;104:657-663.Crossref 2. Veterans Administration Cooperative Study Group on Antihypertensive Agents: Effacts of treatment on morbidity in hypertension: II. Results in patients with diastolic blood pressures averaging 90 through 114 mm Hg . JAMA 1970;213:1143-1152.Crossref 3. Gordon T, Kannel WB: The Framingham Study , section 30, US Dept of Health, Education, and Welfare publication 74-599, 1974. 4. Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the hypertension detection and follow-up program: II. Mortality by race, sex and age . JAMA 1979;242:2572-2577.Crossref 5. Benfari RC, Sherwin R: The multiple risk factor intervention trial after four years: A summing-up . Prev Med 1981;10:544-546.Crossref 6. Lloyd-Still J, Cotton DG: Severe hypertension in childhood . Arch Dis Child 1967;42:34-39.Crossref 7. Rocchini AP: Childhood hypertension . Pediatr Clin North Am 1984;31:1259-1274. 8. Menster M: Diagnosis and treatment of hypertension in children . Pediatr Clin North Am 1982;29:933-945. 9. Johnston CI: Blood pressure in children . Med J Aust 1984;141:4-5. 10. Report of the Task Force on Blood Pressure Control in Children . Pediatrics 1977;59( (suppl) ): 797-820. 11. Umari M: Changes in blood pressure in the first year of life . Acta Paediatr Scand 1980;69: 613-617.Crossref 12. Schacter J, Kuller LH, Perfetti C: Blood pressure in the first two years of life . Am J Epidemiol 1981;116:29-41. 13. Hernandez A, Goloring D, Hartman AF: Measurement of blood pressure in infants and children by the Doppler ultrasonic technique . Pediatrics 1971;48:788-794. 14. Task Force on Blood Pressure Control in Children: Report of the second task force on blood pressure control in children . Pediatrics 1987;79:1-25. 15. Becker R: Hypertension and arteriosclerosis , in Duane TD (ed): Clinical Ophthalmology . New York, Harper & Row Publishers Inc, 1985, vol 3, pp 1-2. 16. Fiselier TJW, Lijtnen P, Monnens L, et al: Levels of renin, angiotensin I, angiotensin II, angiotensin-converting enzyme and allosterone in infancy and childhood . Eur J Pediatr 1983;141: 3-7.Crossref 17. Thind GS: Role of venous vein renins in the diagnosis and management of renovascular hypertension . J Urol 1985;134:2-5. 18. Chobanian AV: Antihypertensive therapy in evolution . N Engl J Med 1986;314:1701-1702.Crossref 19. Prineas RJ, Gillum RF, Horibe M, et al: The Minneapolis children's blood pressure study . Hypertension 1980;2( (suppl) ):I24-I28.Crossref 20. Voors AW, Foster TA, Frericms RR, et al: Studies of blood pressure in children, ages 5-14 years, in a total biracial community: The Bogalusa Heart Study . Circulation 1976;54:319-327.Crossref 21. Ready T: Anthropology and the study of chronic disease: Adolescent blood pressure in Corpus Christi, Texas . Soc Sci Med 1985;21: 443-450.Crossref 22. Gruenewald SM, Collins LT: Renovascular hypertension: Quantitative renography as a screening test . Radiology 1983;149:287-291.Crossref 23. Havey RJ, Krumlovsky F, DelGreco F, et al: Screening for renovascular hypertension: Is digital subtraction angiography the preferred test? JAMA 1985;254:388-393.Crossref 24. Rosen PR, Treves S, Ingelfinger J: Hypertension in children: Increased efficacy of technetium Tc-99m succimer in screening for renal disease . AJDC 1985;139:173-177. 25. Stibolt TB Jr, Bacher JD, Dunnick NR, et al: Use of functional maps in renal scintigraphy to detect segmental arterial lesions . J Nucl Med 1982;23:291-295. 26. Dubbins PA: Renal artery stenosis: Duplex Doppler evaluation . Br J Radiol 1986;59:225-229.Crossref 27. Watt G: Design and interpretation of studies comparing individuals with and without a family history of high blood pressure . J Hypertens 1986;4:1-7.Crossref 28. Gifford RW, Bravo EL, Manger WM: Diagnosis and management of pheochromocytoma . Cardiology 1985;72:126-130.Crossref 29. Chrousos GP, Vingerhoeds A, Brandon D, et al: Primary cortisol resistance in man: A glucocorticoid receptor–mediated disease . J Clin Invest 1982;69:1261-1269.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Investigation of Pediatric Hypertension: Use of a Tailored Protocol

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1987.04460110075026
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Abstract

