Pediatric Systemic Hypertension Risk Factors, Complications, Management, and Longitudinal Multidisciplinary Follow-up

The presence and identification of systemic arterial hypertension (hypertension, HTN) in pediatric age has become increasingly relevant in recent years as a consequence of the increase in its prevalence, linked to the change in health determinants witnessed since the late 1970s, such as sedentariness and increased overweight.

In view of the epidemiological consistency of HTN in pediatric age with the possible complications and repercussions in later ages as well, and the economic burden of the management of this patient beginning in early life, both European and North American Guidelines for the child and adolescent on the identification of the individual at risk for HTN and his or her behavioral-pharmacological therapeutic management have been published.

The prevalence of HTN is about 3.5%, while that of elevated blood pressure (BP) is between 2.2 and 3.5% depending on the studies and the population considered, highest in overweight and obese subjects, in whom HTN affects up to 25 percent of subjects, with an increasing incidence trend since the 1980s until reaching a plateau in recent years, consensual with that of obesity. These data underscore the existence of a linear correlation between obesity, metabolic syndrome, and increased blood pressure. Other known conditions that increase the risk of HTN occurrence are prematurity, type 1 diabetes, nephro-vascular and renal diseases with chronic nephropathy, and sleep disorders. Guidance on the definition, diagnosis, and management is provided not only for pathological hypertension but also for high blood pressure values: it has, in fact, been shown that even blood pressure values that are not frankly pathological but nonetheless high can cause organ damage and tend to increase and become pathological within 2 years if left untreated.Longitudinal study cohorts initiated in the 1970s-1980s in both Europe (Young Finns Study) and North America (Framingham Heart Study, Bogalusa Heart Study) have shown that hypertension and cardiovascular (CV) risk factors already present in pediatric age increase CV morbidity and mortality in adults as in a progression of the march of disease. Considering the cardiovascular risk both in the short and long term to which a child diagnosed with systemic hypertension or with normal-to-high blood pressure values is exposed, and the interdependence with metabolic syndrome, endocrine and chronic nephrological pathologies, there is a clear need to identify as early as possible those at higher risk of developing HTN and to appropriately follow up those with elevated blood pressure through early and personalized multidisciplinary interventions. The possibility of recording even longitudinally the evolution of 'possible multidistrict organ damage and its response to treatment could allow us to always modulate therapeutic intervention from the very early stages of the disease and even before the appearance of pathological values. This type of approach would allow us to reduce CV mortality and morbidity even in later ages. The present study is intended to describe the phenomenon of pediatric hypertension with a multidisciplinary approach (cardiovascular, endocrinological and metabolic, and nephrological), with the aim of making the diagnostic-therapeutic-care pathway more effective.