Normative BP values are based on Age, Sex, and Height (check Harriet-Lane).
BP should be measured in all children >3yrs and in selected children <3yrs.
The younger the child and the higher the BP, the more likely there is a secondary cause.
Most common secondary causes:
1st year of life: RenoVascular anomalies and aortic coarctation.
Early childhood/school-aged kids: Renal Parenchymal Disease
Adolescents: Essential hypertension
25% of children that present with HTN requiring emergent management present with hypertensive encephalopathy (ie. it is a more common presentation of HTN in pediatrics than in adults).
Initial Work-up:
Upper and Lower Extremity BP measurement
BMP and U/A – look for renal disease
CBC – microangiopathic process c/w HUS?
References
Belsha, CW. Pediatric hypertension in the emergency department. Ann Emerg Med. 2008 Mar;51(3 Suppl):S21-3. Epub 2008 Jan 11.
