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Hypertension in Children

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2. Loss of CD31 receptor in CD4+ and CD8+ T-cell subsets in children with primary hypertension is associated with hypertension severity and hypertensive target organ damage. (PubMed)

Loss of CD31 receptor in CD4+ and CD8+ T-cell subsets in children with primary hypertension is associated with hypertension severity and hypertensive target organ damage. Primary hypertension is associated with still poorly known T-cell dependent immunity defects that participate in the disease development. However, the relationship between peripheral T-cell subset distribution and disease severity in humans is not known. The aim of the study was to find out if target organ damage (...) in adolescents with primary hypertension is associated with thymus-dependent lymphocytes renewal reflected by changes in the T-cell subset phenotype characteristics.Using seven-color flow cytometry technique, we assessed CD31, CCR7 and CD28 receptors expression in CD45RA and CD45RO bearing peripheral CD4 and CD8 T-cell subsets. The study included 32 hypertensive children/adolescents and 35 sex-matched and age-matched controls.Children with primary hypertension had slightly increased CD4 T-cell pool

2018 Journal of Hypertension

3. Hypertension Canada's 2018 guidelines for the management of hypertension in pregnancy

. Heterogeneity in types of HDP included might differentially affect clinical outcomes: a. Variable severity of disease (ranging from GHTN to severe preeclampsia) b. Represent different underlying pathophysiology 3. Clinical outcomes not cardiovascular events or mortality a. Use of surrogate outcomes 4. Small sample sizes 5. Short duration of follow-up (hours to months) GHTN, gestational hypertension; HDP, hypertensive disorders of pregnancy. prevention, and treatment of hypertension in adults and children (...) Hypertension Canada's 2018 guidelines for the management of hypertension in pregnancy Guidelines Hypertension Canada’s 2018 Guidelines for the Management of Hypertension in Pregnancy Sonia Butalia, BSc, MD, MSc, a,b,c Francois Audibert, MD, MSc, d Anne-Marie Côt e, MD, MHSc, e Tabassum Firoz, MD, MSc, f Alexander G. Logan, MD, g Laura A. Magee, MD, MSc, h,i William Mundle, MD, j Evelyne Rey, MD, MSc, k Doreen M. Rabi, MD, MSc, a,b,c Stella S. Daskalopoulou, MD, PhD, l and Kara A. Nerenberg, MD

2018 CPG Infobase

4. Differences in prevalence of prehypertension and hypertension in children and adolescents in the eastern, central and western regions of China from 1991-2011 and the associated risk factors. (PubMed)

Differences in prevalence of prehypertension and hypertension in children and adolescents in the eastern, central and western regions of China from 1991-2011 and the associated risk factors. The present study aimed to estimate the differences in rates of prehypertension and hypertension in children and adolescents among three regions with different socioeconomic status in China, and explore the corresponding risk factors associated with prehypertension and hypertension to guide the prevention (...) . Blood pressure measurements of 13 762 children and adolescents aged 6-17 years were obtained from a prospective national survey (the China Health and Nutrition Survey, 1991-2011). Prehypertension and hypertension were defined by age and gender, according to China's standard criteria. Chi-square tests were used to compare the differences in the prevalence of prehypertension and hypertension among three regions. Trend chi-square tests were used to detect the trends in rates of prehypertension

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2019 PLoS ONE

5. Comparison of echocardiographic changes in children with primary hypertension and hypertension due to mild to moderate chronic kidney disease. (PubMed)

Comparison of echocardiographic changes in children with primary hypertension and hypertension due to mild to moderate chronic kidney disease. Chronic systemic hypertension has a well-known association with increased cardiovascular morbidity and mortality. One of the most important target organs affected in systemic hypertension is the heart. In addition, chronic kidney disease (CKD) further increases the mortality from cardiovascular disease. The aim of this study was to evaluate (...) the differences in the cardiovascular changes in pediatric patients with primary hypertension (pHTN) vs. those with secondary hypertension from chronic kidney disease (CKD-HTN).This was a retrospective chart review of patients with CKD-HTN and pHTN. The medical records were reviewed for anthropometric data, biochemical assessment of renal function, and for cardiovascular changes on echocardiogram.Twenty-three patients with pHTN and 29 patients with CKD-HTN were included in the study. There were no differences

2018 Pediatric Nephrology

6. Inhaled nitric oxide for the postoperative management of pulmonary hypertension in infants and children with congenital heart disease. (PubMed)

