Hypertension crisis, the first symptom of renovascular hypertension in children?
China: Most renovascular hypertension (RVH) patients with hypertensive crisis (HTN-C) as the first symptom, particularly in males over six years, should be assessed for RVH even if they were asymptomatic, a recent study has shown. The study was featured in the Italian Journal of Pediatrics on 02 December 2022.
Most asymptomatic patients with renovascular hypertension already had target organ damage, and symptomatic patients developed life-threatening complications. The authors advise routine BP monitoring during children's physical examinations as preventive measures.
Hypertension is a health hazard globally and presents a higher prevalence, and patients tend to be higher. In recent years, hypertension incidence in children has been increasing. Severe hypertension is a potentially life-threatening condition. A hypertensive crisis, one of the most commonly used terms for defining severe hypertension, is a severe and sudden increase in blood pressure, leading to rapid end-organs damage, which could be life-threatening. In children, HTN-C is rare, but if not diagnosed timely or left interested, irreversible damage to vital organs could occur. Presently, there is no unified definition of HTN-C in children and adolescents.
Renovascular hypertension is one of the main causes of hypertensive crisis. It is characterized by acute onset and severe disease, and early diagnosis and treatment are difficult. Lingling Xu, Department of Pediatrics, The First Affiliated Hospital of Sun Yat-Sen University, Guangdong, People's Republic of China, and colleagues aimed to describe the characteristics of RVH and factors associated with RVH leading to HTN-C in children.
For this purpose, the researchers retrospectively analyzed the clinical data of inpatient children with RVH. Patients were categorized into the HTN-C group and the non-hypertensive crisis (non-HTN-C) group according to the first symptoms and blood pressure. Furthermore, HTN-C were classified as hypertensive urgency (HTN-U) or emergency (HTN-E).
The findings led to the following findings:
· Fifty-four pediatric cases (41 boys and 13 girls) were included. 83.3% of the RVH cases were ≥ 6 years old.
· Three cases were classified into the non-HTN-C group. Of the 51 HTN-C cases, 18 were grouped as HTN-U and 33 as HTN-E.
· The HTN-U group were mainly asymptomatic (50.0%, 9/18), while the HTN-E group mainly presented with neurological symptoms (72.7%, 24/33).
· The number of unknown aetiology children was 32 (59.2%). The top three known etiologies were Takayasu's arteritis (50.0%, 11/22), congenital renal dysplasia (27.3%, 6/22) and fibromuscular dysplasia (13.6%, 3/22).
· As for the target organ damage of RVH, patients had a higher prevalence of left ventricular hypertrophy (71.4%, 35/49) and retinopathy (77.8%, 21/27).
To conclude, renovascular hypertension in children was more common in boys aged over six years. 94.4% of children were presented with hypertensive crisis. Clinical manifestations were diverse, 55.6% of cases had neurological symptoms, and 25.9% were asymptomatic.SBP and DBP were remarkably higher in HTN-E cases than in HTN-U cases.
Xu, L., Ba, H., Jiang, X. et al. Hypertension crisis as the first symptom of renovascular hypertension in children. Ital J Pediatr 48, 191 (2022). https://doi.org/10.1186/s13052-022-01378-4
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