Essential hypertension vs. secondary hypertension among children.
BACKGROUND The aim was to determine the proportions and correlates of essential hypertension among children in a tertiary pediatric hypertension clinic. METHODS We evaluated 423 consecutive children and collected demographic and clinical history by retrospective chart review. RESULTS We identified 275 (65% hypertensive children (blood pressure >95th percentile per the "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents" from 423 children referred to the clinic for history of elevated blood pressure. The remainder of the patients had normotension (11% white coat hypertension (11% prehypertension (10% and pending diagnosis (3% Among the 275 hypertensive children, 43% (n 119; boys 56% median age 12 years; range 3 17 years) had essential hypertension and 57% (n 156; boys 66% median age 9 years; range 0.08 19 years) had secondary hypertension. When compared with those with secondary hypertension, those with essential hypertension had a significantly older age at diagnosis (P 0.0002) stronger family history of hypertension (94% vs. 68% P 0.0001) and lower prevalence of preterm birth (20% vs. 46% P 0.001) There was a bimodal distribution of age of diagnosis in those with secondary hypertension. CONCLUSIONS The phenotype of essential hypertension can present as early as 3 years of age and is the predominant form of hypertension in children after age of 6 years. Among children with hypertension, those with essential hypertension present at an older age, have a stronger family history of hypertension, and have lower prevalence of preterm birth.
American journal of hypertension