ABSTRACT
Physical activity is an important component of ideal cardiovascular health. Current guidelines recommend that youth with hypertension participate in competitive sports once hypertensive target organ effects and risks have been assessed and that children with hypertension receive treatment to lower BP below stage 2 thresholds (e.g., < 140/90 mmHg or < 95th percentile + 12 mmHg) before participating in competitive sports. Despite these recommendations, pediatricians and pediatric subspecialists continue to struggle with how best to counsel their patients regarding appropriate forms of physical activity, the impact of exercise on blood pressure, and how best to screen for cardiovascular conditions that place youth at risk for sudden cardiac death. This review provides a summary of our current knowledge regarding the safety and utility of exercise in the management of high blood pressure in youth. We review determinants of blood pressure during exercise, the impact of blood pressure on cardiovascular health and structure, mechanisms for assessing cardiometabolic fitness (e.g., exercise stress test), contraindications to athletic participation, and how best to plan for athletic participation among hypertensive youth. Greater knowledge in these areas may offer clarity to providers faced with the challenge of prescribing exercise recommendations for hypertensive youth.
Subject(s)
Exercise Therapy/methods , Hypertension/therapy , Hypertrophy, Left Ventricular/diagnosis , Mass Screening/standards , Sports/physiology , Adolescent , Antihypertensive Agents/administration & dosage , Blood Pressure/drug effects , Blood Pressure/physiology , Blood Pressure Monitoring, Ambulatory/standards , Child , Diet, Healthy , Diet, Sodium-Restricted , Exercise/physiology , Exercise Test , Exercise Therapy/standards , Humans , Hypertension/complications , Hypertension/diagnosis , Hypertension/physiopathology , Hypertrophy, Left Ventricular/etiology , Hypertrophy, Left Ventricular/prevention & control , Practice Guidelines as Topic , Sedentary BehaviorABSTRACT
We report the case of a 7-year-old girl who presented with bilateral anterior uveitis, acute interstitial nephritis, and asymptomatic pulmonary granulomas and provide novel clinical evidence of an association between tubulointerstitial nephritis and uveitis syndrome and sarcoidosis.
Subject(s)
Nephritis, Interstitial/physiopathology , Sarcoidosis/physiopathology , Uveitis, Anterior/physiopathology , Uveitis/physiopathology , Child , Female , HumansABSTRACT
Prescription of multiple antihypertensive medications for the treatment of essential hypertension (HTN) has been well described in adults but not in children and adolescents. The authors describe the frequency with which children with essential HTN are prescribed a single vs two or more concomitantly administered antihypertensive medications. They also describe demographic features and comorbidities associated with the prescription of a single vs multiple antihypertensive medications. Multiple antihypertensive medication use in the management of pediatric HTN, as in the management of adult HTN, is not uncommon. In this single-center, retrospective study of 113 children with essential HTN, 28% of children were concomitantly prescribed two or more antihypertensive medications for poorly controlled blood pressure following prescription of a single medication. Demographic and comorbid conditions associated with the prescription of more than one antihypertensive medication include advanced hypertensive stage, race, and a family history of HTN.