Inhaled nitric oxide for the postoperative management of pulmonary hypertension in infants and children with congenital heart disease. Nitric oxide (NO) is a prevalent molecule in humans that is responsible for many physiologic activities including pulmonary vasodilation. An exogenous, inhaled form (iNO) exists that mimics this action without affecting systemic blood pressure. This therapy has been implemented in the treatment of pulmonary hypertension. This review examines the efficacy of iNO (...) in the postoperative management of infants and children with congenital heart disease (CHD). The original review was published in 2005, updated in 2008 and again in 2014.To compare the effects of postoperative administration of iNO versus placebo or conventional management, or both, on infants and children with CHD and pulmonary hypertension. The primary outcome was mortality. Secondary outcomes included length of hospital stay; neurodevelopmental disability; number of pulmonary hypertensive crises (PHTC); changes

2014 Cochrane

7. Diagnosis & Assessment of Hypertension - Renovascular Hypertension

McBrien, MD MPH; Sonia Butalia, BSc MD MSc; Meranda Nakhla, MD MSc Co-Chairs: Doreen M. Rabi, MD MSc, Stella S. Daskalopoulou, MD MSc DIC PhD This information is based on the Hypertension Canada guidelines published in Nerenberg, Kara A. et al. Hypertension Canada’s 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children. . Guidelines Patients presenting with ≥ 2 of the following clinical clues listed below, suggesting renovascular hypertension (...) Diagnosis & Assessment of Hypertension - Renovascular Hypertension VII. Assessment for Renovascular Hypertension | Hypertension Canada Guidelines Subgroup Members: Marcel Ruzicka, MD PhD; Sheldon W. Tobe, MD MScCH; Ramesh Prasad, MBBS MSc MA PhD; Michel Vallée, MD PhD; Cedric Edwards, MD Central Review Committee: Stella S. Daskalopoulou, MD MSc DIC PhD (Chair); Kaberi Dasgupta, MD MSc; Kelly B. Zarnke, MD MSc; Kara Nerenberg, MD, MSc; Alexander A. Leung, MD MPH; Kevin C. Harris, MD MHSc; Kerry

2018 Hypertension Canada

8. Diagnosis & Assessment of Hypertension - Endocrine Hypertension

, BSc MD MSc; Meranda Nakhla, MD MSc Co-Chairs: Doreen M. Rabi, MD MSc, Stella S. Daskalopoulou, MD MSc DIC PhD This information is based on the Hypertension Canada guidelines published in Nerenberg, Kara A. et al. Hypertension Canada’s 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children. . Guidelines Hyperaldosteronism: screening and diagnosis Screening for hyperaldosteronism should be considered in hypertensive patients (...) Diagnosis & Assessment of Hypertension - Endocrine Hypertension VIII. Assessment For Endocrine Hypertension | Hypertension Canada Guidelines Subgroup Members: Ally P.H. Prebtani, MD; Gregory Kline, MD, Ernesto L. Schiffrin, MD PhD; Andrew Don-Wauchope, MD Central Review Committee: Stella S. Daskalopoulou, MD MSc DIC PhD (Chair); Kaberi Dasgupta, MD MSc; Kelly B. Zarnke, MD MSc; Kara Nerenberg, MD, MSc; Alexander A. Leung, MD MPH; Kevin C. Harris, MD MHSc; Kerry McBrien, MD MPH; Sonia Butalia

2018 Hypertension Canada

9. Adiposity measures and their validity in estimating risk of hypertension in South Asian children: a cross-sectional study. (PubMed)

Adiposity measures and their validity in estimating risk of hypertension in South Asian children: a cross-sectional study. Given the South Asian phenotype of higher body fat at similar body mass index (BMI) relative to Caucasians, we sought to explore the association between prominent adiposity indicators with blood pressure (BP) and hypertension, to compare the accuracy of these indicators in estimating hypertension, and to provide cut-off values associated with adverse hypertension risk (...) indicators with BP and hypertension and suggests that South Asian children might be at adverse risk of hypertension at levels of adiposity considered normal.© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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2019 BMJ open

