1. Hypertension Dr.Emamzadegan Pediatric Cardiologist

2. Hypertension 1.Risk factor for MI,Stroke & RF. 2.Prevalence in infants & young children: < 1% 3.In infancy & young children : secondary 4.In adolescents: Essential (primary) 5. blood pressure measurement: Routine annual physical examination of all children 3 yr or older.

3. Hypertension 6. Cuff: at least 2/3 of the upper arm length and 80-100% of its circumference. 7. Narrow cuff : increased BP 8. Wide cuff : decreased BP 9. Doppler : extremely accurate method of measuring systolic blood pressure. 10. HTN: consistently above the 95th percentile for age.

4. Hypertension 11.PATH0PHYSI0L0GY:BP is the product of cardiac output and peripheral vascular resistance. 12. secondary hypertension: is the result of another disease process. 13. essential hypertension: no identifiable cause can be found.(heredity, diet, stress, and obesity) 14. Renal and renovascular hypertension: accounts for the majority of children with secondary hypertension.

5. Hypertension 15.Chronic HTN….. P:1990 16. CLINICAL MANIFESTATIONS: Children and adolescents with essential hypertension are usually asymptomatic; the blood pressure elevation is usually mild and is detected during a routine examination or evaluation before athletic participation. These children may have mild to moderate obesity.

6. CLINICAL MANIFESTATIONS Children with secondary hypertension can have blood pressure elevations ranging from mild to severe. Unless the pressure has been sustained or is rising rapidly, hypertension does not usually produce symptoms. (clinical manifestations of the underlying disease, such as growth failure in children with chronic renal disease).

7. Hypertensive encephalopathy vomiting, temperature elevation, ataxia, stupor, seizures

8. CLINICAL MANIFESTATIONS Young children and infants with unexplained heart failure or seizures should have their blood pressure measured.

9. Diagnosis 1.Essential HTN: Age(> 10 y/o); level of BP (mild); weight; FH; no underlying disease; no rising in BP during F/U. 2.Secondary HTN: Age; intermittent fever, FTT, sign,symptom

10. Screening tests CBC; U/A;U/C; Na,K,Ca,BS,BUN,Creat; Uric Acid; TG, Cholesterol(LDL,HDL); Plasma Renin;Echocardiography (chronic); Doppler sonography; Angio; Radionuclide kidney scan; P:1993,1994

11. Treatment Emergency: Adalat; Labetalol; nitroprusside; esmolol Most children with hypertensive crisis have chronic or acute renal disease; in these patients, management of blood pressure also requires careful attention to fluid balance, as well as diuresis. Intravenous furosemide is usually effective, even though glomerular filtration may be impaired.

12. Treatment ACE inhibitors are useful, not only in patients with high-renin hypertension that is secondary to renovascular or renal parenchymal disease but also in patients with high-renin essential hypertension.

13. Treatment Essential HTN: Beta blocker or diuretic ( serum lipid ↑) if not controlled: calcium channel blocker may be added to diuretic; ACE inhibitor may replace the Beta blocker.

14. Heart Failure Heart cannot deliver adequate cardiac output to meet the metabolic needs of the body.

15. CLINICAL MANIFESTATIONS Fatigue; effort intolerance; dyspnea; abdominal pain; anorexia; cough; orthopnea; cardiomegaly; gallop rhythm; holosystolic MM of MR & TR; Infants: Tachypnea; feeding difficulties; perspiration; FTT; weak cry; irritability; respiratory symptoms (wheezing); Edema may be generalized and usually involves the eyelids as well as the sacrum.

16. Etiology P:1978(nelson 2011)

17. Treatment Preload; Afterload; Contractility P:1979,1982