Hypertension Essay

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Hypertension may not be common in children, but if present, may be a problem in children of any age. It is often missed due to medical professionals omitting to take the blood pressure in a child or the technique, used by the doctor to take the blood pressure, is incorrect.[7]
In adults a high blood pressure is defined as a BP of 140/90 and higher but in children, to determine if the BP is high, one has to take into account the child’s age, weight and height. A child is said to have hypertension when their blood pressure goes above the 95th percentile, measured on at least three occasions.[7]
Three categories of hypertension may be defined in children:[7]
• Prehypertension: When the systolic/diastolic measurements are between the 90th and 95th percentile or if the BP exceeds 120/80mmHg.
• Stage 1 Hypertension: When the systolic/diastolic measurement falls between the 95th and 99th percentile plus 5mmHg.
• Stage 2 Hypertension: When the systolic/diastolic measurement exceeds the 99th percentile plus 5mmHg.
A simple formula may be used which gives a correlation to the 95th percentile of BP for the 50th percentile for height up to 16 years of age.[7]
• Systolic BP: 100+(2.5 x patients age in years)
• Diastolic BP: 60+2 for each year until 11 years, then +1 for every year thereafter.
Common causes of hypertension in children
The causes of hypertension may be divided into essential and secondary causes of hypertension in children. Secondary causes are most common in all age groups except in adolescents. [7]
The majority of secondary causes of hypertension are renal or renal-related.90% of sustained hypertension cases in children are caused by renal diseases, renovascular hypertension and co-arctation of the aorta.[7]
Causes of seconda...

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...ure or fluid retention. The onset of action is slow, therefore diuretics are often used as an adjunct rather than on its own. [8&9] Acute renal failure and pulmonary oedema are associated with the use of this drug. [7]
Nicarpidine: Calcium channel blocker that is long acting and causes arterial vasodilation. Used in conjunction with a beta-blocker if patient has coronary artery disease. Easy to prepare and administer as an intravenous infusion. [8&9]

Patients with less severe acute hypertension in which abrupt BP lowering is not necessary, oral anti-hypertensives may be used. [7]
• Amlodipine: Takes up to 2 hours to have an effect on BP, but has a long half-life.
• Nifedipine: Fast onset of action, but has a short half-life. Should only be used in uncomplicated situations without possible end-organ risk due to its ability to drop the blood pressure very rapidly.

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