TABLE 37.3 COMMON CAUSES OF HYPERTENSION Age group Cause Newborn infants Renal artery thrombosis, renal artery stenosis, congenital renal malformations, coarctation of the aorta, bronchopulmonary dysplasia Renal parenchymal diseases, a coarctation of the aorta, renal artery stenosis Renal parenchymal diseases, renal artery stenosis, essential hypertension (including obesity) Essential hypertension (including obesity), renal parenchymal diseases Infancy–6 yrs 6–10 yrs Adolescence a Includes renal structural and inflammatory lesions and tumors Adapted from the Task Force on Blood Pressure Control in Children Report of the second task force on blood pressure control in children—1987 Pediatrics 1987;79:1–25 The workup of a child with symptomatic stage or severe hypertension (defined in children as blood pressure >95th percentile + 30 mm Hg or >180/120 in adolescents) requires careful evaluation for the presence of clinical findings that may represent either the primary cause of the elevated blood pressure or the secondary systemic effects of hypertension Histories of frequent urinary tract infections, unexplained fevers, hematuria, dysuria, frequency, or edema all suggest renal disease Previous umbilical artery catheterization increases the risk of renal artery stenosis or thrombosis Ingestion of prescription, over-the-counter or illicit drugs, or rapid withdrawal of some antihypertensive medications, may support the diagnosis of drug-related hypertension A history of sweating, flushing, palpitations, fever, and weight loss may suggest a pheochromocytoma Physical examination should concentrate on identifying involved organ systems, paying particular attention to cardiovascular, renal, and central nervous systems All patients should be screened with upper and lower extremity blood pressure measurements to assess for the possibility of coarctation of the aorta Absent or decreased femoral pulses are also suggestive of aortic coarctation The cardiac examination should seek evidence of congestive heart failure (CHF) and pulmonary edema Abdominal examination may reveal the presence of a bruit or renal mass such as Wilms tumor, implicating a renovascular cause for the hypertension Peripheral edema may suggest volume overload from renal or