I have had two cases in the past two weeks that reminded me to review vital signs and trends CAREFULLY and not just with a cursory glance. I’ve had two teens with elevated blood pressures….both had had elevated pressures at previous visits — so with this visit we delved into the history and possible causes. The National Heart Lung and Blood Institute publishes normal blood pressures for children (http://www.nhlbi.nih.gov/guidelines/hypertension/child_tbl.pdf). The tables are based on sex, age and height. Both of these teens had pressures greater than the 95%-ile.
Neither teen was obese, both are atheletes, both were African American and neither had family histories of hypertension. I ordered renal ultrasounds, u/a, bmp, urine drug screens, cbc and renin level on both. Fortunately, neither teen had a secondary cause of the hypertension. One teen had low HDL, the other, a totally normal screen. I have placed both of them on low dose lisinopril and am rechecking in a couple of weeks.
So, a good lesson for me……