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    14 views38 pages

    Hipertensi in Children When To Treat Prof DR Adrian Umboh, SP AK

    Uploaded by

    Hendra Wardhana

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 38
    fay ‘@ [DA eee) iment of Chi Faculty of Medicine, Sam Ratulangi University Prof Dr. R. D, Kandou General Hospital ’ Highlight Global health problems. Morbidity and mortality have increased fea ns Oe de YS tea The last decade has spread to a younger age. Hypertension (Organ damage and atherosclerotic processes in blood vessels due to hypertension have begun from childhood and remained until adulthood. Management is important because it is often not easy, confusing and becomes a question of when to start Epidemiology Globally 2%-4% . Boys 15%-19% Girls 7%-12% ‘Amerika China @ Children 12-19 y 4,2% Children 6-13 y 18,4% Bali 2% Good nutrition Children 6-18 y 36,3% 14% Obesity India 22,2% Grade 1 HTN Children 5-15 y 23% 14,1% Grade 2 HTN Brazil : e Children 6-13 y 7% Indonesia ‘Adolescent 16-18 y 18,9% Afrika Children 2-19 y 5,5% Fyne Total. inca prciveguteln for sreering and ranagement of high Hood pres in chiro and alacant. Ps 3, Gebel Prevalance of Hypertension In Chiren: A Systematic Review end Metsanaves JAMA Pedal, ‘Wo DK. det Chl Blood Pressure Prefs Bt, ndonaia. Open Acceas Maced J Med Sl 2019 Jun 3.7 Increase in diastolic and systolic blood pressure : based on age, height and gender e PEDIATRICS cult with > 40% upper arm cheumfrence (Rewoon sromon and aloo) ‘oo arg cea lower od pressure value Too sma ci size ghar blood pressure value {3 Blood Pressure Measurement ° estar Hl BekunD.Hpeions pads Anak Dalam: Racha et a, ku Ar Netolag Anek, Ed. DA, Jk Levels by Age and Height Percentile (AAP 2017) Fyn J, linea pracve qudlne for earing an management of high ood pressure in chisron and ag Levels by Age and Height eet) (AAP 2017) Fly JT, a Cia rate guitene or sceenng and management thigh bleed presse chien a vy : Hypertension ‘ es e UKK Nefrologi IDAI The fourth report from the national High Blood Pressure Educ: (NHBPEP) 2004 Tekanan Tekanan darah sistole (TDS) dan/atau tekanan darah diastole (TDD) < P90 darah normal n Program Pre-Hipertensi_ TDS atau TDD > P90, tetapi < P95, atau jika TD > 120/80 Hipertensi Rata-rata TDS dan/atau TDD > P95 > setidaknya 3x pengukuran pada waktu berbeda HT derajat 1 —_Hipertensi derajat 1 > TD berada antara P95 dan P99 + 5 mmHg HT derajat 2 —_Hipertensi derajat 2> TD > P99 + 5 mmHg DW ° = dypertension “FR AAP e Sey ue Children >13 y Normal < P90 < 120 / <80 mmHg > P90" to < P95 OR Elevated BP 120/80 mmHg to < P95" 120/<80 to129/<80 mmHg > P95"" to < P95 + 12 mmHg, Stage 1 HTN OR 130/80 to 139/89 mmHg 130/80mmHg to 139/89 mmHg > P95 + 12 mmHg Stage 2 HTN oR > 140/90 mmHg > 140/90 mmHg Flynn JT. a a Clinical practve guideline for seeing and management of high blood pressure in cron and adolscont, Petes 2017.140G3) Classification svssa""" | : 01 02 Underlying cause could not be identified Underlying organic causes Most Causes > Renal and Renovascular disease 03 04 = : = : BP > P95 in the office or clinical setting but Normal office BP but elevated BP on < P95" outside of the office or clinical setting ABPM ynn J, ot al. tne! proctve guideline for ereenng and management of high ond preseurain children and adolescent. Petatics 2017: 14013) Common Causes of Pediatric Hypertension 128 y \Woever Di. Hypertension n Citron and Adonsconts, Peace Pathogenesis ee l ; } eQeeeeeeeceeeeQecedeeQecece <2 | » 1, Bithop MO, Aseo LD, Jose PA, Vilar VA, Pimary Pest Hype Pathogenesis : ex T vessel T cox T TPR = cites S Ale ee am, diameter ~~ /Tsympathetic overload 7 \ 7 tone activation of 7 Uremia renin angiotensin E t— | endothelial \ damage renal scars renal artery Underlying disease orcysts _ stenosis sdstein C, Schasfer F. Hypertension i chilren wit conic Kidney disease; pathophysiology and managernent. Pediatr Neptwol. 