Pediatric Focus - Vol. 1, Issue 1

• Letter from Chairman

• New Director of Pediatric
Cardiology

• Hospital Receives Lounge

• Pediatric Hypertension

• Ewing's Sarcoma Family
of Tumors

• New Physician Profiles

Spotlight on Research: Pediatric Hypertension

With approximately 750,000 children nationwide afflicted with high blood pressure, and less than a third of those children diagnosed with the condition, increasing our knowledge and understanding of pediatric hypertension is more important than ever.

Susan Mendley, M.D., assistant professor and director of pediatric nephrology at the University of Maryland School of Medicine, heads a special research program designed to enhance our understanding of pediatric hypertension.

Dr. Mendley's research will be added to other efforts that, during the past twenty years, have been aimed at exploring the causes, treatment methods and long-term consequences of pediatric hypertension.

Studies have demonstrated early evidence of arteriosclerosis and left ventricular hypertrophy even in children, leading researchers to believe that high blood pressure can affect individuals of all ages. In fact, the American Academy of Pediatrics now recommends making blood pressure screening a routine part of pediatric care.

Since blood pressure changes with age, rising throughout childhood and approaching adult values by the late teen years, a child's blood pressure measurements must first be compared to normal values for that child's age, gender and height. High blood pressure in infants or young children often indicates an underlying disease process, referred to as secondary hypertension. Common causes of secondary hypertension in children include renal disease and coarctation of the aorta. In some cases, high blood pressure is correctable when recognized early.

Pediatric hypertension that is not the result of an underlying disease is referred to as essential hypertension, similar to that seen in adults. Essential hypertension is more prevalent among adolescents, teenagers and those with moderately elevated blood pressure. The early development of essential hypertension is linked to childhood obesity and children with diabetes mellitus, as well as a strong family history of hypertension.

The long-term consequences of pediatric hypertension have not yet been adequately researched and explored. Adults with essential hypertension often develop an increased risk of cardiovascular and cerebrovascular disease, which can lead to heart attack, congestive heart failure and stroke.

The absence of pediatric clinical trials of antihypertensives complicates pediatric hypertension treatment. Nearly all blood pressure lowering medications approved by the Food and Drug Administration (FDA) lack approval for use in children due to insufficient pediatric safety and efficacy data. Thus, clinicians are forced to rely on adult data to treat pediatric hypertension.

In Dr. Mendley's special research program, children with high blood pressure are carefully observed and evaluated. When appropriate, children enrolled in the program are treated with medication in a controlled setting, as part of Dr. Mendley's ongoing clinical trials of antihypertensive agents.

Dr. Mendley's program provides pediatric hypertension patients with an extra measure of security when beginning therapy. Data derived from the program lays the groundwork for the development of comprehensive safety and efficacy data -- information that will prove integral in gaining FDA approval of pediatric antihypertensive agents. The long-term goal of the program involves providing rational therapy for pediatric hypertension and preventing later complications from the condition.

For more information about UMHC or to make an appointment, call the University Physicians Consultation and Referral Service at:
1-800-492-5538 (patients) or 1-800-373-4111 (physicians).

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