In infants and young children, hypertension is a common disease with a prevalence below 1%, but when present, often reflects an underlying disease (secondary hypertension). In children, severe hypertension and symptomatic is usually secondary. In contrast, the prevalence of essential hypertension or primary (no known cause), mainly in children and adolescents has increased in parallel with the obesity epidemic.

 

In adults, essential hypertension accounts for 90% to 95% of cases. For this and because it is often asymptomatic, this disease is also recognized as "The Silent Murderer."

 

Hypertension in children and adolescents was defined in the Fourth Report of the American National Institute of Health in 2004 as the average elevation sustained systolic blood pressure (maximum) and / or diastolic blood pressure (minimum) greater than or equal to 95 percent for age, sex and height of them, taken at least three times. If the average values of blood pressure are demarcated between greater than or equal to percentile 90 and lower 95 percentile are diagnosed with pre-hypertension.

 

In the U.S., approximately 10% of children have pre-hypertension and 4% had hypertension. The influence of obesity to raise blood pressure is evident in children between 2 to 5 years. Approximately 20% of young Americans are obese and over 10% had hypertension.

 

This disease can be asymptomatic, but in children may be associated with cardiac causes, renal tumors, vascular, etc. Symptoms and signs, when present range from failure of growth to headache, dizziness, nasal bleeding, loss of appetite, visual changes, seizures and other neurological signs.

 

We know that hypertension in the adult with cardiovascular complications, it usually occurs in childhood, but 40% of hypertensive children show growth of left heart (left ventricular hypertrophy) clearly defined by echocardiography and also the inner and middle layers of the carotid arteries thicken defining Early Atherosclerosis.

 

The primary or essential hypertension in childhood often extends into adulthood. It has been determined that children with a pressure greater than 90 percent are 2.4 times more likely to be hypertensive as adults. Also in other studies, about 50% of adults with hypertension had a blood pressure greater than 90 percent during his childhood. In addition there is an association between childhood hypertension and early atherosclerosis in young adults.

 

For all these reasons, the rise of the primary or essential hypertension in pediatrics in turn causes a rise in the epidemic of cardiovascular morbidity and mortality, which is the leading cause of mortality in North America.

 

Diagnosis depends on: a-The inclusion in Pediatrics, formal and mandatory, measurement of blood pressure throughout childhood physical exam. They met all the factors of rigor to the values obtained are accurate. This has been amply corroborated internationally. b-Recognize risk factors such as prematurity, congenital heart disease, kidney disease, cancer, organ transplants, certain prescription drugs and family history as hyperlipidemia, hypertension and / or cardiovascular disease.

 

When in doubt in the diagnosis, monitoring continuous ambulatory blood pressure, plays a major role, since the child has a device that takes the pressure every 20 to 30 minutes for 24 hours, during their periods of activity and sleep. With this property is set with the diagnosis.

 

Prevention of this disease is imposed not only for adults but also in Pediatrics. The lifestyle change is essential. Weight loss is a basic factor, without affecting the essential requirements for growth and bone mineralization. It is important to recommend fresh fruits, vegetables, fiber, grains, dairy products with reduced fat and reduced their overall sodium. Likewise, regular physical activity is paramount.

 

If necessary to control blood pressure, turn to drugs. Diuretics are used that force the amount of urine produced and drugs that act directly to maintain normal pressure. Is preferred Always trying to control with a single drug.

 

Finally and in summary, hypertension can be a silent murderer that begins in childhood, even though we know that we are always Pediatrics forced to discard a cause or disease explaining their presence.