Abstract
With the increasing prevalence of childhood obesity worldwide, children and adolescents are more frequently diagnosed with primary/essential hypertension (HTN), mostly related to overweight/obesity, abnormal fat mass distribution (central obesity), increased fructose/salt intake, and decreased physical activity (PA). The consequences of elevated blood pressure (BP) include vascular lesions, left ventricular hypertrophy (LVH), and other target organ damages (TODs), which may be reversible if hypertension is diagnosed and treated early in the development of the disease. As primary hypertension (PH) is considered as a disease of premature vascular aging associated with neuro-, immuno-, and metabolic abnormalities, a multi-targeted non-pharmacological and pharmacological therapy is recommended and attempted, which is however frequently hindered by patients’ noncompliance. As high/untreated BP in childhood has detrimental effects on cardiovascular health in hypertensive children who often become hypertensive adults due to the tracking phenomenon, we advocate that primary prevention of cardiovascular morbidity and mortality starts early in the development of the disease, that is, as soon as hypertension is detected in children and adolescents.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Flynn J. The changing face of pediatric hypertension in the era of the childhood obesity epidemic. Pediatr Nephrol. 2013;28(7):1059–66.
Gupta-Malhotra M, Banker A, Shete S, Hashmi SS, Tyson JE, Barratt MS, et al. Essential hypertension vs. secondary hypertension among children. Am J Hypertens. 2015;28(1):73–80.
Falkner B. The childhood role in development of primary hypertension. Am J Hypertens. 2018;150(5):640–8.
Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904.
Xi B, Zhang T, Li S, Harville E, Bazzano L, He J, et al. Can pediatric hypertension criteria be simplified? A prediction analysis of subclinical cardiovascular outcomes from the Bogalusa Heart Study. Hypertension. 2017;69(4):691–6.
Ma C, Kelishadi R, Hong YM, Bovet P, Khadilkar A, Nawarycz T, et al. Performance of eleven simplified methods for the identification of elevated blood pressure in children and adolescents. Hypertension. 2016;68(3):614–20.
Litwin M, Michałkiewicz J, Gackowska L. Primary hypertension in children and adolescents is an immuno-metabolic disease with hemodynamic consequences. Curr Hypertens Rep. 2013;15(4):331–9.
Litwin M, Feber J, Ruzicka M. Vascular aging: lessons from pediatric hypertension. Can J Cardiol. 2016;32(5):642–9.
Litwin M, Feber J, Niemirska A, Michałkiewicz J. Primary hypertension is a disease of premature vascular aging associated with neuro-immuno-metabolic abnormalities. Pediatr Nephrol. 2015;31(2):185–94.
Flynn JT. High blood pressure in the young: why should we care? Acta Paediatr. 2018;107(1):14–9.
Chen X, Wang Y. Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation. 2008;117(25):3171–80.
Tirosh A, Afek A, Rudich A, Percik R, Gordon B, Ayalon N, et al. Progression of normotensive adolescents to hypertensive adults: a study of 26,980 teenagers. Hypertension. 2010;56(2):203–9.
Karatzi K, Protogerou AD, Moschonis G, Tsirimiagou C, Androutsos O, Chrousos GP, et al. Prevalence of hypertension and hypertension phenotypes by age and gender among schoolchildren in Greece: The Healthy Growth Study. Atherosclerosis. 2017;259:128–33.
Kim S, Lewis JR, Baur LA, Macaskill P, Craig JC. Obesity and hypertension in Australian young people: results from the Australian Health Survey 2011-2012. Intern Med J. 2017;47(2):162–9.
Martin L, Oepen J, Reinehr T, Wabitsch M, Claussnitzer G, Waldeck E, et al. Ethnicity and cardiovascular risk factors: evaluation of 40,921 normal-weight, overweight or obese children and adolescents living in Central Europe. Int J Obes. 2015;39(1):45–51.
Kułaga Z, Litwin M, Grajda A, Kułaga K, Gurzkowska B, Góźdź M, et al. Oscillometric blood pressure percentiles for Polish normal-weight school-aged children and adolescents. J Hypertens. 2012;30(10):1942–54.
Rosner B, Cook NR, Daniels S, Falkner B. Childhood blood pressure trends and risk factors for high blood pressure: the NHANES experience 1988-2008. Hypertension. 2013;62(2):247–54.
Kaczmarek M, Stawińska-Witoszyńska B, Krzyżaniak A, Krzywińska-Wiewiorowska M, Siwińska A. Who is at higher risk of hypertension? Socioeconomic status differences in blood pressure among Polish adolescents: a population-based ADOPOLNOR study. Eur J Pediatr. 2015;174(11):1461–73.
