Paediatrics: Hypertension: Free MSRA Podcast

🩺 FREE MSRA PODCAST – Hypertension in Children: Silent But SeriousHow do you actually diagnose hypertension in children? Why is it so often missed, and what makes paediatric cases different to adults? In this focused deep dive, we cut through the noise and give you the essential knowledge – causes, risk factors, red flags, investigation, management, and complications – all mapped to the MSRA and UK paediatrics guidelines.🧠 Key Learning Points📌 Definition & Diagnosis• Hypertension in children = BP ≥95th percentile for age, sex, and height, on 3+ occasions• Pre-hypertension = 90th–95th percentile• Always use correct cuff size – too small gives false highs• Confirmed by auscultation; consider white coat and masked hypertension• Ambulatory or home monitoring if needed📌 Causes• Secondary hypertension = most common in children (up to 85%) – Renal disease (most common overall) – Cardiac (e.g. coarctation of aorta) – Endocrine (Cushing’s, hyperthyroid, CAH) – Medications/substances (steroids, amphetamines, cocaine, decongestants) – Sleep apnoea, pheochromocytoma, rheumatological conditions• Primary hypertension becomes more common in adolescents, usually linked to obesity📌 Risk Factors• High salt diet• Obesity• Low birth weight + catch-up growth• Family history of hypertension/early CVD• Male sex• Maternal smoking in pregnancy• Breastfeeding is protective📌 Mnemonic – Remember the "3 R’s":• Renal (most common)• Risk factors (obesity, family, diet)• Repeated readings (≥95th percentile, 3 times)📌 Clinical Features• Often asymptomatic!• If symptoms: headache, blurred vision, dizziness, fatigue, nosebleeds• Signs of end organ damage can be present even in childhood: LVH, retinopathy, renal impairment, cognitive changes📌 Key Physical Exam Tips• Measure BP in both arms• Check lower limb pulses (radiofemoral delay for coarctation)• Look for: café-au-lait spots (neurofibromatosis), abdominal mass/bruit (Wilms tumour, renal artery stenosis), Cushingoid features, virilisation, skin changes📌 Investigations3 Goals:Find the cause: Urinalysis, U&Es/creatinine (for CKD), renal US, specific hormone/metabolic screensComorbidities: Lipids, glucose, drug screen, sleep study (if OSA suspected)Organ damage: ECG, echocardiogram, retinal exam• Special: Plasma renin/aldosterone (differentiates renal vascular vs hyperaldosteronism), 24-hr urine, advanced imaging if indicated📌 Management• Lifestyle modification: Diet, weight loss, exercise, reduce salt, stop smoking/alcohol• Treat underlying cause if found• Medication if: symptomatic, secondary cause, organ damage, diabetes, or unresponsive to lifestyle – ACE inhibitors, beta blockers, CCBs, thiazide diuretics – Minoxidil for refractory cases• Hypertensive crisis: Emergency! IV antihypertensives (nifedipine, labetalol, sodium nitroprusside, clevidipine), lower BP gradually over 48h – Anticonvulsants do not fix BP-related seizures – treat the hypertension📌 Complications• Left ventricular hypertrophy & heart failure• CKD/renal failure• Retinopathy & vision loss• Stroke• Cognitive impairment• Persistence into adult life → ↑ risk of CVD📎 More MSRA Revision Resources for Hypertension in Children:📝 Revision Notes: https://www.passthemsra.com/topic/hypertension-in-children-revision-notes/🧠 Flashcards: https://www.passthemsra.com/topic/hypertension-in-children-flashcards/💬 Accordion Q&A: https://www.passthemsra.com/topic/hypertension-in-children-accordion-qa-notes/🚀 Rapid Quiz: https://www.passthemsra.com/topic/hypertension-in-children-rapid-quiz/🎓 Paediatrics Course: https://www.passthemsra.com/courses/paediatrics-for-the-msra/#MSRA #Hypertension #Paediatrics #MSRARevisionNotes #ChildhoodHypertension #MSRAQuiz #MSRAFlashcards #MSRAAccordions #Obesity #RenalDisease #Coarctation #UKGuidelines #HighYield