Childhood Hypertension.ppt

Childhood HypertensionSummary Identify presence of HTN Define severity of HTN Evaluate for secondary causes of HTN Institute treatment and ongoing monitoring Recognize and treat hypertensive emergencies Xièxie * * * * * * * * * * * * * * * * * * * * * * * * 7 * 9 * * * * * * Device worn on a belt and weighs 9 oz (255g) with batteries Recent advances have made them smaller and quieter There is just a soft buzz when it is making a measurement Small + quiet = discrete Many measurements: you set them to record every 20-30 min during the day and every 30-60 minutes during the night Measuring techniques: Auscultatory: listens for the Korotkoff sounds with a single or dual microphone Oscillometry: detects initial systolic BP and the maximal arterial vibrations (mean arterial pressure) and calculates the diastolic BP * * * * * * * * * * * * * * * * Niyadurupola, N et al. Br J Ophthalmol 2005;89:924-925 Axial T2 weighted MRI showing high signal intensity involving the white matter of both occipital lobes (arrows). MRI Findings in Hypertensive Encephalopathy Pediatric Hypertensive Emergencies Hypertensive Encephalopathy Usually cerebral autoregulation maintains MAP in brain of 60-100 mmHg If BP exceeds critical level (180 mmHg in adults), vessels dilate leading to excessive blood flow with resultant cerebral edema Critical level may be higher in patients with chronic HTN Other organ systems Less well-studied, but presumably similar changes occur as are seen in the brain Pathophysiology Autoregulation of Cerebral Bloodflow 1 Pediatric Hypertensive Emergencies History of prior HTN, renal or cardiac disease Physical exam Fundoscopic: presence of retinal hemorrhages, other signs of retinopathy Cardiac: presence of congestive heart failure, new murmur, 4-extremity BP’s Neurologic: level of consciousness General: edema, pallor Laboratory evaluation Serum chemistries, CBC, urinalysis Chest x-ray, echocardiogram, renal ultrasound Assessment Pediatric Hypertensive Emer