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...
... middle of paper ...
...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.
Ace Inhibitors are used to treat hypertension and congestive heart failure (CHF). Most of the drugs that are Ace Inhibitors have the common ending –pril. It inhibits an enzyme; that decreases the tension of blood vessels and the blood volume, thus lowering blood pressure. Lotensin (benzapril) comes in tablets and is used for oral administration. It is one of the ace inhibitors that are indicated for treating hypertension. There is warning while using Lotensin when pregnant, it indicates to stop using immediately when pregnancy is detected. Vasotec (enalpril) comes in tablets and injection. It is indicated for the treatment of hypertension and is effective alone or in combination with other Ace Inhibitors agents, especially thiazide-type diuretics. There is a warning for fetal toxicity; when pregnancy is detected; stop using.
How does this history of high blood pressure demonstrate the problem description and etiology components of the P.E.R.I.E. process? What different types of studies were used to establish etiology or contributory cause?
Epinephrine can be added to NE if needed to maintain acceptable BP, or substituted if necessary. Vasopressin (0.03 units/min) can be used as an adjunct to increase MAP,or to lower NE dose; it should not be used as a single agent. Dopamine can be used as an alternative to NE, but only in patients meeting criteria due to risk of arrhythmias; low dose dopamine not to be used for renal protection. Phenylephrine not recommended in most cases; can be utilized if NE leads to serious arrhythmias, CO is known to be high yet BP continues to be low, or as salvage therapy when MAP target is not achieved by other means. An arterial cath should be placed ASAP in patients who require vasopressors. Inotropes can be added to vasopressors or used alone, with a doubatmine trial of up to 20 mcg/kg/min as an option if myocardial dysfunction is suspected by elevated cardiac filling pressures and low CO, or if hypoperfusion is still evident although intravascular volume and MAP are at goal. Bicarbonate should not be used in patients with pH greater than or equal to
Blood pressure is measured by mmHg (millimetres of mercury) and it is written as two numbers. The first number is the highest pressure that the heart reaches in beats and the second number is the lowest blood pressure reached between the heart beats. A normal blood pressure level in adults is blood pressure less than 120/80 but for someone with CKD; high blood pressure is if it is 130/80.
minutes, the AHR escalated even more, to 369 bpm. See Table 5 and Figure 3.
One of the main reasons hypertension can be so dangerous is because you may not even know you’re suffering from it, in fact, nearly one-third of patients suffering from hypertension don’t even know that they have it (WebMD 2015). The number one reason hypertension goes undetected for so long is because in most cases, there are no clear warning signs of the blood pressure being high. Some signs/symptoms
High blood pressure is called the “silent killer” because it often has no warning signs or symptoms, and many people don’t know they have it. For most patients, high blood pressure is found when they visit their health care provider or have it checked elsewhere. Because there are no symptoms, people can develop heart disease and kidney problems without knowing they have high blood pressure. Some people may experience: bad headache, mild dizziness, and blurry vision. Traditionally, diagnosis of high blood pressure (BP) has relied on consecutive checks of clinic BP over a 2 to 3 month period, with hypertension confirmed if BP remains persistently raised over 140/90 mmHg. This method of diagnosis has significant limitations because the BP measured for an individual patient in a clinic setting may not reflect their BP in day-to-day life. The main concern is that as a result of the “white coat syndrome”, hypertension may be over-diagnosed when checked in the clinic setting; resulting ...
Systolic blood pressure is 120/80 the diastolic blood pressure within normal range. Any blood pressure above 139/89 is pre-hypertension. Stage one hypertension is between 140-159 or 90-99, Stage two 160-179 or 100-109 diastolic and Stage three 180 above diastolic110. (Lewis, S.M, Heitkemper M.M &Dirksen, S.R 2004) pg 779.
BMR = 66 + (6.23 x weight in pounds) + (12.7 x height in inches) - (6.8 x age in year).
Hypertension is diagnosed by measuring the blood pressure by a device known as the sphygmomanometer. Blood pressure is taken and presented by the systolic blood pressure and diastolic blood pressure. The systolic and diastolic numbers will be recorded and compared to a chart of values. At the same time, doctor would also ask for patient’s family history of hypertension and the associated risk factors such as high cholesterol food intake.
Blood pressure, like a person's heart rate, will vary occasionally with exercise or stress. For people over age 18, an optimal blood pressure reading is considered 120/80 or lower. A blood pressure reading consistently higher than 120/80 is considered "pre-hypertension." High blood pressure or “stage one hypertension” is a measurement of 140/90 or higher. People who have high blood pressure have one and a half times the risk of having a stroke compared to those who consistently have optimal blood pressure of 120/80. Anyone who has had a previous heart attack, stroke, is diabetic, has kidney disease, high cholesterol or is overweight should speak with a doctor about aggressively controlling and lowering blood pressure. Maintaining a blood pressure reading below 140/90 may reduce the risk of further complications.
There are generally two categories of hypertension, primary hypertension and secondary hypertension. The causes of primary hypertension are usually unknown and it develops gradually over the years. As for secondary hypertension, the causes are mainly underlying other health problems and it develops in a sudden of time. (The Healthline Editorial Team 2013) First of all, hypertension can be related to renin-angiotensin-aldosterone system (RAAS). Renin is an enzyme secreted mainly via the juxtaglomerular apparatus of the kidney when the sodium retention and water retention are reduced in the blood. (Beevers, Lip, and O'Brien 2001) Renin will bind to a substrate which is angiotensinogen and form angiotensin I which is an inactive peptide. (Foëx and Sear 2004) After that, angiotensin I will be rapidly converted to an active peptide angiotensin II by angiotensin-converting enzyme (ACE) in lungs. As a result, vasoconstriction occurs due to presence of angiotensin II and this increases the blood pressure. Moreover, angiotensin II can stimulate the releasing of aldosterone by adrenal glands. Secretion of aldosterone raises the blood pressure by reabsorbing sodium salts and water to increase sodium and water retentions. (Beevers, Lip, and O'Brien 2001)
When the patient had the first follow-up visit for blood work after taking the medication for a month, she lost 18 pounds. The blood work is to check the patient’s kidney and liver functions, electrolytes, and the functions of blood cells. The patient denies any symptoms of the side effects. Her vital signs were stable. The patient looked energized and happy.
Blood pressure is measured by two pressures; the systolic and diastolic. The systolic pressure, the top number, is the pressure in the arteries when the heart contracts. The diastolic pressure, the bottom number, measures the pressure between heartbeats. A normal blood pressure is when the systolic pressure is less than 120mmHg and Diastolic pressure is less than 80mmHg. Hypertension is diagnosed when the systolic pressure is greater than 140mmHg and the diastolic pressure is greater than 90mmHg. The physician may also ask about medical history, family history, life style habits, and medication use that could also contribute to hypertension
High blood pressure affects children and their health in many ways. For example, “75 children age 10 to 18 with untreated high blood pressure performed worse on several tests of