Pediatric Hypertension: A Case Series

Introduction: Pediatric hypertension (HTN) is an increasingly common health concern. Essential HTN now surpasses secondary causes in prevalence amongst children. Early diagnosis and management are crucial. Pediatric HTN is diagnosed with three elevated systolic or diastolic blood pressure (BP) readings (≥ 95th percentile) adjusted for age, height, and sex. Case Description: Case A: A 17-year-old female presented following an elevation of her blood pressure. On further history, she reported hot flashes, diaphoresis, palpitations, and lightheadedness in association with significantly elevated pressures. Pheochromocytoma was suspected, and serum catecholamines and CT confirmed the diagnosis. She underwent robotic resection, and pathology confirmed a paraganglioma with surgical correction of hypertension. Case B: A 9-year-old morbidly obese female was noted to have intermittently elevated BP for two years. She was evaluated for concerns about secondary HTN. Serologic evaluation and imaging were unremarkable. She was diagnosed with essential HTN and managed with medication and lifestyle modifications. Case C: A 16-year-old male presented for visual changes and was found to have optic nerve swelling with retinal hemorrhage due to a hypertensive emergency. The workup revealed an elevated serum creatinine, and a kidney biopsy was performed. The patient was found to have IgA nephropathy with extensive necrotizing and fibrous crescents with interstitial fibrosis. Hemodialysis was initiated, and he is awaiting a kidney transplant. Discussion: The evaluation of pediatric HTN starts with a comprehensive history. Documenting dietary habits, physical activity, family history, and screening for obstructive sleep apnea is crucial. Annual BP measurements for children ≥3 years with more frequent checks for those at higher risk should be performed. Secondary causes such as endocrinologic, vascular, and renal disorders should be excluded. In addition to serologic evaluation, ambulatory BP monitoring can aid in determining the presence of true HTN. Pediatric patients, especially those presenting before puberty or with any laboratory abnormality, should trigger an evaluation for secondary causes of HTN.