高血压英文课件Pediatric

Pediatric hypertension Supervisor:VS.邱元佑 Speaker :Int.謝宜勳.Pediatric hypert1Case informationPatient 1Patient 2Age/Gender13 y/o,male17 y/o,maleDiagnosis2003/11Nephrotic syndrome2003/11/27Prednisolone(5)4#tid1997:IgA nephropathy2003/10:ESRD s/p CAPDHypertensiononset2003/12/112003/8:hypertension2003/12/10:hypertensive crisis.Case informationPatient 1Patie2Review:Pediatric hypertension-Definition-Etiology-Clinical manifestation-Treatment.Review:Pediatric hypertensi3DefinitionlTask Force on Blood Pressure Control in Children (National Heart,Lung,and Blood Institute&National Institutes of Health)lAge,sex and heightlObesity important independent risk.DefinitionTask Force on Blood 4Measurement of BP in Children.Measurement of BP in Children.5Measurementlstandard mercury sphygmo-manometer right arm bladder width:40%of the circumference of the arm cuff size covered 80%to 100%of the circumference of the arm.Measurementstandard mercury sp6Pediatrics 1996,98(4):649-58.Pediatrics 1996,98(4):649-587.8systolic or diastolic BPNormal 95th%.systolic or diastolic BPNormal9EtiologylPrimary hypertensionlSecondary hypertension.EtiologyPrimary hypertension.10Primary hypertensionlEssential hypertensionlOften in adolescentlfamily historylMulti-factorial cause:-heredity,obesity,diet and stress -genetic alterations in Ca&Na transport -insulin resistance -vascular smooth muscle reactivity -renin-angiotensin system dysfunction.Primary hypertensionEssential 11Prenatal cause (1)children with intrauterine growth retardation(IUGR)had significantly higher mean values of systolic,diastolic,and mean blood pressure Fattal-Valevski A,Bernheim J,Leitner Y,et al.:Blood pressure values in children with intrauterine growth retardation.Isr Med Assoc J 2001;3:805808.(2)intrauterine environment In women:resting SBP4.27 mm Hg and DBP 2.18 mm Hg per kilogram increase in birth weight in men:no associations!Loos RJ,Fagard R,Beunen G,et al.:Birth weight and blood pressure in young adults:a prospective twin study.Circulation 2001;104:16331638.Prenatal cause (1)children 12Secondary hypertensionlMost common in the period of infant and younger childrenlUnderlying disease:-Renal and renovascular disease -coarctation of the aorta -endocrine disorder -medication.Secondary hypertensionMost com13Conditions Associated with Transient or Intermittent Hypertension in Children.Conditions Associated with.14RENAL lAcute postinfectious glomerulonephritislAnaphylactoid(Henoch-Schnlein)purpura with nephritislHemolytic-uremic syndromelAcute tubular necrosislAfter renal transplantation After blood transfusion in patients with azotemialHypervolemialAfter surgical procedures on the genitourinary tractlPyelonephritislRenal traumalLeukemic infiltration of the kidneylObstructive uropathy associated with Crohn disease.RENAL.15DRUGS AND POISONS lCocainelOral contraceptiveslSympathomimetic agentslAmphetamineslPhencyclidinelCorticosteroids and adrenocorticotropic hormonelCyclosporine or sirolimus treatment post-transplantationlLicorice(glycyrrhizic acid)lLead,mercury,cadmium,thalliumlAntihypertensive withdrawal(clonidine,methyldopa,propranolol)lVitamin D intoxication.DRUGS AND POISONS.16lCENTRAL AND AUTONOMIC NERVOUS SYSTEM lIncreased intracranial pressurelGuillain-Barr syndromelBurnslFamilial dysautonomialStevens-Johnson syndromelPosterior fossa lesionslPorphyrialPoliomyelitislEncephalitis.CENTRAL AND AUTONOMIC NERVOUS 17 Conditions