Paediatrics: Hypertension - causes and features
High body mass index, excessive salt intake, lack of exercise, and family history may be underlying predisposing factors.
Hypertension: causes and features
Causes of hypertension
Primary (essential) hypertension
This is a diagnosis of exclusion. High body mass index, excessive salt intake, lack of exercise, and family history may be underlying predisposing factors
- Renal (commonest cause in-hospital referral practice):
o chronic renal parenchymal disease (reflux/scarring)
o polycystic kidney disease
o obstructive uropathy
o acute nephritis
o chronic renal failure
o umbilical arterial/venous catheters
o renal artery stenosis
o renal vein thrombosis
o coarctation of the aorta
o congenital adrenal hyperplasia
o increased steroids (iatrogenic or endogenous)
o phaeochromocytoma (BP intermittently raised)
o 2° to pain
o raised intracranial hypertension
o oral contraceptive pill
o calcineurin inhibitors; decongestants
o amphetamines; cocaine
Most are asymptomatic.
- Failure to thrive (rare).
- Congestive cardiac failure/respiratory distress (in newborns).
- Headache/nausea and vomiting.
- Visual symptoms.
- Bell’s palsy.
- Growth failure.
- Altered consciousness.
- Check fundi.
- Feel abdomen for abdominal masses.
- Listen for renal bruits.
- Feel femoral pulses and compare to radial/brachial pulses (to exclude
- coarctation) and check BP in all 4 limbs.
- Examination of the heart.
As the cause is more likely with severe hypertension. Treatment and investigations may need to proceed together.
- urinalysis, microscopy, and culture;
- vanillylmandelic acid (VMA): creatinine ratio;
- steroid profile and toxicology.
- Blood tests:
- U&E and creatinine;
- Bicarbonate, calcium, phosphate, albumin;
- Plasma renin and aldosterone.
- CXR and ECG.
- The US of urinary tract + Doppler if renal artery stenosis suspected.
- Further imaging will depend upon suspected cause and ultrasound
- findings, e.g. DMSA, CT scan, arteriogram.
- Specialized tests, e.g. for phaeochromocytoma.