高血压英文ppt精品课件pediatric

Pediatric hypertension Supervisor : VS. 邱元佑 Speaker : Int. 謝宜勳 Case information Patient 1 Patient 2 Age/Gender 13 y/o, male 17 y/o, male Diagnosis 2003/11 Nephrotic syndrome 2003/11/27 Prednisolone(5) 4# tid 1997: IgA nephropathy 2003/10: ESRD s/p CAPD Hypertension onset 2003/12/11 2003/8: hypertension 2003/12/10: hypertensive crisis Review: Pediatric hypertension - Definition - Etiology - Clinical manifestation - Treatment Definition l Task Force on Blood Pressure Control in Children ( National Heart, Lung, and Blood Institute 3:805808. (2) intrauterine environment In women: resting SBP4.27 mm Hg and DBP 2.18 mm Hg per kilogram increase in birth weight in men: no associations! Loos RJ, Fagard R, Beunen G, et al.: Birth weight and blood pressure in young adults: a prospective twin study. Circulation 2001;104:16331638 Secondary hypertension l Most common in the period of infant and younger children l Underlying disease: - Renal and renovascular disease - coarctation of the aorta - endocrine disorder - medication Conditions Associated with Transient or Intermittent Hypertension in Children RENAL l Acute postinfectious glomerulonephritis l Anaphylactoid (Henoch-Schnlein) purpura with nephritis l Hemolytic-uremic syndrome l Acute tubular necrosis l After renal transplantation After blood transfusion in patients with azotemia l Hypervolemia l After surgical procedures on the genitourinary tract l Pyelonephritis l Renal trauma l Leukemic infiltration of the kidney l Obstructive uropathy associated with Crohn disease DRUGS AND POISONS l Cocaine l Oral contraceptives l Sympathomimetic agents l Amphetamines l Phencyclidine l Corticosteroids and adrenocorticotropic hormone l Cyclosporine or sirolimus treatment post- transplantation l Licorice (glycyrrhizic acid) l Lead, mercury, cadmium, thallium l Antihypertensive withdrawal (clonidine, methyldopa, propranolol) l Vitamin D intoxication l CENTRAL AND AUTONOMIC NERVOUS SYSTEM l Increased intracranial pressure l Guillain-Barr syndrome l Burns l Familial dysautonomia l Stevens-Johnson syndrome l Posterior fossa lesions l Porphyria l Poliomyelitis l Encephalitis Conditions Associated with Chronic Hypertension in Children l RENAL l Chronic pyelonephritis l Chronic glomerulonephritis l Hydronephrosis l Congenital dysplastic kidney l Multicystic kidney l Solitary renal cyst l Vesicoureteral reflux nephropathy l Segmental hypoplasia (Ask-Upmark kidney) l Ureteral obstruction l Renal tumors l Renal trauma l Rejection damage following transplantation l Postirradiation damage l Systemic lupus erythematosus (other connective tissue diseases) l VASCULAR l Coarctation of thoracic or abdominal aorta l Renal artery lesions (stenosis, fibromuscular dysplasia, thrombosis, aneurysm) l Umbilical artery catheterization with thrombus formation l Neurofibromatosis (intrinsic or extrinsic narrowing of vascular lumen) l Renal vein thrombosis l Vasculitis l Arteriovenous shunt l Williams-Beuren syndrome l Moyamoya disease l ENDOCRINE l Hyperthyroidism l Hyperparathyroidism l Congenital adrenal hyperplasia (11 -hydroxylase and 17- hydroxylase defect) l Cushing syndrome l Primary aldosteronism l Dexamethasone-suppressible hyperaldosteronism l Pheochromocytoma l Other neural crest tumors (neuroblastoma, ganglioneuroblastoma, ganglioneuroma) l Diabetic nephropathy l Liddle syndrome l CENTRAL NERVOUS SYSTEM l Intracranial mass l Hemorrhage l Residual following brain injury l Quadriplegia Clinical manifestation l Essential HTN: - asymptomatic - mild BP elevation - mild to moderate obesity l Secondary HTN: - mild to severe BP elevation - not usually produce symptoms (headache, dizziness, epistaxis, anorexia, visual change) - underlying disease - hypertensive encephalopathy: vomiting, temperature, ataxia, stupor and seizure - End-organ (cardiac and renal ) dysfunction Treatment Goal: Blood pressure below 95 th percentile according to age, sex and height Treatment of essential HTN l Non-pharmacologic therapy: - weight reduction - sodium intake reduction - aerobic exercise - No tobacco and alcohol Treatment of essential HTN l Pharmacologic therapy l diuretics volume-dependent HTN l -blocking agent high-renin high cardiac output HTN l CCB l ACE-I Treatment of secondary HTN Overactivity of RAAS -blocking agent ACE-I Aldosterone antagonist Renovascular or renal parenchymal dz ACE-I Renal vessel thrombus angio Captopril Neural crest tumor + -blocking agent Labetalol High dose of cocaine labetalol Treatment of hypertensive crisis l Stepwise reduction: first 6 hr 1/3 total planned reduction BP following 48-72 hr 2/3 l Intravenous administration l Labetalol l Nitroprusside l Sublingual nifedipine Reference Nilson 17th ed. Novaritis; 1997 : p1592-1598 Joseph D. Kay, Alan R. Sinaiko. Pediatric hypertension. Am Heart J 2001;142:422- 3 National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Update on the 1987 task force report on high blood pressure in children and adolescents: a working group report from the National High Blood Pressure Education Program. Pediatrics 1996;98:649-58. Albert P. Rocchini. Pediatric hypertension 2001. Current Opinion in Cardiology 2002, 17:385389