Children's Hospital Boston's Hypertension Program is dedicated to the comprehensive care of infants, children and young adults with elevated blood pressure. Our team of physicians, nurses, dietitians and social workers provides a coordinated, individualized approach to the evaluation and management of childhood hypertension based on the unique needs of each patient and family.
Patients and families meet for an initial extended consultation with a pediatric nephrologist with expertise in childhood hypertension. Based on that consultation, an appropriate evaluation will be completed to assess for possible underlying causes for hypertension as well as associated hypertensive end organ damage. Nursing staff provide extensive instruction regarding home and/or school blood pressure monitoring. Families will have an opportunity to meet with program dietitians to receive specific education regarding appropriate dietary choices and nutritional modification. Our program staff work in partnership with primary physicians to both evaluate and treat children with hypertension.
- Secondary hypertension Historically, approximately 90 percent of children with persistent hypertension were found to have an underlying etiology (secondary hypertension), with renal causes by far the most common. This continues to be true in young children (under age 7) with hypertension as well as all children with severe hypertension. Our physicians employ an organized, stepwise approach to identifying an etiology in these patients.
Possible secondary causes of pediatric hypertension include:
- renal parenchymal disease
- renovascular disease
- mid-aortic syndrome
- renal tubular disease
- cardiac disease
- Primary (essential) hypertension Over the last several decades, primary hypertension has become an increasing health problem in the pediatric population, particularly among school-aged children and adolescents. The prevalence of hypertension in this age group has nearly doubled since the 1970s. Much of this increase is believed to be related to an increase in primary hypertension associated with the ongoing obesity epidemic. Primary hypertension is generally considered a diagnosis of exclusion in the pediatric population.
- Elevated blood pressure without hypertension
- White coat hypertension Transient blood pressure elevations
associated with nervousness and anxiety around clinic visits
("white coat hypertension") is particularly common in pediatrics.
Identification of white coat hypertension early in the evaluation
process is imperative to avoid unnecessary testing or initiation
of therapies. Our physicians perform standardized ambulatory
blood pressure monitoring, the gold standard to formally
diagnose this entity.
- Prehypertension Many patients referred to our program
are found to have elevated blood pressure (greater than
90th percentile for age, gender, height or greater than 120/80
mmHg), though without frank hypertension (greater than 95th
percentile for age, gender, height on three separate occasions).
These patients have an increased risk of developing persistent
hypertension in the future. Although such patients do not
initially require long-term follow-up with hypertension specialists,
appropriate counseling is provided regarding lifestyle
modification and future monitoring.
The diagnostic studies considered for children seen in the renal Hypertension Program depend on the clinical presentation and may include laboratory studies, imaging studies or ambulatory blood pressure monitoring.
Treatment is tailored to the cause and severity of hypertension, as well as to each child's unique situation. Sometimes treatment involves referral—for interventional procedures if there is a vascular anomaly, or to appropriate specialists in the case of suspected cardiac or endocrine disease. Most frequently therapy consists of counseling and antihypertensive medications.
Children with obesity-related hypertension require extensive guidance regarding lifestyle modification, including appropriate dietary choices and increased physical activity. Our physicians, dietitians and nurses work with primary care physicians to provide ongoing support in these areas.
When drug therapy is necessary, a medication is chosen based on the underlying etiology of hypertension whenever possible, with careful consideration of potential side effects. We work with the primary care physician to closely monitor all children on medication.
Michael A. Ferguson, MD
Deborah Stein, MD
Meera Boghani, MS, RD, LDN, CLC
Janice Farren, RN
Renal Consult Nurse
Lynn Miczek, RN
Renal Consult Nurse
Gisell De La Cruz
More information: childrenshospital.org/hypertension
Make a referral: 617-355-6129