Hypertension in middle childhood

Hypertension is increasingly recognized among children. The etiology and presentation depend crucially on the child’s age. In infancy, secondary causes clearly predominate; however, this is less the case as the child grows. Our study aimed to evaluate children with hypertension aged 6 to 11 years, where secondary causes are not as frequent as in younger age, and primary/obesity-related hypertension is not as pronounced as in adolescence. We retrospectively analyzed data from 784 children with consistently elevated blood pressure confirmed by ambulatory blood pressure monitoring. Among these, we analyzed the frequency of hypertension presence and etiology in children aged 6 to 11 years, along with anthropometric measures, target organ damage, and laboratory results. 22.2% of children with hypertension belonged to the group of children aged from 6 to 11 years. A total of 167 children were analyzed retrospectively. In 18%, the cause was at least possibly secondary, most commonly of renal etiology, where a straightforward association can not be confirmed or excluded. In primary hypertension, excess weight was frequent, with 76.7% overweight, which significantly affected clinical presentation. Liver steatosis and left ventricular hypertrophy were more common in children with obesity-related primary hypertension (p < 0.001 for both variables). The occurrence of hypertension between 6 and 11 years is mostly due to essential hypertension, and overweight is the most critical risk factor. Target organ damage is significantly associated with being overweight rather than having hypertension, which exacerbates cardiovascular risk in middle childhood. Some comorbidities associated with obesity are less pronounced in middle childhood than in adolescence, providing an early opportunity to implement preventive measures. In middle childhood, cases of secondary hypertension are rare but not uncommon. Especially, children with kidney disease are at increased risk for the development of hypertension and should be screened.