Joseph T Flynn

..Continued interest in neonatal hypertension has led to generation of new data on normal blood pressure (BP) values in neonates, identification of new causes of hypertension in the neonatal period, and improved insights into therapy...

..Since the number of such patients surviving to adulthood is increasing, strategies to reduce this risk are urgently needed...

..To compare the reliability of blood pressure (BP) readings obtained with an oscillometric device with those obtained by auscultation and assess for differences in BP status classification based on the 2 techniques...

..These findings emphasize unique aspects of childhood hypertension that should be considered when evaluating children and adolescents with elevated blood pressure and in designing future clinical trials...

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..In this review we present an updated approach to the outpatient management of hypertension in the child or adolescent, utilizing representative cases to illustrate important principles as well as possible controversies...

..Guidelines for use of antihypertensive medications, including choice of initial agent and how to prescribe appropriately, will be presented...

..Greater efforts are needed to identify and effectively treat hypertension in these vulnerable patients to reduce the future burden of adult cardiovascular disease...

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..In this study, the first trial of an antihypertensive agent conducted in children <6 years of age, valsartan effectively lowered SBP and diastolic blood pressure compared with placebo...

..The field of childhood hypertension has been changing rapidly since publication of the most recent consensus guidelines contained in the 2004 'Fourth Report'...

..This review will focus on the differential diagnosis of hypertension in the neonate, the optimal diagnostic evaluation, and therapy...

..Even in the absence of ideal normative data, ABPM can and should be widely applied, and a potential algorithm for such an approach is presented...

..We sought to determine if there are differences in clinical, laboratory, or echocardiographic characteristics among children with primary hypertension from different racial groups...

..Hence, among children with moderate chronic kidney disease, dyslipidemia is common and is associated with lower GFR, nephrotic proteinuria, and non-renal factors including age and obesity...

..Elevated BP was 10 times more frequent in obese minority youth, emphasizing the importance of screening for hypertension in this high-risk population...

..Treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may improve BP control in these patients...

..Our objective was to determine whether children with CKD and elevated BP (EBP) had decreased performance on neurocognitive testing compared with children with CKD and normal BP...

..Hypertension can be effectively managed with effective lifestyle change and medication when necessary...

..The authors conclude that isradipine effectively reduces BP in a wide variety of hospitalized children and adolescents with acute hypertension. A lower initial dose of 0.05 mg/kg may be appropriate in children younger than 2 years...

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..Decreased BMI and cardiovascular disease may be associated with increased mortality in children with HIV on RRT...

..The emphasis of management should be reduction of future cardiovascular risk...

..Future studies should focus on further defining the pathophysiology of primary hypertension in children, including the roles of renin and insulin resistance, so that improved methods of prevention and treatment can be developed...

..Therapy should begin with lifestyle modifications, but will often need to include one or more antihypertensive medications...

..Genetic testing for known mutations associated with resistance to immunosuppression may be advisable before treatment of SR-FSGS patients with cyclosporin. Prospective studies should be conducted to explore this hypothesis...

..We will also review additional information on outcome that has become available over the past decade...

..CONCLUSIONS: Amlodipine effectively lowers systolic BP in a dose-dependent manner in hypertensive children who require drug treatment...

..Children with CKD are known to be at increased cardiovascular risk. This study sought to identify cardiovascular risk factors associated with increased cIMT in children with CKD...

..To determine whether ambulatory blood pressure monitoring (ABPM) can help differentiate children with secondary hypertension from those with primary hypertension...

..These findings highlight the need for further studies to determine whether recommendations for treatment of hypertension in adults should be followed in children...

..Usually a combination of pharmacologic and nonpharmacologic measures will result in satisfactory control of hypertension while permitting a normal quality of life...

..Weight-adjusted CL/F and V/F of amlodipine in younger children were significantly greater than in older children, suggesting a need for higher doses when treating young children with amlodipine...

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..This paper discusses the possible causes, management and complications of recurrent chyloperitoneum...

..Given this, it may be more appropriate to treat severe hypertension in children with intravenous antihypertensive agents that can be titrated to produce controlled reductions in blood pressure...

..Wider use of NIVM-guided ultrafiltration may decrease cardiovascular morbidity in pediatric hemodialysis patients...

..Against this background, and with a strong emphasis on protection of this vulnerable patient population, a strict set of conditions for use of placebos in pediatric antihypertensive trials is proposed...

..Further studies are necessary to determine what effects if any long-term calcium channel blocker treatment has on the growth and development of children with hypertension...

..We conclude that isradipine successfully lowers BP in hypertensive children with secondary forms of hypertension. Use of isradipine suspension allows infants and young children to be treated as readily as older children...

..05). Current practice does not appear to follow recent consensus recommendations. Interventions designed to address the issues identified in this survey may lead to improved care for pediatric patients with HTN...

..65 infections per 1000 patient days after the switch to the closed connector (t = 0.04). The adoption of a closed connector system appeared to produce a significant reduction in bloodstream infections...

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..These data serve as the basis for new evidence-based guidelines. Modification of empiric therapy to include aminoglycosides should be considered...

..1 versus 5.1%, P = .008) and compared with the control subjects (2.6%, P < .001). CONCLUSION: As in adults, adolescents with T2DM exhibit abnormalities of ABP, dyslipidemia, and microalbuminuria...

..Adding PV-B19 testing of the donor and recipient to the standard pretransplant evaluation may be beneficial in diagnosing and managing a potential infection. If IVIg is to be used it may be safer to use a sucrose-free IVIg preparation...

..Strategies for reno-protection are discussed, and treatment recommendations are made for control of hypertension in this patient population...

..Investigators involved in such studies must ensure that the unique aspects of using antihypertensive drugs in children are adequately addressed...

..It may serve as an alternative method of administration to local instillation and may be used to restore patency before resorting to surgical revisions...

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