System Hypertension: How will it be investigated?

Investigating SYSTEMIC HYPERTENSION in Children

Confirmation:

§  24-hour Ambulatory Blood Pressure Monitoring (ABPM).

§  Calculate mean daytime BP, and sleep BP over 24 hr.

§  ABPM is useful in the evaluation for:

-        White coat hypertension

-        Risk of hypertensive target organ damage

-        Response to pharmacologic therapy 

Workup for secondary causes:

1. Renal

§  Urine analysis, urine culture, renal function tests.

§  Abdominal ultrasound.

§  Renal Doppler.

§  If blood pressure is not controlled on ≥2 anti-hypertensive drugs, then do pre and post captopril renal scintigraphy and/or CT or MRI angiography

§  If strong suspicion of renovascular hypertension, then perform digital subtraction angiography and/or selective renal vein rennin level

2. Cardiac

§  Chest X-ray

§  Echocardiography (For a cause or effect of hypertension)

3. Endocrinal

§  Electrolytes (potassium & sodium).

§  Night time blood or salivary cortisol level which will be increased in Cushing.

4. Tumors

§  24-hour urine vallynile mandilic acid (VMA); (metabolite of catecholamines) in pheochromocytoma and Neuroblastoma and Abdominal ultrasound, CT, MRI.