Grajda A, Kułaga Z, Gurzkowska B, Wojtyło M, Góźdź M, Litwin M. Preschool children blood pressure percentiles by age and height. J Hum Hypertens. 2017;31(6):400–8.
Lurbe E, Litwin M, Pall D, Seeman T, Stabouli S, Webb NJA, et al. Insights and implications of new blood pressure guidelines in children and adolescents. J Hypertens. 2018;36(7):1456–9.
Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34:1887–920.
Sharma AK, Metzger DL, Rodd CJ. Prevalence and severity of high blood pressure among children based on the 2017 American Academy of Pediatrics Guidelines. JAMA Pediatr. 2018;172(6):557–65.
Xi B, Zong X, Kelishadi R, Hong YM, Khadilkar A, Steffen LM, et al. Establishing international blood pressure references among nonoverweight children and adolescents aged 6 to 17 years. Circulation. 2016;133(4):398–408.
Flynn JT, Alderman MH. Characteristics of children with primary hypertension seen at a referral center. Pediatr Nephrol. 2005;20(7):961–6.
Litwin M, Trelewicz J, Wawer Z, Antoniewicz J, Wierzbicka A, Rajszys P, et al. Intima-media thickness and arterial elasticity in hypertensive children: controlled study. Pediatr Nephrol. 2004;19(7):767–74.
Chiolero A, Cachat F, Burnier M, Paccaud F, Bovet P. Prevalence of hypertension in schoolchildren based on repeated measurements and association with overweight. J Hypertens. 2007;25(11):2209–17.
Leiba A, Twig G, Vivante A, Skorecki K, Golan E, Derazne E, et al. Prehypertension among 2.19 million adolescents and future risk for end-stage renal disease. J Hypertens. 2017;35(6):1290–6.
Niemirska A, Litwin M, Antoniewicz J, Jurkiewicz E, Kościesza I, Sladowska J, et al. Fat tissue distribution and metabolic alterations in boys with primary hypertension. Przegl Lek. 2006;63(Suppl 3):49–53.
Markus MRP, Stritzke J, Siewert U, Lieb W, Luchner A, Döring A, et al. Variation in body composition determines long-term blood pressure changes in pre-hypertension: the MONICA/KORA (Monitoring Trends and Determinants on Cardiovascular Diseases/Cooperative Research in the Region of Augsburg) cohort study. J Am Coll Cardiol. 2010;56(1):65–76.
Lee RM, Dickhout JG, Sandow SL. Vascular structural and functional changes: their association with causality in hypertension: models, remodeling and relevance. Hypertens Res. 2017;40(4):311–23.
Falkner B. Monitoring and management of hypertension with obesity in adolescents. Integr Blood Press Control. 2017;10:33–9.
Chirico D, Wade TJ, Cairney J, Klentrou P, O’Leary DD. Evidence of a hyperkinetic state in children with elevated blood pressure. Ann Hum Biol. 2015;42(3):246–52.
Sorof JM, Poffenbarger T, Franco K, Bernard L, Portman RJ. Isolated systolic hypertension, obesity, and hyperkinetic hemodynamic states in children. J Pediatr. 2002;140(6):660–6.
Niemirska A, Litwin M, Feber J, Jurkiewicz E. Blood pressure rhythmicity and visceral fat in children with hypertension. Hypertension. 2013;62(4):782–8.
Litwin M, Simonetti GD, Niemirska A, Ruzicka M, Wühl E, Schaefer F, et al. Altered cardiovascular rhythmicity in children with white coat and ambulatory hypertension. Pediatr Res. 2010;67(4):419–23.
Eisner GM. Hypertension: racial differences. Am J Kidney Dis. 1990;16(4 Suppl 1):35–40.
Calhoun DA, Oparil S. Racial differences in the pathogenesis of hypertension. Am J Med Sci. 1995;310(Suppl 1):S86–90.
Litwin M, Sladowska J, Antoniewicz J, Niemirska A, Wierzbicka A, Daszkowska J, et al. Metabolic abnormalities, insulin resistance, and metabolic syndrome in children with primary hypertension. Am J Hypertens. 2007;20(8):875–82.
Litwin M, Michałkiewicz J, Niemirska A, Gackowska L, Gockowska L, Kubiszewska I, et al. Inflammatory activation in children with primary hypertension. Pediatr Nephrol. 2010;25(9):1711–8.
Litwin M, Niemirska A, Sladowska-Kozlowska J, Wierzbicka A, Janas R, Wawer ZT, et al. Regression of target organ damage in children and adolescents with primary hypertension. Pediatr Nephrol. 2010;25(12):2489–99.