2008.2%9}:969-71, o . Diagnostic Fan JT, et Chica rave gadene Diagnostic ‘Seat child correctly and measure BP by auscultation or by using Fon. eal incl ms gene orsrening ard managment High ood resem chien an agshsoent Pedic 217140) gy according table Physical Examination Findings and History Suggestive Secondary Hyperte! n or Related to End Organ Damage 3 yon. sa Cia prsive guano sereenng ar management thigh cod prsaiein cen andadclescan Pesncs 201716063) @y Physical Examination Findings and History Suggestive Secondary Hypertension or Related to End Organ Damage Fen hel peso goto reat end mareponet fiph Hood presen en end decent Peden 217.408) @ Screening Test Patient Population Screening Tests All patients Urinalysis Chemistry panel, including electroytes, blood urea nitrogen, and e creatinine Lipid profile (fasting or nonfasting to include high-density lipoproteina ‘and total cholesterol) Renal ultrasonography in those <6 y of age or those with abnormal Urinalysis or renal function In the obese (BMI >95th Hemoglobin Alc (accepted screen for diabetes) percentile) child or Aspartate transaminase and alanine transaminase (screen for fatty adolescent, in addition to liver) the above Fasting lipid panel (screen for dyslipidemia) Optional tests to be obtained Fasting serum glucose for those at high risk for diabetes mellitus ‘on the basis of history. __Thyroid-stimulating hormone physical examination, and Drug screen initial studies Sleep study (if loud snoring, daytime sleepiness, or reported history of apnea) Complete blood count, especially in those with growth delay or ‘abnormal renal function Fyn JT, Chica practve guide or sceeing wd management of igh ocd pressure in chien ard adalascn Peace 20 100) @ . ww. Management Goals COON Ce CRs meee a Moe aOR uae ea} Hypertension in children without chronic renal failure or diabetes is systolic and diastolic blood pressure < P95" Hypertension Management (AAP, 2017) Plantstrong det (ate and vegetables) {Sodium Intake Uncontroles HTN with fe style moctiction £ imptomate HN, Stage 2 HIN wnout modMable factor nashaty (Example abesty) or HIN with CKD of OM s ‘Single drug (low dose) »> ipesial ape Dea RC ACE/ ARB/CCB Mhazide dluretios Caleta Can be increased every 2-4 weeks until controled aa (ee00)h rad dove cr fs ee ede oe DF vecontrores 2ormore profrred agent WF uncontrones BF vvontrones pera eel sc ce eget ae blocker, +, combination of both, centrally acting agents, potassium-sparting Sar erent) Alcester coninaton tbat cna acing agents potnshinpring Fyn Joa nical recta gultine fostering an management thigh Hod pressure hit ad adlascen, Peto 2047;1408) Non Pharmacologic ° DASH Smoking, Alcohol Lower scum ile (057 MERGE Way atau 4.52 gramtay, ted supa and evect: igh nko ot Puta, Limited drugs that | BP war mc procs, weeks gens Bah pouty, ra an ean eo oats Body weight oes = 3M All CNA Peru ces Life Style Modification Moderate-Vigorous ProHTN er Poo Po") Finn JT at Cinicl eaeve ne or sree sh ranegement of igh ood pe ‘anak Dalam: Rached at Gi A Nef Lifestyte modification Weight reduction if Overweight orobese Regular physical activity, Healthy diet Avoidance of Stress reduction Famity-based Riley M, Hernande? AK, Kuznia AL. High Blood Pressure in Childran and Adolescents. Am Fam Physician. 