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High blood pressure - infants

Definition: High blood pressure (hypertension) is an increase in the force of blood against the arteries in the body. This article focuses on high blood pressure in infants.

Alternative Names: Hypertension - infants

Causes, incidence, and risk factors:

Blood pressure measures how hard the heart is working, and how healthy the arteries are. There are two numbers in each blood pressure measurement:

The first (top) number is the systolic blood pressure, which measures the force of blood released when the heart beats.
The second (bottom) number is the diastolic pressure, which measures the pressure in the arteries when the heart is at rest.

Blood pressure measurements are written this way: 120/80.

Several factors affect blood pressure, including:

Hormones
The health of the heart and blood vessels
The health of the kidneys

High blood pressure in infants is usually the result of kidney or heart disease that is present at birth (congenital). In newborn babies, high blood pressure can also result from a blood clot in a kidney blood vessel, a complication of having an umbilical catheter .

Other causes of high blood pressure in infants may include:

Certain medications
Exposure to illegal drugs such as cocaine
Certain tumors
Inherited conditions (problems that run in families)
Thyroid problems

Blood pressure rises as the baby grows. The average blood pressure in a newborn is 64/41. The average blood pressure in a child ages 1 month - 2 years is 95/58. Some variations in these numbers are normal and are not cause for concern.

Symptoms:

Most babies with high blood pressure will not have symptoms. Instead, symptoms may be related to the condition causing the high blood pressure. These symptoms may include:

Bluish skin
Failure to grow and gain weight
Frequent urinary tract infections
Pale skin (pallor)
Rapid breathing

Symptoms may appear if the baby has very high blood pressure. These symptoms include:

Irritability
Seizures
Trouble breathing
Vomiting

Signs and tests:

Usually, the only sign of high blood pressure is the blood pressure measurement itself.

Signs of very high blood pressure include:

Heart failure
Kidney failure
Rapid pulse

Blood pressure in infants is measured with an automatic device.

If coarctation of the aorta is the cause, there may be decreased pulses in the legs. A click may be heard if a bicuspid aortic valve occurs with the coarctation.

Other tests in infants with high blood pressure will try to find the cause of the problem. Such tests may include:

A special type of x-ray that uses a dye to look at blood vessels (angiography)
Laboratory tests, including blood and urine tests
X-rays of the chest or abdomen
Ultrasounds, including an ultrasound of the working heart (echocardiogram) and of the kidneys
Using magnets to create images of the heart and great vessels (MRI)

Treatment:

The treatment depends on the cause of high blood pressure in the infant. Treatment can include:

Dialysis
Medications
Surgery (including transplantation surgery or repair of the coarctation)

Expectations (prognosis):

How well the baby does depends on the cause of high blood pressure.

Other factors that may affect how well the baby with high blood pressure does include:

The presence of other health problems in the baby
Whether any damage (such as kidney damage) has occurred as a result of the high blood pressure

Complications:

Heart or kidney failure
Organ damage
Seizures

Calling your health care provider:

Call your health care provider if your baby:

Fails to grow and gain weight
Has bluish skin
Has frequent urinary tract infections
Seems irritable
Tires easily

Take your baby to the emergency department if your baby:

Has seizures
Is not responding
Is vomiting constantly

Prevention:

There is no way to prevent conditions that cause high blood pressure in infants. However, there are some things you can do that may reduce the baby's risk of developing such problems.

Some causes of high blood pressure run in families. Talk to your health care provider before you get pregnant if you have a family history of:

Congenital heart disease
High blood pressure
Kidney disease

If you have any medical condition and take medication for it, talk to your health care provider before becoming pregnant. Exposure to certain medications in the womb may increase your baby's risk of developing problems that can lead to high blood pressure.

References:

Behrman RE. Nelson Textbook of Pediatrics. 17th ed. Philadelphia, Pa: WB Saunders; 2004.

Robertson J, Shilkofski N, eds. Johns Hopkins: The Harriet Lane Handbook: A Manual for Pediatric House Officers, 17th ed. Philadelphia, Pa: Mosby; 2005.

Park MK. Park: Pediatric Cardiology for Practitioners, 5th ed. Philadelphia, PA: Mosby Elsevier; 2008.

Review Date: 4/30/2008
Reviewed By: Mark A Fogel, MD, FACC, FAAP, Associate Professor of Pediatrics and Radiology, Director of Cardiac MR, The Children's Hospital of Philadelphia, Division of Cardiology, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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