Feig DI, Johnson RJ. Hyperuricemia in childhood primary hypertension. Hypertension. 2003;42(3):247–52.
Kaneko C, Ogura J, Sasaki S, Okamoto K, Kobayashi M, Kuwayama K, et al. Fructose suppresses uric acid excretion to the intestinal lumen as a result of the induction of oxidative stress by NADPH oxidase activation. Biochim Biophys Acta. 2017;1861(3):559–66.
Rhone ET, Carmody JB. Birthweight and serum uric acid in American adolescents. Pediatr Int. 2017;59(8):948–50.
Orlando A, Cazzaniga E, Giussani M, Palestini P, Genovesi S. Hypertension in children: role of obesity, simple carbohydrates, and uric acid. Front Public Health. 2018;6:129.
Alper AB, Chen W, Yau L, Srinivasan SR, Berenson GS, Hamm LL. Childhood uric acid predicts adult blood pressure: the Bogalusa Heart Study. Hypertension. 2005;45(1):34–8.
Koratala A, Singhania G, Alquadan KF, Shimada M, Johnson RJ, Ejaz AA. Serum uric acid exhibits inverse relationship with estimated glomerular filtration rate. Nephron. 2016;134(4):231–7.
Feig DI, Soletsky B, Johnson RJ. Effect of allopurinol on blood pressure of adolescents with newly diagnosed essential hypertension: a randomized trial. JAMA. 2008;300(8):924–32.
Viazzi F, Rebora P, Giussani M, Orlando A, Stella A, Antolini L, et al. Increased serum uric acid levels blunt the antihypertensive efficacy of lifestyle modifications in children at cardiovascular risk. Hypertension. 2016;67(5):934–40.
Wang Y, Hu J-W, Lv Y-B, Chu C, Wang K-K, Zheng W-L, et al. The role of uric acid in hypertension of adolescents, prehypertension and salt sensitivity of blood pressure. Med Sci Monit. 2017;23:790–5.
Thomas P, Dasgupta I. The role of the kidney and the sympathetic nervous system in hypertension. Pediatr Nephrol. 2015;30(4):549–60.
He FJ, MacGregor GA. Importance of salt in determining blood pressure in children: meta-analysis of controlled trials. Hypertension. 2006;48(5):861–9.
Yang Q, Zhang Z, Kuklina EV, Fang J, Ayala C, Hong Y, et al. Sodium intake and blood pressure among US children and adolescents. Pediatrics. Am Acad Pediatr. 2012;130(4):611–9.
Correia-Costa L, Cosme D, Nogueira-Silva L, Morato M, Sousa T, Moura C, et al. Gender and obesity modify the impact of salt intake on blood pressure in children. Pediatr Nephrol. 2016;31(2):279–88.
Falkner B, Kushner H, Khalsa DK, Canessa M, Katz S. Sodium sensitivity, growth and family history of hypertension in young blacks. J Hypertens Suppl. 1986;4(5):S381–3.
Simonetti GD, Raio L, Surbek D, Nelle M, Frey FJ, Mohaupt MG. Salt sensitivity of children with low birth weight. Hypertension. 2008;52(4):625–30.
Ruys CA, Rotteveel J, van de Lagemaat M, Lafeber HN, Finken MJJ. Salt sensitivity of blood pressure at age 8 years in children born preterm. J Hum Hypertens. 2018;19(3 Pt 2):112.
Śladowska-Kozłowska J, Litwin M, Niemirska A, Płudowski P, Wierzbicka A, Skorupa E, et al. Oxidative stress in hypertensive children before and after 1 year of antihypertensive therapy. Pediatr Nephrol. 2012;27(10):1943–51.
Solak Y, Afsar B, Vaziri ND, Aslan G, Yalcin CE, Covic A, et al. Hypertension as an autoimmune and inflammatory disease. Hypertens Res. 2016;39(8):567–73.
Pevsner-Fischer M, Blacher E, Tatirovsky E, Ben-Dov IZ, Elinav E. The gut microbiome and hypertension. Curr Opin Nephrol Hypertens. 2017;26(1):1–8.
Gackowska L, Michalkiewicz J, Niemirska A, Helmin-Basa A, Klosowski M, Kubiszewska I, et al. 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. J Hypertens. 2018;36(11):2148–56.
Sorriento D, De Luca N, Trimarco B, Iaccarino G. The antioxidant therapy: new insights in the treatment of hypertension. Front Physiol. 2018;9:258.
Ahn S-Y, Gupta C. Genetic programming of hypertension. Front Pediatr. 2017;5:285.
Robinson RF, Batisky DL, Hayes JR, Nahata MC, Mahan JD. Significance of heritability in primary and secondary pediatric hypertension. Am J Hypertens. 2005;18(7):917–21.
