Abstract Ref Number = APCP103
DIAGNOSIS AND MANAJEMEN OF HYPERTENSION IN CHILDREN: AN UPDATE
M Heru Muryawan, Omega Mellyana, RochmanadjiWidajat
Pediatric Department, Faculty of Medicine Diponegoro Universitydr Kariadi Hospital Semarang
Hypertension is a global health problem that needs serious treatment. Much evidence suggests that hypertension in children increasing the incidence of adults hypertension. Hypertension also risk of short and long term target organ damage including brain, heart and kidney. Younger children are more likely to suffer from secondary hypertension, whereas the prevalence of primary hypertension is increased in school-age and adolescent children as a result of increased incidence of obesity .The prevalence of blood pressure in adults is higher than in children, with ratio prevalence of 15-19%, while in girls (7-12%). Increased incidence of persistent blood pressure, in this case prehypertension is 2.2% to 3.5% with the highest average among children and adults who have overweight and obesity. The average of hypertension in children is higher in certain chronic conditions such as obesity (3.8% to 24.8%), sleep-disorder breathing (3.6% to 14%), CKD (50%) and preterm history ( 7.3%).
According to the new definition of hypertension by American Academic of Pediatric (AAP, 2017), classification of hypertension in children are divided normotension, elevated blood pressure, and hypertension (stage I and stage II). The term elevated blood pressure is new term to change of prahypertension in clasification of hypertention by The National High Blood Pressure Education Program(NHBPEP) Working Group on High Blood Pressure Education in children and adolescents 2004. In new definition hypertension is defined as systolic (S)and diastolic blood pressure (DBP) more than 95th percentile for age, sex and height. Stage I hypertenstion is defined SBP or DBP between 95th percentile and 95th percentile +12 mmHg and tage II hypertention is SBP or DBP more than 95th percentile +12 mmHg.
The major cause of hypertension in children or adolescent are secondary hypertention including parenchymal kidney disease (60 – 70%) and renovascular disease, but hypertension in teen cause of primary or essential hypertension (85-90%).
Diagnosis of hypertention in children should be started by hystory of illness, , pysical examination and advance examination as like specific imaging according to the clinical finding. Patients with hypertention almost undetected cause of nonspecific symptoms, so all of children and adolescent more than 3-years old should be measured their blood pressure unless annually. All patients with hypertention should be screened for target organ damage including eyes (hypertensive retinopathy), , heart (left ventricular mass and diastolic dysfunction) and kidneys (proteinuria/albuminuria).
Management of hypertension in children including non-pharmacological and pharmacological treatment. The target therapy is lowered blood pressure below the 95th percentile. If comorbidity is present the target is below 90th percentile and control blood pressure between 50th percentile and 75th percentile is associated with slower decline in renal function in children with chronic kidney disease. Pharmacologic treatment ussualy start to patients with symtomatichypertention, Therapy is initiated with a single drug/medication from any of the following classes as like angiotensin converting enzim inhibitors (ACE I), Beta Blockers or calsiumchanel blocker. Diuretics are used as adjunct therapy when fluid overload is present.