10. The population-based prevalence of hypertension and correlates of blood pressure among Australian children. (PubMed)

The population-based prevalence of hypertension and correlates of blood pressure among Australian children. Hypertension is increasingly recognized as a disease spanning the entire life course. Continued efforts to refine the diagnosis and management of hypertension in children are highlighted by the recent American Academy of Pediatrics (AAP) guidelines, which include lower threshold values than the previous reference standard (Fourth Report). We aimed to determine the population-based (...) prevalence of children exceeding thresholds for hypertension using these two guidelines. We also sought to identify the correlates of blood pressure (BP) among Australian children.Cross-sectional data from the Growing Up in Australia: Longitudinal Survey of Australian Children were analyzed. Blood pressure was measured in 7139 Australian children aged 10-12 years and sampled using population-based methodology. The association between BP and explanatory variables linked to BP in other populations

2019 Pediatric Nephrology

11. Treating Hypertension in Children With <i>n</i>-of-1 Trials. (PubMed)

Treating Hypertension in Children With n-of-1 Trials. : media-1vid110.1542/5995522846001PEDS-VA_2018-1818Video Abstract OBJECTIVES: Clinicians prescribe antihypertensive medication to children with primary hypertension, but without data to define a particular choice as first-line therapy. A one-size-fits-all approach may not be appropriate for these patients. Our aim was to develop a personalized approach to hypertension treatment, using repeated ambulatory blood pressure monitoring (...) (ABPM) in n-of-1 trials (single-patient randomized crossover trials).Children undergoing hypertension management at a single pediatric referral center were offered participation in an n-of-1 trial with repeated ABPM to compare 3 commonly used medications. The medication producing the greatest blood pressure reduction, and without unacceptable side effects, was selected as the preferred therapy for the individual.Forty-two children agreed to participate; 7 were normotensive without medication; and 3

2019 Pediatrics

12. Usefulness of Red Cell Width Distribution (RDW) in the Assessment of Children with Pulmonary Arterial Hypertension (PAH). (PubMed)

Usefulness of Red Cell Width Distribution (RDW) in the Assessment of Children with Pulmonary Arterial Hypertension (PAH). Red cell width distribution (RDW) is known to be a prognostic marker in adults with pulmonary hypertension. The value of this test in the pulmonary arterial hypertension (PAH) pediatric population was not yet established. The aim of the study was to evaluate the prognostic value of RDW in children with PAH and utility of this parameter in the management. Data were collected

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2019 Pediatric Cardiology

13. Prevalence of Hypertension in Children. (PubMed)

Prevalence of Hypertension in Children. In 2017, the American Academy of Pediatrics issued a new clinical practice guideline for defining hypertension in children as an update to the previous Fourth Report guidelines issued in 2004. Prevalence of confirmed pediatric hypertension in children has ranged from 2% to 4% based on previous guidelines yet it is unknown what the prevalence is under the new guideline. We estimated the prevalence of elevated blood pressure, stage 1, and stage 2 (...) from 14.8% by Fourth Report to 16.3% by the new American Academy of Pediatrics guideline. This increase in elevated blood pressure resulted from differential classification changes in younger and older children. Prevalence of confirmed hypertension remains at 2% to 4% in this population, however shorter children <13 years old and taller, older children 13+ years old are systematically more likely to be diagnosed with hypertension by new guidelines.

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2019 Hypertension

14. Partial Splenic Embolization is a Safe and Effective Alternative in the Management of Portal Hypertension in Children. (PubMed)

Partial Splenic Embolization is a Safe and Effective Alternative in the Management of Portal Hypertension in Children. There are multiple approaches to manage the clinical complications of portal hypertension (PHTN) to treat/prevent spontaneous hemorrhage by mitigating thrombocytopenia. No single approach is ideal for all patients given the heterogeneity of this population. Our goal was to determine whether partial splenic embolization (PSE) was safe and effective in the pediatric (...) patients (80.8%). Children with prior esophageal varices showed improvement after PSE with only nine (34.6%) requiring further endoscopic therapy. After PSE, patients developed transient abdominal pain, distention, fever, and peri-splenic fluid collections. Serious complications such as splenic abscess, splenic rupture, bleeding, pancreatic infarction, opportunistic infection or death were not observed. One patient experienced thrombotic complications following PSE and was later diagnosed

2019 Journal of Pediatric Gastroenterology and Nutrition

15. Hepatic Venous Pressure Gradient Measurements in Children: Correlation With Hepatic Histology and Clinical Indicators of Portal Hypertension. (PubMed)

