1. Investigations: Urine examination. Urine examination. Serum K. Serum K. Serum creatinine. Serum creatinine. Blood Sugar. Blood Sugar. Hb. Hb.

2. Investigations: Serum uric acid. Serum uric acid. Lipid profile. Lipid profile. ECG. ECG. Fundus. Fundus. More extensive investigations are needed in secondary hypertension. More extensive investigations are needed in secondary hypertension.

3. BP levels above which hypertension in child should be considered:

4. Common causes of hypertension according to age

5. Evaluation of asymptomatic hypertensive child:

6. Pediatric doses of anti hypertensive drugs:

7. Substances that can elevate BP

8. Why to treat HTN? –52%  in CHF –35-40%  in stroke morbidity and mortality –35%  in LVH –20-25%  CAD events –21%  vascular mortality

9. Benefits of Lowering BP Sustaining a 12 mmHg reduction in SBP over 10 years will prevent one death for every 11 patients treated with Stage I HTN w/additional CVD risk factors Sustaining a 12 mmHg reduction in SBP over 10 years will prevent one death for every 11 patients treated with Stage I HTN w/additional CVD risk factors

10. JNC-7 Management of BP for Adults BP classification NormalPrehypertension Stage I HTN Stage II HTN Lifestyle  EncourageYesYesYes No compelling indication No drug tx Thiazide for most 2 drug combo including thiazide Compelling indication Drugs targeted for the compelling indications < 120/80 120-139 / 80-89 140-159 / 90-99 > 160 / > 100

11. Treatment Outline Goals of Therapy Goals of Therapy Lifestyle modification Lifestyle modification Pharmacologic treatment Pharmacologic treatment Follow-up and monitoring Follow-up and monitoring

12. Goals of Therapy Reduce CVD and renal morbidity and mortality Reduce CVD and renal morbidity and mortality Treat to BP < 140/90 mmHg or BP <130/80 mmHg in patients with DM or less in patients with chronic KD Treat to BP < 140/90 mmHg or BP <130/80 mmHg in patients with DM or less in patients with chronic KD

13. Goals of Therapy Achieve BP goal especially in persons > 50 years of age Achieve BP goal especially in persons > 50 years of age Maintain QOL Maintain QOL Minimize side effects Minimize side effects

14. Lifestyle Modification Modification Approx. SBP reduction (mmHg) Weight reduction Adopt DASH diet Dietary Na+ restriction Physical activity Moderation of alcohol consumption 5 – 10 / 10 kg 8 – 14 2 – 8 4 – 9 2 – 4 http://hin.nhlbi.nih.gov/nhbpep_slds/menu.htm

15. Lifestyle Modification Works best in motivated individuals Works best in motivated individuals Initiate at prehypertension classification Initiate at prehypertension classification Obesity  risk for HTN and DM Obesity  risk for HTN and DM If > 20% over ideal body weight (IBW) – considered obese If > 20% over ideal body weight (IBW) – considered obese –Decrease intake by 500 cal/day –Increase exercise and activity

16. One KG decrease in BW is accompanied by reduction of 1.6 and 1.3 mmHg in systolic and diastolic BP.

18. Salt sensitivity is more common in: Elderly. Elderly. Blacks. Blacks. Type 1 diabetes. Type 1 diabetes. Secondary hypertension. Secondary hypertension.

19. Guidelines for moderate salt restriction:

20. Dietary potassium: Diet rich in fruits and vegetables is superior to pills. Diet rich in fruits and vegetables is superior to pills. Potassium supplements should be avoided in: renal insufficiency, with diuretics, ACE inhibitors or ARBs. Potassium supplements should be avoided in: renal insufficiency, with diuretics, ACE inhibitors or ARBs.

21. Food rich in potassium: