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Nandini Sodha1, Rajshree Rajurkar2, Gunjan Kela3
1, 2, 3 Department of Paediatrics, Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India.
CORRESPONDING AUTHOR
Dr. Gunjan Kela, Vijay Nagar, Opposite Apollo Rajshri Hospital, Indore, Madhya Pradesh, India.
Email : drgunjankela@yahoo.com
ABSTRACT
BACKGROUND
We wanted to study the clinical and aetiological profile of hypertension in children and compare the results with previous studies done in paediatric hypertension among children between 3 and 15 years of age.
METHODS
All children between 3 and 15 years of age who visited the Outpatient & Inpatient Department of Paediatrics, SAIMS were screened for the presence of hypertension. Systematic investigations were done to find out the aetiology of hypertension.
RESULTS
Maximum number of patients were in the age group of 3 to 9 years, followed by 12 to 15 years and 9 to 12 years age groups. Males were affected more. Nephrotic syndrome was the commonest cause of hypertension in children.
CONCLUSIONS
In this study, it has been observed that minimum number of patients were in age group 9 - 12 years patients (19.3 %) and maximum number of patients were in the age group 3 - 9 years (51.6 %) with a M : F ratio of 1 : 0.93. and the main aetiology of hypertension was found to be nephrotic syndrome.
KEY WORDS
Childhood Hypertension, Nephrotic Syndrome, Post Streptococcal Glomerulonephritis, Headache
BACKGROUND
There is a gradual increase in hypertension among children. Early cardiovascular and renal morbidity and mortality are seen in children with childhood hypertension along with damage to the end organs and hypertensive encephalopathy. In most of children, hypertension accompany with underlying disorder. Hypertension can be present for the first time without features of a cardiovascular or renal disorder. The prevalence of paediatric population hypertension was examined at 1963. In most of the studies the range is from 1 to 5 percent. As high as 10 percent prevalence is reported for some of the geographic areas.
METHODS
This is a cross-sectional study. Children between 3 and 15 years of age who visited the outpatient & inpatient Department of Paediatrics, SAIMS, Indore, were screened for the presence of hypertension between June 2012 to June 2015. Hypertension was classified according to fourth report. Systematic investigations were done to find out the aetiology of hypertension.
Exclusion Criteria
Age < 3 yrs. or age above 15 yrs.
Methodology
Ethical clearance for this study was obtained from Institutional Ethical Committee before commencement of study. After explaining the intent of this study, its objective & its methodology to the parents of all children who were included in the study a written consent from parents / guardian accompanied were taken. All children coming to the outpatient & inpatient Department of Paediatrics at Sri Aurobindo Institute of Medical science and Post graduate Institute Indore, between June 2012 to June 2015 were screened for the presence of hypertension.
Statistical Analysis
All the data were collected and analysed using Microsoft Excel and EPI Info software 3.4.3. Results were calculated using percentages.
RESULTS
Blood pressure was measured, BMI of all patients was calculated and a predesigned proforma was filled which included the details about each patient.
Age Distribution
Maximum number of patients were in age group of 3 to 9 (total 15 patients) 48.3 %. Second maximum number of patients were age group of 12 to 15 yrs. (total 10 patients) 32.2 %. On age group of 9 to 12 yrs. (total 6 patients) 19.3 %.
Figure 4. Distribution Based on Clinical Presentation
Sex Distribution (N = 31)
In the study out of 31 patients, 15 were female patients (48.3 %) and 16 male patients (51.6 %), with overall sex ratio of 1 : 0.93 (male : female).
BMI Distribution
In the study maximum number of patients were underweight, 28 patients (90.3 %) with BMI < 18.5, followed in frequency with 2 patients (6.4 %) having BMI 18.5 - 25, one patient having BMI > 25.
Clinical Presentation (N = 31)
In the study the commonest symptom was generalized oedema in 20 patients (64.5 %), fever in 15 patients (48.3 %), decreased urine output in 12 patients (38.7 %), vomiting in 10 patients (32.2 %), headache in 7 patients (22.5 %), cough & cold in 5 patients (16.1 %), rashes in 4 patients (12.9 %), blurring of vision in 3 patients (9.6 %), altered sensorium in 2 patients (6.4 %) and abdominal pain in one patient.
Aetiology of Hypertension
Nephrotic syndrome was found as the most common cause & found in 8 patients (25.8 %), followed by post streptococcal glomerular nephritis in 7 patients (22.5 %), 4 patients (12.9 %) had chronic kidney disease, 4 patients (12.9 %) of renal artery stenosis, SLE (Systemic Lupus Erythematosus) was found in 2 patients (6.4 %), others had uncommon causes like Henoch-Schonlein purpura nephritis seen in 3 patients (9.6 %) & 1 patient (3.2 %) with juvenile dermatomyositis.