Gupta-Malhotra M, Hashmi SS, Barratt MS, Milewicz DM, Shete S. Familial aggregation of first degree relatives of children with essential hypertension. Blood Press. 2018;26(4):1–8.
Morgado J, Sanches B, Anjos R, Coelho C. Programming of essential hypertension: what pediatric cardiologists need to know. Pediatr Cardiol. 2015;36(7):1327–37.
Pickering GW. The role of the kidney in acute and chronic hypertension following renal artery constriction in the rabbit. Clin Sci. 1945;5(3–4):229–47.
Katz SH, Hediger ML, Schall JI, Bowers EJ, et al. Blood pressure, growth and maturation from childhood through adolescence. Mixed longitudinal analyses of the Philadelphia Blood Pressure Project. Hypertension. 1980;2(4 Pt 2):55–69.
Pludowski P, Litwin M, Niemirska A, Jaworski M, Sladowska J, Kryskiewicz E, et al. Accelarated skeletal maturation in children with primary hypertension. Hypertension. 2009;54(6):1234–9.
Sun SS, Schubert CM. Prolonged juvenile States and delay of cardiovascular and metabolic risk factors: the Fels Longitudinal study. J Pediatr. 2009;155(3):S7.e1–6.
Kivimäki M, Lawlor DA, Smith GD, Elovainio M, Jokela M, Keltikangas-Järvinen L, et al. Association of age at menarche with cardiovascular risk factors, vascular structure, and function in adulthood: the Cardiovascular Risk in Young Finns study. Am J Clin Nutr. 2008;87(6):1876–82.
Lee HS, Shim YS, Jeong HR, Kwon EB, Hwang JS. The Association between Bone Age Advancement and Insulin Resistance in Prepubertal Obese Children. Exp Clin Endocrinol Diabetes. 2015;123(10):604–7.
Kavey R-EW. Left ventricular hypertrophy in hypertensive children and adolescents: predictors and prevalence. Curr Hypertens Rep. 2013;15(5):453–7.
Stabouli S, Kotsis V, Rizos Z, Toumanidis S, Karagianni C, Constantopoulos A, et al. Left ventricular mass in normotensive, prehypertensive and hypertensive children and adolescents. Pediatr Nephrol. 2009;24(8):1545–51.
Urbina EM, Khoury PR, McCoy C, Daniels SR, Kimball TR, Dolan LM. Cardiac and vascular consequences of pre-hypertension in youth. J Clin Hypertens (Greenwich). 2011;13(5):332–42.
Litwin M, Niemirska A, Sladowska J, Antoniewicz J, Daszkowska J, Wierzbicka A, et al. Left ventricular hypertrophy and arterial wall thickening in children with essential hypertension. Pediatr Nephrol. 2006;21(6):811–9.
Brady TM, Fivush B, Flynn JT, Parekh R. Ability of blood pressure to predict left ventricular hypertrophy in children with primary hypertension. J Pediatr. 2008;152(1):73–8, 78.e1
Pruette CS, Fivush BA, Flynn JT, Brady TM. Effects of obesity and race on left ventricular geometry in hypertensive children. Pediatr Nephrol. 2013;28(10):2015–22.
Jansen MAC, Uiterwaal CSPM, Visseren FLJ, van der Ent CK, Grobbee DE, Dalmeijer GW. Abdominal fat and blood pressure in healthy young children. J Hypertens. 2016;34(9):1796–803.
Seeman T, Gilík J, Vondrák K, Simková E, Flögelová H, Hladíková M, et al. Regression of left-ventricular hypertrophy in children and adolescents with hypertension during ramipril monotherapy. Am J Hypertens. 2007;20(9):990–6.
Śladowska-Kozłowska J, Litwin M, Niemirska A, Wierzbicka A, Wawer ZT, Janas R. Change in left ventricular geometry during antihypertensive treatment in children with primary hypertension. Pediatr Nephrol. 2011;26(12):2201–9.
Williamson W, Foster C, Reid H, Kelly P, Lewandowski AJ, Boardman H, et al. Will exercise advice be sufficient for treatment of young adults with prehypertension and hypertension? A systematic review and meta-analysis. Hypertension. 2016;68(1):78–87.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Feber, J., Litwin, M. (2019). Primary Hypertension. In: Lurbe, E., Wühl, E. (eds) Hypertension in Children and Adolescents. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-030-18167-3_7
Download citation
DOI: https://doi.org/10.1007/978-3-030-18167-3_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-18166-6
Online ISBN: 978-3-030-18167-3
eBook Packages: MedicineMedicine (R0)