2018 Oct 15;98(8):486-494 e Lifestyle Modifications for Children and Adolescents with Elevated Blood Pressure or Hypertension Recommendations Focus on a multifaceted approach empha: sizing changes to diet and increased Physical activity: refer for comprehensive, Intensive intervention if patient is obese 50 to 60 minutes of moderate to vigor ous physical activity at least three to five Gays per week ‘The Dietary Approaches to Stop Hyper- tension diet. which emphasizes increased fresh fruits and vegetables, fiber, and low-fat dairy, and decreased sodium intake Avoid smoking and excessive alcohol intake Breathing awareness meditation and yosa may help lower blood pressure Involving the family in counseling on diet and exercise to make changes for the entire house- hold has been shown to improve success 01 Asymptomatic HTN stage 1, after lifestyle modification, BP reduction target is not achieved ( < Dose adjustment when there are side effects Titration of the drug dose gradually intervals of 2-4 weeks until BP target is reached or add one ‘other type of drug . os. pc ere ee ec mw ws Monotherapy Anti-Hypertensive ° e AAP recommends initial therapy for hypertension treatment ° with ACEI, CCB, ARB, or diuretic drugs. ‘ e Beta inhibitor should not be used as a first-line therapy in children as it relates to safety profile. e Patients with LVH, DM, or CKD recommended ACEI as a first- line or angiotensin-receptor blocker (ARB) during estimated glomerular filtration rate > 30 mL/min/1.73 m2. e CCB is often used in cases of hypertension due to steroid use e Diuretics (with or without CCB) as the main option in cases of hypertension with glomerulonephritis. e Combination of Anti-Hypertensive Agents Thiazide dluretics 1 Risk DM Anglotensin-receptor Other — : Preferred Usetul (with some imitations) Possible but less well ested Not recommended Luo tal 2948 Etopen Soy tmyparanton data manageert.f Nigh ld resin cite an alc, hyp 24 20 Recommendation fon Anti- shy Pentensive Agent (AAP) =o an vost Br Hpauomane ome oy yon JT, a Cncal pracivaguline or seening anc ranagement af igh tod pressure incon and adlescont, Petes 2017; 1403) Anti-Hypertensive Agents (AAP) ‘es ‘oe Seton tn pec . inevinru ich wergrfoe Se eee vein nee coosant ca tae vii ty tees sutintoe @ trees me wae iygecauiie psn, tommy me Sonane tererrnato 1g mi one teams inpgeciguning wyamaiy tec = Soewsarsn prs town saraar aun rpedsar oh evenness eeu —e 4 te dteptetnre 8 " Boss ~ mach > nas mis om wy csr ag one wee oie umeie dteplaetere tiemexanes cence ravarecat raeramitiet Bey suncor Mepurenaiinn tad aapgws Ingenta cojenaieey — teniaweteme ine a ‘ewe ag yan JT, ta. Cinizlpraciv gustne for seroonng and management ct high blood pressure chlton and adolescont Pesies 20171408) @ Treatment of primary and secondary hypertension in children General demographics of patients with either primary 7 hypertension (PH) or secondary hypertension (SH) Characteristic Primary Secondary ° hypertension hypertension value” e eH" GH Number of patients 45 13. NA ‘Aftican-American: 3 58:52:2:1 NA ‘Caucasian: Hispanic: Asian Female:male 26:19 52:61 NA Age at diagnosis 151.487.1 127.836.9 0.08 (months) e Distribution of age at diagnosis (%) (0-83 months 147 85.3 7 83-143 months 35.5 6a. 144+ months 312 oa8 ° Weight (ke) 75.3445 53.643.2 0.0003 Duration of follow-up 241431 23.3421 08 (months) Douglas M. Silverste oN Matti Vehaskart Diego H. Aviles Edward Champoux Treatment of primary and secondary hypertension in children » _ Response to therapy according to the class of anti-hypertensive agent {éssenta HEN: or PH. There are only's hited number Of smudies assesting. the characteristics and teatment ‘Strcacy of PH vor svondary HTN (SHD, We condacted ‘Steroopective aniysi of Ts pease pat ana ape 108 yess ex ratio S11 female, 8.9% male) with majority” wore either “Affican-American or Caucasian ‘Among all patioat, therapy induced a significa decrease innysolie Blood pressure (SDP) and ciswoke BP (DBP) {Goh p-0.0008, "Sam ps0 0001 and Dip 002) ‘with a body mass index (BMI) >9Sth pe Ngnifcantly higher posetherapy SBM tooth 203) than thowe with & BAI ‘380 20000 4a ~ "300 (oe: 306) & wera ue 980 49100, [72 — 00 (oan; 052) 7 womtmenvo 1120 34200 Ssh (25017801 fe « Saas (287; 1074 109.0% Newogemiy: Ferma? =t680,p

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