Fifty percent of children and adolescents who have chronic renal disease are hypertensive, and hypertension is not under control in 20–70% of these patients. Hypertension is found in 6.1% of children with neurofibromatosis-1, and this prevalence is higher compared with the general population ( 21).
In sleep apnea syndrome, which is another risk factor, the prevalence of increased blood pressure ranges between 3.6% and 14% ( 2, 20).
Individuals with type 2 diabetes carry a high risk in terms of end-organ damage because type 2 diabetes is associated with obesity. The prevalence of hypertension is 4–16% in children and adolescents with type 1 diabetes and 12–31% in children and adolescents with type 2 diabetes these prevalences are higher compared with the general population ( 2, 8, 18, 19). In addition, co-existence of hypertension and obesity increases cardiovascular risk factors (for example, dyslipidemia, disrupted glucose tolerance) ( 17). Excessive salt intake by diet is also an important risk factor especially for obese and overweight children ( 15, 16). The prevalence of hypertension is 4–14% in overweight children and 11–23% in obese children ( 11, 12). According to Turkish data, the prevalence of obesity increased from 0.6% in the period of 1990–1995 to 7.3% between 20 ( 14). According to data of the World Health Organization (WHO), there were 42 million obese or overweight children aged under 5 years worldwide in 2013 ( 12, 13). The frequency of hypertension increases in some conditions including obesity, sleep apnea syndrome, chronic renal disease, and prematurity ( 2, 11, 12). In these studies, the prevalence of hypertension in children aged between 6 and 15 years was found to range between 8.5% and 15%. There is a limited number of studies related to the epidemiology of childhood hypertension in Turkey ( 9, 10). It has been predicted that the prevalence of hypertension in childhood is 3.5%, and the prevalence of increased blood pressure (a blood pressure between the 90–94 percentiles or a blood pressure between 120/80 mm Hg and 130/80 mm Hg in adolescents) is between 2.2% and 3.5% ( 2). This article will discuss the approach to childhood hypertension in company with the current literature including mainly these two guidelines. Both guidelines created great reactions and were discussed in the scientific community.
The AAP guideline includes 30 key recommendations and 27 consensus opinions ( Appendix 1). The other is the American Academy of Pediatrics (AAP) guideline, which was updated in 2017 ( 3, 8).
The first is the European Society of Hypertension (ESH) guideline, which was constituted and published by the ESH in 2009 and updated in 2016 ( 1, 7). There are mainly two guidelines for childhood hypertension. In the light of these data, new studies related to childhood hypertension have been conducted, and hypertension guidelines have been updated in view of the information obtained ( 1, 2). The origins of hypertension in adulthood extend to childhood ages, and the frequency of increased blood pressure (BP) in adolescence progresses to hypertension by 7% yearly ( 5, 6). When adult data are examined, it can be observed that the frequency of hypertension, which is the most important risk factor and cause of mortality for cardiac diseases, reaches up to 40% after the age of 25 years ( 4). In recent years, the prevalence of hypertension has increased with the increase in the prevalence of overweight and obesity and change in eating habits in children and adolescents ( 1– 4).