Treating the causes of paediatric hypertension using non-invasive physiological parameters.
Although hypertension is uncommon in childhood, when present, clinicians should investigate the cause and manage appropriately, which can be challenging in children with renal disease. Our knowledge of normal homeostatic mechanisms of blood pressure control, such as the renin-angiotensin system or endothelial function, and the pathophysiology of these systems in hypertensive patients, has significantly advanced in recent years. However, our therapeutic strategy in paediatric hypertension is limited in delineating the underlying physiological derangement of individual patients. New non-invasive technologies are increasingly offering quantification of haemodynamic parameters to physicians. We suggest use of these parameters (normally limited to intensive care physicians by virtue of previously invasive methods of quantification) to less acute medical areas such as outpatients. If a child is hypertensive due to an elevated cardiac index then choosing anti-hypertensive agents such as beta-blockers seems appropriate. As mean arterial pressure is the product of cardiac output and systemic vascular resistance, if the cardiac output is not raised then utilising vasodilators to reduce the systemic vascular resistance is logical. Modern therapeutic strategies targeted at a child's individual physiological derangement should offer more rapid and effective anti-hypertensive medication than current therapy based on physician preference.
Brierley
Joe
J
Paediatric and Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Marks
Stephen D
SD
D002648:Child; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy*; D007362:Intensive Care Units