Figure 5. Distribution Based of Aetiology
DISCUSSION
Verma et al,1 did a study in 1995 in Punjab city to evaluate the profile of BP in school children between the age of 5 to 15 years, their study concluded that blood pressure showed an abrupt increase in age between 11 - 13 years in girls whereas in boys this increase seen between 12 and 13 years. In comparison to Verma et al and our study the BP was mainly seen between the age group 3 - 9 years in both the sexes. There after there was maximum number of patients were in age group 12 - 5 years but there was no such difference found in blood pressure rise in both the sexes.
Krishna et al2 did a study in children of age group 3 - 18 years, and their study conclude maximum number of children having hypertension was of age group 14 years and minimum number of children in age group 4 - 5 years were found to be hypertensive.In comparison to Krishna et al my study had maximum number of children who were hypertensive in age group 3 - 9 years, followed by children of age between 12 to 15 years.
Durrani et al3 did a study among 701 school going children in Aligarh in age group 12 - 16 years. In his study highest prevalence of children with hypertension was observed in 15 years of age in both the sexes 19.5 % in boys and 16.66 % in girls, followed by 13 years 9.83 % in boys and 11.61 % in girls 3. In comparison Durrani et al study my study had maximum children with hypertension in the age group 3 - 9 years (51.6 %) followed by 12 - 15 years (32.2 %).
Buch et al4 did a study of children at school with hypertension at Seurat city aged 6 - 18 years. The study observed that prevalence of hypertension increases with age. In comparison to study of Buch et al my study did not show any increase in prevalence of hypertension with increasing age.
Shah et al5 did a study on prevalence of hypertension & association with obesity, their study concluded that hypertension prevalence was more in females (23.82 %) in comparison to males (14.7 %).In comparison to study of Shah et al my study had prevalence of more female patients with hypertension in comparison to males, 16 male patients (51.6 %), with overall sex ratio of 1 : 0.93 male: female ratio.
Mohan et al6 did a study of raised blood pressure in obese children in Ludhiana, his study concluded males outnumbered the females in both urban and rural areas.In comparison to study of Mohan et al my study there are more male patients than female, but the difference was not so large.
Sayeemuddin et al7 did a study on blood pressure profile of school children the study concluded that the blood pressure (systolic and diastolic) increases with height, age, weight and BMI.In comparison to the above study this study had no such relation of increasing trend of hypertension with increasing age. In this study the commonest symptom was fever in 15 patients (48.3 %), generalised oedema in 20 patients (64.5 %), and decreased urine output in 12 patients (38.7 %).
Khalil et al8 did a study of clinical profile and aetiology, paediatric hypertension, their study concluded that commonest clinical feature found was headache in 13 patients (52.5 %), followed by oedema in 9 patients (39.1 %).Yang et al.,9 did study of hypertension in children in emergency department, their study found dizziness and headache as the most common presenting symptom in adolescent age.
Kota et al did a study of clinical analysis of hypertension in children, the chief causes include glomerulonephritis, endocrine disorders, and renovascular disease. Commonest cause found for renovascular hypertension was Takayasu's disease. Bagga et al10 did a study, to study the aetiology and clinical profile of children with sustained hypertension. Their study concluded that main causes includes glomerulonephritis (GN), obstructive uropathy and reflux nephropathy. Commonest cause for renovascular hypertension was Takayasu's disease.
Still et al11 did a study on severe hypertension in childhood, their study found (64 %) evidence of pyelonephritis, either on renal biopsy or at necropsy in approximately half (16 cases) of the cases. There had been a previous history of urinary infection, the original infection occurring under 6 months of age in 50 % and under 3 years in 90 %.12
Flynn et al did a study on paediatric hypertension update found that prevalence of hypertension has increased, a major factor being increase in childhood obesity.
Redwine and Falker et al in 201213 December did a study on progression of pre-hypertensive children to hypertension, this description helped to identify children who were at greater risk for the development of hypertension.
CONCLUSIONS
In this study, it has been observed that minimum number of patients were in age group 9 - 12 years patients (19.3 %) and maximum number of patients were in the age group 3 - 9 years (51.6 %) with a M : F ratio of 1 : 0.93. and the main aetiology of hypertension was found to be nephrotic syndrome. In this study maximum patients were underweight; there was no relation between increasing weight and hypertension.
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CrossRef | Google Scholar | PubMedDISCLOSURE AND FUNDING
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How to cite this article
Sodha N, Rajurkar R, Kela G. Etiological and clinical profile of hypertension in children. J Evolution Med Dent Sci 2020;9(43):3192-3195, DOI: 10.14260/jemds/2020/700