7^th Brazilian Guideline of Arterial Hypertension: Chapter 10 – Hypertension in Children and Adolescents

Epidemiological context and importance of hypertension in pediatrics

Arterial hypertension was identified as the major source of combined mortality and morbidity, representing 7% of global disability-adjusted life years. The adoption of the BP definitions and normalization of the “National High Blood Pressure Education Program” (NHBPEP) 2004 has standardized the BP classification in the pediatric population. The percentage of children and adolescents diagnosed with AH is estimated to have doubled in the past two decades. The current prevalence of AH in the pediatric population is around 3% to 5%,^– while that of PH reaches 10% to 15%,^,,, and such values are mainly attributed to the large increase in childhood obesity. The etiology of pediatric AH can be either secondary, most often associated with nephropathies, or primary, attributed to genetic causes with environmental influence, predominating in adolescents.

Pediatric AH is usually asymptomatic, but as many as 40% of hypertensive children have LVH at the initial diagnosis of AH. Although oligosymptomatic in childhood, LVH is a precursor of arrhythmias and HF in adults. In addition, pediatric AH is associated with the development of other changes in target organs, such as increased carotid IMT, arterial compliance reduction, and retinal arteriolar narrowing. Early diagnosis and treatment of childhood AH are associated with a lower risk for AH and for increased carotid atheromatosis in adult life. Therefore, periodical BP measurements in children and adolescents are recommended, even contradicting the U.S. Preventive Services Task Force’s suggestion, which considers the evidence of benefits of primary AH screening in asymptomatic children and adolescents insufficient to prevent CVD in childhood or adulthood.

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