1. Pediatric Hypertension A Nephrologists View Jeremy Gitomer, MD Pediatric Nephrology Alaska Kidney Consultants

5. Arteriosclerosis

13. Example of ABPM 0 3 6 9 12 15 18 21 24 100 120 140 160 180 Awake SBP load = 80% Sleep SBP load = 60% Time of Day

14. ABPM American Journal of Kidney Diseases (1999) 33: 667-674

17. Hypertension Less than 1 Year Old Neurogenic tumors Renal artery stenosis Intraventricular hemorrhage Congenital renal disease Patent ductus arteriosus Coarctation of the aorta Bronchopulmonary Dysplasia Renal artery thrombosis after umbilical artery catheterization Infants and Neonates Less Common Most Common Age Group

18. Causes of Hypertension All diagnosis listed above Renal Disease 11 and older Essential hypertension Head trauma associated Sleep apnea associated hypertension Hypertension induced by immobilization Glucocorticoid remediable hypertension Liddle’s syndrome Apparent mineralocorticoid excess 17 α hydroxylase deficiency 11 β hydroxylase deficiency Primary hyperaldosteronism Pheochromocytoma Neurofibromatosis Essential Hypercalcemia Coarctation of the aorta Renal artery stenosis Renal Disease 1-10 Less Common Most Common Age Group

26. Apparent Mineralocorticoid Excess Mineralocorticoid Receptor Normal Cortisol 11 β -hydroxysteroid dehydrogenase Type 2 Corticosterone Aldosterone Cortisol 11 β -hydroxysteroid dehydrogenase Type 2 Corticosterone Cortisol Mineralocorticoid Receptor AME

28. Glucorticoid Remediable Hypertension Glomerulosa Fasciculata Progesterone Progesterone Progesterone Deoxycorticosterone Deoxycorticosterone 17 hydroxyprogesterone CYP11 β 1 CYP11 β 1 Corticosterone Corticosterone 11-deoxycortisol CYP11 β 1 Cortisol 18-hydroxycorticosterone 18-hydroxycorticosterone CYP11 β 2 Chimeric CYP11 β 2 Aldosterone Aldosterone

33. Red Blood Cell Cast

42. Renal Scan And Angiogram

43. RAS on Angiogram

47. Hypertension in office Correct size cuff Wait 5 minutes and repeat Still high Check 2 more visits Home BP Monitoring Ambulatory BPM BP Normal White Coat HTN BP Abnormal Family History Physical Exam CBC Urine Analysis Renal Panel Aldosterone/Renin Urine Protein/creatinine Comorbid Conditions Diabetes, Renal Disease, Cardiac Disease, Obesity Treat with Antihypertensives No Comorbid Conditions Lifestyle Modifications Consider Echocardiogram No LVH LVH Present HTN after 1 year HTN Resolved BP check every 6 months Workup Negative Workup Positive Treat

49. Medication Algorithm Hypertension IHSS Renal Disease No Comorbidities Obesity Beta Blocker Cardizem ACE Inhibitor ACE Inhibitor Angiotensin Receptor Blocker Diuretic Calcium Channel Blocker ACE Inhibitor Calcium Channel Blocker Second Calcium Channel Blocker Diuretic Second Calcium Channel Blocker Calcium Channel Blocker ACE Inhibitor Second Calcium Channel Blocker Angiotensin Receptor Blocker