432
U N I T 5
Circulatory Function
aorta is another cause of hypertension in children and
adolescents. Endocrine causes of hypertension, such as
pheochromocytoma and adrenal cortical disorders, are
rare. Hypertension in infants is most commonly asso-
ciated with high umbilical catheterization and renal
artery obstruction caused by thrombosis.
65
Most cases
of essential hypertension are associated with obesity or
a family history of hypertension.
A number of drugs of abuse, therapeutic agents,
and toxins also may increase blood pressure.
60
Alcohol
should be considered as a risk factor in adolescents. Oral
contraceptives may be a cause of hypertension in ado-
lescent girls. The nephrotoxicity of the drug cyclospo-
rine, an immunosuppressant used in transplant therapy,
may cause hypertension in children (and adults) after
bone marrow, heart, kidney, or liver transplantation.
The coadministration of corticosteroid drugs appears to
increase the incidence of hypertension.
Diagnosis and Treatment.
Children 3 years of age
through adolescence should have their blood pressure
taken once each year.
58
The auscultatory method using
a cuff of an appropriate size for the child’s upper arm
is recommended.
58
Repeated measurements over time,
rather than a single isolated determination, are required
to establish consistent and significant observations.
Children with high blood pressure should be referred
for medical evaluation and treatment as indicated.
Treatment includes nonpharmacologic methods and, if
necessary, pharmacologic therapy.
High Blood Pressure in the Elderly
The prevalence of hypertension increases with advanc-
ing age to the extent that half of people aged 60 to 69
years and approximately three fourths of people 70
years and older are affected.
29
The age-related rise in
systolic blood pressure is primarily responsible for the
increase in hypertension that occurs with increasing age.
Pathogenesis and Risk Factors.
Among the aging
processes that contribute to an increase in blood pres-
sure are a stiffening of the large arteries, particularly
TABLE 18-5
The 90th and 95th Percentiles of Systolic and Diastolic Blood Pressure for Boys and Girls
1 to 16Years of Age by Percentiles for Height
Blood Pressure
Percentile
Height Percentile for Boys
Height Percentile for Girls
Age (yrs)
5th 25th 75th 95th 5th 25th 75th 95th
Systolic Pressure
90th
1
94
97
100
103
97
98
101
103
95th
98
101
104
106
100
102
105
107
90th
3
100
103
107
109
100
102
104
106
95th
104
107
110
113
104
105
108
110
90th
6
105
108
111
113
104
106
109
111
95th
109
112
115
117
108
110
113
115
90th
10
111
114
117
119
112
114
116
118
95th
115
117
121
123
116
117
120
122
90th
13
117
120
124
126
117
119
122
124
95th
121
124
128
130
121
123
126
128
90th
16
125
128
131
134
121
123
126
128
95th
129
132
135
137
125
127
130
132
Diastolic Pressure
90th
1
49
51
53
54
52
53
55
56
95th
54
55
58
58
56
57
59
60
90th
3
59
60
62
63
61
62
64
65
95th
63
64
66
67
65
66
68
69
90th
6
68
69
71
72
68
69
70
72
95th
72
73
75
76
72
73
74
76
90th
10
73
74
76
78
73
73
75
76
95th
77
79
81
82
77
77
79
80
90th
13
75
76
78
79
76
76
78
79
95th
79
80
82
83
80
80
82
83
90th
16
78
79
81
82
78
79
81
82
95th
82
83
85
87
82
83
85
86
The height percentile is determined using the newly revised CDC growth charts. Blood pressure levels are
based on data from the 1999–2000 National Health and Nutritional Examination Survey (NHANES) that have
been added to the childhood BP database.
From the National High Blood Pressure Education ProgramWorking Group on High Blood Pressure in
Children and Adults. Fourth report on the diagnosis, evaluation, and treatment of high blood pressure in
children and adolescents. Pediatrics. 2004;114:555–576.
