Adolescents hypertension

Children and adolescents stage 1 hypertension is classified by blood pressure levels that range from the 95th percentile to 5 mm Hg above the 99th percentile. 

The adverse effects of TCAs are also similar to those reported in adults (see Chapter 7). The secondary amine TCAs (e.g., desipramine, nortriptyline) are generally as well tolerated as newer antidepressants. Increased blood pressure may be more likely to occur in children than in adults but hypertension per se is rare ( 135). The most common cardiovascular effect is mild tachycardia. Despite their generally favorable adverse effect profile, secondary amine TCAs can cause serious toxicity in children and adolescents just as in adults when a taken in an overdose or when a high TCA plasma level occurs as a result of slow metabolism ( 136). For that reason, most clinicians reserve TCAs for the child or adolescent who has at least a moderate depressive disorder unresponsive to a trial of one or more newer antidepressants. In such instances, TDM should be done at least once to ensure plasma concentrations greater than 450 ng/mL do not develop ( 137). Such levels are associated with an increased risk of the following ... 

The chance that an obese child will become an obese adult is estimated to increase from approximately 20% if overweight at age 4 years to approximately 80% if overweight during adolescence (Guo and Chumlea, 1999). Patients who are overweight are at a higher risk for type 2 diabetes, hypertension, and dyslipidemia. 

Ssalt-sensitive people tend to develop hypertension with an intake of 125 to 250 mmol of Na per day, whereas salt-resistant people may not have a rise in blood pressure with up to 500 irunol of Na per day. Very large amounts of Na (800 mmol/day) lead to hypertension in both salt-sensitive and -insensitive people. It has been estimated that close to 20% of adult Americans lire salt sensitive. African-Americans have a greater incidence of Na sensitivity and hypertension than Americans of European descent. Generally, blood pressure tends to increase with age in salt-sensitive individuals consuming mrrderate or high levels of sodium. The prevalence of hypertension is very low in children and adolescents. The interracial differences in blood pressure that are found in adults arc not found among children (Sinaiko, 1996). 

Lombaert A, Carton H. Benign intracranial hypertension due to A-hypervitaminosis in adults and adolescents. Eur Neurol 1976 14(5) 340-50. 

Blood Pressure Education Program. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Pediatrics 1996 98 649-658. 

Lettgen, B., Wagner, S., Hanze,J., Lang, R.E. Rascher, W. (1994) Elevated plasma concentration of neuropeptide Y in adolescents with primary hypertension. J. Hum. Hypertens. 8, 345-349. 

In this preantimicrobial era large city hospital patients as recently as 1930 consisted primarily of those with bacteremia, endocarditis, syphilis, rheumatic fever, and tuberculosis, diseases for which no meaningful treatment existed. Tragically, large segments of these patients were children and adolescents—most of whom would die. Today the great preponderance of patients in the hospitals of the industrial countries suffer from cancer, heart diseases, and diabetes-related hypertension and its consequences. 

In 3000 autopsies of persons aged 15-34 whose deaths were caused by either accident, homicide, or suicide, the extent of fatty streaks and raised lesions in the right coronary artery (RCA) and abdominal aorta positively correlated with high-density lipoprotein cholesterol (HDL-C), hypertension, impaired glucose tolerance (IGT), and obesity. Because they also were associated negatively with HDL-C and positively with smoking for atherosclerosis of the abdominal aorta, controlling risk factors should start in adolescence (8). 

Observational studies In an open singledose study of valsartan in children and adolescents with hypertension, only minor adverse effects (such as headache) were recorded there were no serious adverse events or clinically significant laboratory results [58 ]. 

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