Associated with Chronic Hypertension in Children.Conditions Associated with 18lRENAL lChronic pyelonephritislChronic glomerulonephritislHydronephrosislCongenital dysplastic kidneylMulticystic kidneylSolitary renal cystlVesicoureteral reflux nephropathylSegmental hypoplasia(Ask-Upmark kidney)lUreteral obstructionlRenal tumorslRenal traumalRejection damage following transplantationlPostirradiation damagelSystemic lupus erythematosus(other connective tissue diseases).RENAL.19lVASCULAR lCoarctation of thoracic or abdominal aortalRenal artery lesions(stenosis,fibromuscular dysplasia,thrombosis,aneurysm)lUmbilical artery catheterization with thrombus formationlNeurofibromatosis(intrinsic or extrinsic narrowing of vascular lumen)lRenal vein thrombosislVasculitislArteriovenous shuntlWilliams-Beuren syndromelMoyamoya disease.VASCULAR.20lENDOCRINE lHyperthyroidismlHyperparathyroidismlCongenital adrenal hyperplasia(11-hydroxylase and 17-hydroxylase defect)lCushing syndromelPrimary aldosteronismlDexamethasone-suppressible hyperaldosteronismlPheochromocytomalOther neural crest tumors(neuroblastoma,ganglioneuroblastoma,ganglioneuroma)lDiabetic nephropathylLiddle syndrome.ENDOCRINE.21lCENTRAL NERVOUS SYSTEM lIntracranial masslHemorrhagelResidual following brain injurylQuadriplegia.CENTRAL NERVOUS SYSTEM.22Clinical manifestationlEssential HTN:-asymptomatic -mild BP elevation -mild to moderate obesity .Clinical manifestationEssentia23lSecondary HTN:-mild to severe BP elevation -not usually produce symptoms(headache,dizziness,epistaxis,anorexia,visual change)-underlying disease -hypertensive encephalopathy:vomiting,temperature,ataxia,stupor and seizure -End-organ(cardiac and renal)dysfunction.Secondary HTN:.24TreatmentGoal:Blood pressure below 95 th percentileaccording to age,sex and height.TreatmentGoal:.25Treatment of essential HTNlNon-pharmacologic therapy:-weight reduction -sodium intake reduction -aerobic exercise -No tobacco and alcohol.Treatment of essential HTNNon-26Treatment of essential HTNlPharmacologic therapyl diuretics volume-dependent HTNl-blocking agent high-renin high cardiac output HTNlCCBlACE-I .Treatment of essential HTNPhar27Treatment of secondary HTNOveractivity of RAAS-blocking agentACE-IAldosterone antagonistRenovascular or renal parenchymal dzACE-IRenal vessel thrombus angioCaptoprilNeural crest tumor+-blocking agentLabetalolHigh dose of cocainelabetalol.Treatment of secondary HTNOver28Treatment of hypertensive crisislStepwise reduction:first 6 hr 1/3 total planned reduction BP following 48-72 hr 2/3lIntravenous administrationlLabetalollNitroprussidelSublingual nifedipine.Treatment of hypertensive cris29.30Reference 1.Nilson 17th ed.Novaritis;1997:p1592-15982.Joseph D.Kay,Alan R.Sinaiko.Pediatric hypertension.Am Heart J 2001;142:422-33.National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents.Update on the 1987 task force report on high blood pressure in children and adolescents:a working group report from the National High Blood Pressure Education Program.Pediatrics 1996;98:649-58.4.Albert P.Rocchini.Pediatric hypertension 2001.Current Opinion in Cardiology 2002,17:3853895.Loos RJ,Fagard R,Beunen G,et al.:Birth weight and blood pressure in young adults:a prospective twin study.Circulation 2001;104:16331638.6.Umbereen S.Nehal and Julie R.Ingelfinger.Pediatric hypertension:recent literature.Current Opinion in Pediatrics 2002,14:189196.Reference Nilson 17th ed.Nova31