Hypertension (partially complete...)

Toddlers

• most commonly due to intrinsic renal disease or renovascular hypertension
• the severest cases are usually due to renovascular hypertension (consider vasculitis in this ddx, renal artery stenosis, polyarteritis nodosa, fibromuscular dysplasia,)
  • Fibromuscular dysplasia: a heterogenous group of disorders defined pathologically by their site of involvement in the arterial wall; it may be a primary condition or secondary to such diseases as NF-1 or cutis laxa
• consider thoracic coarctation of aorta

Diagnosis

• renal ultrasound
• vascular imaging (renal arteries): MR angiography, CT angiography. CT-A has greater resolution.
• nuclear renogram to assess function

Management

• don't drop blood pressure too low after a child has had longstanding hypertension as the coronary perfusion pressure might drop, precipitating an MI
• if a hypertensive child has B/L renal disease, a sharp fall in BP may cause renal failure because higher pressures are needed to maintain perfusion

Pediatric Annals 34(1) Jan 2005