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Hypertension in the young

ESC Congress Report

  • Incidence of hypertension in children
  • Perform 24-hour monitoring and exclude secondary hypertension.
  • Cardiovascular risk in young subjects should be assessed as relative or lifetime risk.
Hypertension


View the Slides from this session in ESC Congress 365

The prevalence of hypertension in young people varies from country to country, but epidemiological data supports the hypothesis that hypertension is an increasing problem in young people, irrespective of their country of origin.
Data from the CARDIA study showed that elevated blood pressure in children is a predictor of the development of hypertension, and correlates with the presence of coronary artery calcification.

Prof. Thomas Maclennan MacDonald (Dundee, GB) explained that the non-treatment of hypertension in early age increases the probability of an earlier death from cardiovascular disease, and suggested that calculating the “life time risk” could be a better way to assess cardiovascular risk in young individuals.

Prof. D Maria Dorobantu (Bucharest, RO) believes that the best way to confirm the diagnosis of hypertension in children and young people is the use of 24-hour blood pressure monitoring; carefully considered diastolic blood pressure and the exclusion of common and uncommon causes of secondary hypertension. As the score used for global cardiovascular risk are mainly age dependent, organ damage and additional cardiovascular risk factors should be checked and the relative risks assessed. 

Prof Empar Lurbe (Valencia, ES) summarized the therapeutic strategies for treating hypertension in young people. Too few studies have evaluated the effect of antihypertensive drugs in young people and often drugs are used  “off label” in pediatrics. The presence of left ventricular hypertrophy, microalbuminuria or diabetes can help us make the decision to treat or not treat young patients.  In overweight youth, salt intake and reduced arterial elasticity are often associated with hypertension. In this case, central aortic pressure should be considered and non pharmacological therapy as first-line therapy or combined with drugs should always be discussed.

The last speaker focused on young women and hypertension. Prof Renata Cifkova (Prague, CZ) said there are three things we should take into consideration when treating young women with hypertension: the effect of different hormonal contraception on blood pressure; treatment in women with child-bearing potential and correctly diagnosing and treating the different pathological elevation of blood pressure which may occur during  pregnancy.

If we think that cardiovascular prevention is important, we should start as early as possible. There is a long way to go and further studies are needed to validate tools for assessing cardiovascular risk in subjects below 40, to identify the prognostic effect and safety of antihypertensive therapy started in early age, and understanding the correct timing for initiating drug therapy in young people.
 

References


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SessionTitle:

Hypertension in the young

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.