Abstract • Using a comprehensive protocol, the efficacy of simple clinical data, including history, physical examination, and urinalysis, In the discrimination of essential or secondary hypertension was investigated by a review of 103 patients, aged 2 weeks to 18 years, consecutively referred for investigation. Essential hypertension (55/103 mm Hg) was the most common diagnosis, even in infancy, whereas various renal disorders formed the next most common diagnostic category (21/103 mm Hg). Family history and the presence of "fixed" vs "labile" hypertension were of no value in detecting secondary hypertension. Urinalysis was useful in detecting inflammatory renal lesions but not structural disorders of the kidney. This study emphasizes the need for thorough investigation, including renal imaging, of asymptomatic hypertensive children and suggests a useful protocol to achieve this end. (AJDC 1987;141:1205-1209) References 1. Loggie JMM, Horan MJ, Hohn AR, et a[ill] Juvenile hypertension: Highlights of a worksho[ill] J Pediatr 1984;104:657-663.Crossref 2. Veterans Administration Cooperative Study Group on Antihypertensive Agents: Effacts of treatment on morbidity in hypertension: II. Results in patients with diastolic blood pressures averaging 90 through 114 mm Hg . JAMA 1970;213:1143-1152.Crossref 3. Gordon T, Kannel WB: The Framingham Study , section 30, US Dept of Health, Education, and Welfare publication 74-599, 1974. 4. Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the hypertension detection and follow-up program: II. Mortality by race, sex and age . JAMA 1979;242:2572-2577.Crossref 5. Benfari RC, Sherwin R: The multiple risk factor intervention trial after four years: A summing-up . Prev Med 1981;10:544-546.Crossref 6. Lloyd-Still J, Cotton DG: Severe hypertension in childhood . Arch Dis Child 1967;42:34-39.Crossref 7. Rocchini AP: Childhood hypertension . Pediatr Clin North Am 1984;31:1259-1274. 8. Menster M: Diagnosis and treatment of hypertension in children . Pediatr Clin North Am 1982;29:933-945. 9. Johnston CI: Blood pressure in children . Med J Aust 1984;141:4-5. 10. Report of the Task Force on Blood Pressure Control in Children . Pediatrics 1977;59( (suppl) ): 797-820. 11. Umari M: Changes in blood pressure in the first year of life . Acta Paediatr Scand 1980;69: 613-617.Crossref 12. Schacter J, Kuller LH, Perfetti C: Blood pressure in the first two years of life . Am J Epidemiol 1981;116:29-41. 13. Hernandez A, Goloring D, Hartman AF: Measurement of blood pressure in infants and children by the Doppler ultrasonic technique . Pediatrics 1971;48:788-794. 14. Task Force on Blood Pressure Control in Children: Report of the second task force on blood pressure control in children . Pediatrics 1987;79:1-25. 15. Becker R: Hypertension and arteriosclerosis , in Duane TD (ed): Clinical Ophthalmology . New York, Harper & Row Publishers Inc, 1985, vol 3, pp 1-2. 16. Fiselier TJW, Lijtnen P, Monnens L, et al: Levels of renin, angiotensin I, angiotensin II, angiotensin-converting enzyme and allosterone in infancy and childhood . Eur J Pediatr 1983;141: 3-7.Crossref 17. Thind GS: Role of venous vein renins in the diagnosis and management of renovascular hypertension . J Urol 1985;134:2-5. 18. Chobanian AV: Antihypertensive therapy in evolution . N Engl J Med 1986;314:1701-1702.Crossref 19. Prineas RJ, Gillum RF, Horibe M, et al: The Minneapolis children's blood pressure study . Hypertension 1980;2( (suppl) ):I24-I28.Crossref 20. Voors AW, Foster TA, Frericms RR, et al: Studies of blood pressure in children, ages 5-14 years, in a total biracial community: The Bogalusa Heart Study . Circulation 1976;54:319-327.Crossref 21. Ready T: Anthropology and the study of chronic disease: Adolescent blood pressure in Corpus Christi, Texas . Soc Sci Med 1985;21: 443-450.Crossref 22. Gruenewald SM, Collins LT: Renovascular hypertension: Quantitative renography as a screening test . Radiology 1983;149:287-291.Crossref 23. Havey RJ, Krumlovsky F, DelGreco F, et al: Screening for renovascular hypertension: Is digital subtraction angiography the preferred test? JAMA 1985;254:388-393.Crossref 24. Rosen PR, Treves S, Ingelfinger J: Hypertension in children: Increased efficacy of technetium Tc-99m succimer in screening for renal disease . AJDC 1985;139:173-177. 25. Stibolt TB Jr, Bacher JD, Dunnick NR, et al: Use of functional maps in renal scintigraphy to detect segmental arterial lesions . J Nucl Med 1982;23:291-295. 26. Dubbins PA: Renal artery stenosis: Duplex Doppler evaluation . Br J Radiol 1986;59:225-229.Crossref 27. Watt G: Design and interpretation of studies comparing individuals with and without a family history of high blood pressure . J Hypertens 1986;4:1-7.Crossref 28. Gifford RW, Bravo EL, Manger WM: Diagnosis and management of pheochromocytoma . Cardiology 1985;72:126-130.Crossref 29. Chrousos GP, Vingerhoeds A, Brandon D, et al: Primary cortisol resistance in man: A glucocorticoid receptor–mediated disease . J Clin Invest 1982;69:1261-1269.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Nov 1, 1987

References