Paediatrics: Hypertension: definition

2021-04-15 02:56 PM

Normal: systolic and diastolic <90th centile.

Hypertension: definition

Defined by reference to sex, height centile charts (see Fig. 11.1).

  • Normal: systolic and diastolic <90th centile.
  •  High normal: systolic or diastolic between 90th and 95th centile.
  • Hypertension: systolic or diastolic >95th centile.
  • Severe hypertension: systolic or diastolic >99th centile.

 BP measurement should be part of a routine examination.

Measurement technique

  • Cuff size.
  • bladder width—70% of acromion olecranon distance or 40%

o mid-arm circumference;

bladder length—should completely encircle arm.

Note: small cuff area is a common cause of false-positive high BP!

  • After 5min rest (ideally!).
  • A sitting position with the arm at the level of the heart (children).
  • Supine position in infants.
  • On auscultation: 1st and 5th (disappearance) Korotkoff sounds used for systolic and diastolic values, respectively.

Measurement devices

  • Manual oscillometric sphygmomanometer (mercury is now withdrawn).
  • Doppler: infants (for systolic pressure).
  • Automatic oscillometry: not all devices suitable.
  • Ambulatory blood pressure monitoring (ABPM) for 24-hr profiles:

o little normative data in paediatrics;

o significant hypertension ≥30% readings above 95th centile.

  • Intra-arterial (in intensive therapy unit (ITU) setting).