Novelty in hypertension in children and adolescents: focus on hypertension during the first year of life, use and interpretation of ambulatory blood pressure monitoring, role of physical activity in prevention and treatment, simple carbohydrates and uric acid as risk factors

Abstract

The present article intends to provide an update of the article "Focus on prevention, diagnosis and treatment of hypertension in children and adolescents" published in 2013 (Spagnolo et al., Ital J Pediatr 39:20, 2013) in this journal. This revision is justified by the fact that during the last years there have been several new scientific contributions to the problem of hypertension in pediatric age and during adolescence. Nevertheless, for what regards some aspects of the previous article, the newly acquired information did not require substantial changes to what was already published, both from a cultural and from a clinical point of view. We felt, however, the necessity to rewrite and/or to extend other parts in the light of the most recent scientific publications. More specifically, we updated and extended the chapters on the diagnosis and management of hypertension in newborns and unweaned babies, on the use and interpretation of ambulatory blood pressure monitoring, and on the usefulness of and indications for physical activity. Furthermore, we added an entirely new section on the role that simple carbohydrates (fructose in particular) and uric acid may play in the pathogenesis of hypertension in pediatric age.

Fig. 1

Percentiles of systolic and diastolic blood pressure from birth to 12 months of age Task Force on Blood Pressure Control in Children. Modified from Pediatrics 1987 [1]

Fig. 2

Differences between office and ambulatory blood pressure in children and adolescents Office blood pressure-ambulatory blood pressure differences in various subgroups of children (systolic values at left, diastolic values at right). a and b Groups defined by tertiles of age. Blue: low age tertile (4–10 years); red: medium age tertile (10–14 years); green: high-age tertile (14–18 years). c and d Groups defined by blood pressure status. Blue: normotensive patients (normal blood pressure in absence of treatment); red: treated hypertensive patients; green: untreated hypertensive patients. Numbers of patients in each subgroup are indicated in Table 1. The histograms represent means of the various types of differences listed at the bottom and bars represent _ SDs. Δ mmHg, differences in mmHg; 24-h ABP, 24-h mean of ambulatory blood pressure; dt-ABP, mean of daytime ambulatory blood pressure; nt-ABP, mean of night-time ambulatory blood pressure; OBP, office blood pressure. From Salice P. et al. [79] (permission required)

Fig. 3

Cardiovascular response to physical exercise according to type of exercise. a Response to dynamic exercise with progressively increasing workload up to maximal oxygen consumption. b Response to dynamic exercise (handgrip at 30 % of the maximal voluntary contraction). VO2 (ml/min/kg): oxygen consumption; HR (bpm): Heart Rate; SV (ml/beat): Stroke Volume; ABP (mmHg): systolic, diastolic and mean blood pressure; TPR (PRU): Total Peripheral Resistance (expressed in Peripheral Resistance Unit) http://content.onlinejacc.org/data/Journals/JAC/23038/02015.pdf