PEDIATRIC HYPERTENSION - THE ROLE OF THE GENERAL PRACTITIONER IN HIGHLIGHTING A SILENT DISEASE

Abstract

Blood Pressure (BP) assessment within Primary Health Care (CSP) surveillance consultations results from the recognition of a growing importance of Hypertension (HTN) problematic at a young age. Hypertension is defined by systolic and / or diastolic BP above the 95th percentile (P). Secondary hypertension is more frequent in pre-adolescent children and the main etiology are renal causes. Due to treatable cause of hypertension, early diagnosis and treatment are essential. We present a case of an asymptomatic pre-adolescent (12 years old), who, in the CSP surveillance consultation presented blood pressure values ​​of 120/70 mm Hg (systolic and diastolic TA> 5 mm Hg from P99). The personal background showed episodes of feverish urinary tract infections during the first 3 years of life; from family background,  obesity, hypertension and kidney stones are highlighted . Physical examination, besides high value of BP, which was maintained in outpatient control the following days. Renal ultrasound revealed asymmetry, with globose dimensions on right kidney (RD) and smaller dimensions on left kidney (ER), irregular contours and cortical structure irregularities (sequelae of inflammatory processes ). She was referred to Pediatric Nephrology consultation, where complemented the investigation of secondary causes of HTN. The renal scintigram showed ER of reduced dimensions and with marked hypofunction (12.63%), increased dimensions on RD (87.37%) and bilateral cicatricial lesions; serial voiding cystouretrography revealed bilateral grade IV vesicourethral reflux, which was corrected. Started antihypertensive therapy with ramipril, with difficulty in tension control confirmed by ABPM. Currently being followed at Pediatric Nephrology consultation, medicated with ramipril 5 + 5 mg, cholecalciferol and oral iron. Due to treatment resistance, nephrectomy is considered. Parenchymal kidney disease is a frequent cause of child hypertension, whose prognosis depends on early treatment. This show the importance of systematic BP assessment in child health consultations. When identified, the disease must be investigated and adequately treated.