Hepatic Venous Pressure Gradient Measurements in Children: Correlation With Hepatic Histology and Clinical Indicators of Portal Hypertension. In adults, elevated hepatic venous pressure gradients (HVPGs) are correlated with the degree of liver fibrosis on histopathology and predict worse outcomes including variceal bleeding and death. We aimed to examine the association between HVPG measurements, histopathologic findings, and clinical indicators of portal hypertension in children.Utilizing (...) retrospective data from 2 pediatric centers between 2006 and 2015, we identified children who underwent simultaneous HVPG measurement and transjugular liver biopsy. Medical charts were reviewed for histopathology, imaging, endoscopic, and clinical data.Forty-one children (median age 11 years) were included in the analysis with diagnoses of acute hepatitis (n = 15), chronic liver disease (n = 12), hepatic noncirrhotic portal hypertension (n = 4), acute liver failure (n = 3), and nonhepatic causes of portal

2019 Journal of Pediatric Gastroenterology and Nutrition

16. Does treatment-resistant hypertension exist in children? A review of the evidence. (PubMed)

Does treatment-resistant hypertension exist in children? A review of the evidence. Treatment-resistant hypertension (TRH) is a well-described condition in adult patients that is associated with poor clinical outcomes. While case reports of hypertension resistant to therapy in children have been published, it is unclear if TRH truly exists in childhood. This educational review will briefly summarize recent evidence and recommendations for TRH in adults, as well as will review the literature (...) regarding medically resistant hypertension in children and adolescents. Finally, we propose a clinical approach for evaluation hypertensive children and adolescents with apparent treatment resistance.

2019 Pediatric Nephrology

17. Diagnostics, monitoring and outpatient care in children with suspected pulmonary hypertension/paediatric pulmonary hypertensive vascular disease. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European (PubMed)

Diagnostics, monitoring and outpatient care in children with suspected pulmonary hypertension/paediatric pulmonary hypertensive vascular disease. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Pulmonary hypertension (PH) is a condition of multiple aetiologies with underestimated prevalence and incidence. Indeed, despite access to modern therapies, pulmonary hypertensive vascular disease (PHVD) remains a progressive, usually life (...) -limiting condition, severely impacting on the patients' well-being. We herein provide practical, expert consensus recommendations on the initial diagnostic work-up, clinical management and follow-up of children and adolescents with PH/PHVD, including a diagnostic algorithm. The major topics and methods that need to be tailored and put into context of the individual patient include PH classification, clinical signs and symptoms, basic diagnostic and advanced imaging measures (ECG, chest X-ray

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2016 Heart

18. Cardiac MR and CT imaging in children with suspected or confirmed pulmonary hypertension/pulmonary hypertensive vascular disease. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmo (PubMed)

Cardiac MR and CT imaging in children with suspected or confirmed pulmonary hypertension/pulmonary hypertensive vascular disease. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmo Childhood pulmonary hypertension (PH) is a heterogenous disease associated with considerable morbidity and mortality. Invasive assessment of haemodynamics is crucial for accurate diagnosis and guidance of medical therapy. However, adequate (...) imaging is increasingly important in children with PH to evaluate the right heart and the pulmonary vasculature. Cardiac MR (CMR) and computed tomography (CT) represent important non-invasive imaging modalities that may enable comprehensive assessment of right ventricular (RV) function and pulmonary haemodynamics. Here, we present graded consensus recommendations for the evaluation of children with PH by CMR and CT. The article provides a structured approach for the use of CMR and CT imaging

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2016 Heart

19. Screening for hypertension in children and adolescents to prevent cardiovascular disease

Screening for hypertension in children and adolescents to prevent cardiovascular disease Screening for hypertension in children and adolescents to prevent cardiovascular disease Screening for hypertension in children and adolescents to prevent cardiovascular disease Thompson M, Dana T, Bougatsos C, Blazina I, Norris SL CRD summary This review found that there was no direct evidence that screening for hypertension in children and adolescents reduced their adverse cardiovascular outcomes (...) as adults; the available evidence was generally poor. The limited nature and poor quality of the evidence suggest that these conclusions are appropriate. Authors' objectives To assess the effectiveness of screening asymptomatic children and adolescents for hypertension to prevent cardiovascular disease. Searching MEDLINE and The Cochrane Library were searched in July 2012, for studies published in English. Reference lists were searched, and the search strategy was reported. Study selection The review

2013 DARE.

20. A randomized, double-blind, placebo-controlled, dose-ranging study of oral sildenafil citrate in treatment-naive children with pulmonary arterial hypertension

A randomized, double-blind, placebo-controlled, dose-ranging study of oral sildenafil citrate in treatment-naive children with pulmonary arterial hypertension PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?

2013 PedsCCM Evidence-Based Journal Club

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