Are we achieving our goals of minimizing end organ damage in children with essential hypertension

Background : Essential hypertension (EH) is increasing in prevalence among children. Risk factors include obesity, prematurity, low birth weight (LBW) and family history. There is scarcity of data on long-term follow-up of these children. Methods : We reviewed charts of children referred for evaluation of EH for the past 5 years. Demographic data, medical history, symptoms, degree of hypertension (HTN) and signs of end-organ involvement, such as microalbuminuria (MA) and left ventricular hypertrophy (LVH) were reviewed at presentation and at 1 year follow-up. Results: We identified 285 cases of EH of which 62 were followed for at least 1 year (median follow-up of 4 years). At presentation : median age=14 years, 74% males, 51% AA, 80% had family history of EH, 16 % were premature/LBW, 40 % were symptomatic, 45 % had dyslipidemia; HTN stages:  105 (37 %) pre-HTN, 108 (38 %) stage I, 72 (25%) stage II. LVH was seen in 30/159 (19%) and MA in 31/225 (14%); BMI was >85 th % in 75%. Follow-up data > 1 year : LVH in 16 %, MA in 13%, 42% were normotensive (most taking medications); HTN stage I/II: 29% (p=0.0005). Conclusions : EH was the most common cause of HTN and it was associated with obesity and poor follow-up. Children were often symptomatic and required pharmacotherapy despite intensive education on dietary and life style modification. Evidences of end-organ injury as LVH and MA were seen in 17% at presentation. This supports the need for early referral and aggressive intervention to effectively treat essential HTN in children.