Pediatric Hypertension: Diagnosis, Evaluation, and Treatment

To present a case of increased systemic hypertension and pupil dilation related to low dose atropine eyedrops.

A thirteen-year-old male with progressive myopia received atropine 0.05% ophthalmic drops to slow down myopia progression. He exhibited systemic systolic hypertension, photophobia, and bilateral nonreactive mydriasis. The atropine drops were discontinued, and his blood pressure and pupillary function normalized.

This case demonstrates sensitivity to low dose atropine with increased systemic blood pressure and pupillary dilation.

Pediatric Obstructive Sleep Apnea Syndrome (OSAS) has been shown to affect not only quality of sleep but overall health. OSAS is associated with the development of blood pressure dysregulation and hypertension (HTN).

• a.

  We aim to review the pathophysiology of pediatric obstructive sleep apnea and subsequent association with hypertension.

• b.

  We aim to identify if early treatment of pediatric obstructive sleep apnea minimizes the risk of developing blood pressure dysregulation later in life.

• a.

  Pathophysiology of OSAS

• b.

  Pathophysiology of HTN

• c.

  Relationship between pediatric OSAS and development of HTN

• d.

  Treatment of pediatric OSAS and effects on HTN

Renal artery stenosis(RAS) is responsible for about 10% of secondary childhood hypertension that lead to end organ dysfunction and mortality. Angioplasty is gold intervention approach for stenosis treatment. However, there are rare studies in term of the pediatric RAS and angioplasty outcome in the children.

In this Single-center, retrospective study, the medical records of pediatric RAS patients were analyzed who referred for Rajaei cardiovascular medical and research center of Tehran from 2005 to 2018. Of these, 13 patients underwent PTA (Percutaneous transluminal angioplasty) treatment. Demographic data, etiology, symptoms, presenting feature, stenosis, blood pressure, number of drugs, hematological and biochemical parameters, intervention type, treatment complication and echocardiography reports were reviewed. Statistical analysis was performed with SPSS Version 23 software package. Descriptive statistics, Chi square and Pearson correlation, parametric and non-parametric tests used for statistical analysis.

Our results showed headache and cardiovascular damage was most common presenting feature. PTA intervention is effective in order of 50% of patients that reduced the blood pressure and improved medical therapy. The numbers of administrated antihypertensive drugs were reduced after PTA therapy. Restenosis and contrast induced-nephropathy emerge as major complications. Higher stenosis present but not lesion length had a negative relationship with treatment success and outcome. Age, ESR and serum potassium levels predicted the treatment outcome significantly.

In conclusion, this study confirm the effectiveness of PTA in the treatment of pediatric RAS but need more technical and biomedical improvement to yield higher success and outcome.

For physical health conditions, earlier intervention typically results in better prognoses and improved quality of life (QoL). Despite some evidence that early intervention yields better subsequent functioning too for behavioral health conditions like alcohol and other drug (AOD) disorders, less is known. This study examined the relationship between the life-stage at which individuals entered AOD recovery, demographic and clinical correlates, and its relationship to a variety of indices of current functioning, QoL and well-being.

Nationally representative sample of U.S. adults who resolved an AOD problem (Weighted N = 1844). Structured regression analyses tested whether life-stage at which individuals entered recovery (i.e., as a young [18−30yrs,n = 746] vs. older [>30yrs,n = 1098] adult), was associated with current QoL, happiness, self-esteem, distress, and recovery capital, independent of confounders. Sensitivity analyses investigated effects during the first 5-years of recovery.

Young adult recovery entry was independently associated with current employment, younger age of onset for primary substance, primary substance other than alcohol, and less lifetime psychiatric comorbidity. In fully-adjusted models examining indices of functioning, no association was found between life-stage at recovery entry and current self-esteem, happiness, or distress, but an association was found between young adult recovery entry and better current functioning and QoL. This effect was even more pronounced during the first 5-years of recovery.

Irrespective of current age, duration of recovery, and clinical markers of impairment, entering recovery as a young, versus older, adult, is associated with better subsequent QoL - an advantage that appears even more discernable early in recovery.