Essential hypertension vs. secondary hypertension among children.
BACKGROUND
The aim was to determine the proportions and correlates of essential hypertension among children in a tertiary pediatric hypertension clinic.


METHODS
We evaluated 423 consecutive children and collected demographic and clinical history by retrospective chart review.


RESULTS
We identified 275 (65%) hypertensive children (blood pressure >95th percentile per the "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents") from 423 children referred to the clinic for history of elevated blood pressure. The remainder of the patients had normotension (11%), white coat hypertension (11%), prehypertension (10%), and pending diagnosis (3%). Among the 275 hypertensive children, 43% (n = 119; boys = 56%; median age = 12 years; range = 3-17 years) had essential hypertension and 57% (n = 156; boys = 66%; median age = 9 years; range = 0.08-19 years) had secondary hypertension. When compared with those with secondary hypertension, those with essential hypertension had a significantly older age at diagnosis (P = 0.0002), stronger family history of hypertension (94% vs. 68%; P < 0.0001), and lower prevalence of preterm birth (20% vs. 46%; P < 0.001). There was a bimodal distribution of age of diagnosis in those with secondary hypertension.


CONCLUSIONS
The phenotype of essential hypertension can present as early as 3 years of age and is the predominant form of hypertension in children after age of 6 years. Among children with hypertension, those with essential hypertension present at an older age, have a stronger family history of hypertension, and have lower prevalence of preterm birth.
Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, University of Texas Health Science Center, Houston, Texas; monesha.gupta@uth.tmc.edu.
Monesha
M
Gupta-Malhotra
Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, University of Texas Health Science Center, Houston, Texas;
Ashish
A
Banker
Department of Biostatistics, MD Anderson Cancer Center, University of Texas Health Science Center, Houston, Texas;
Sanjay
S
Shete
Pediatric Research Center, Department of Pediatrics, University of Texas Health Science Center, Houston, Texas;
Syed Sharukh
SS
Hashmi
Division of Neonatology, Department of Pediatrics, Children's Memorial Hermann Hospital, University of Texas Health Science Center, Houston, Texas;
John E
JE
Tyson
Divisions of Community and General Pediatrics and Adolescent Medicine, Department of Pediatrics, Children's Memorial Hermann Hospital, University of Texas Health Science Center, Houston, Texas;
Michelle S
MS
Barratt
Pediatric Research Center, Department of Pediatrics, University of Texas Health Science Center, Houston, Texas;
Jacqueline T
JT
Hecht
Division of Medical Genetics, Department of Internal Medicine, University of Texas Health Science Center, Houston, Texas;
Diane M
DM
Milewicz
Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, Texas.
Eric
E
Boerwinkle
D000293:Adolescent; D017677:Age Distribution; D017668:Age of Onset; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006973:Hypertension / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010375:Pedigree; D010641:Phenotype; D047928:Premature Birth / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013781:Texas / Q000453:epidemiology
blood pressure; etiology; hypertension; pediatrics; primary hypertension; secondary hypertension.