❤️ Hypertension · Pediatric BP · Secondary vs Primary · Renovascular · Coarctation

Schwartz Clinical Handbook — Chapter 43 · BP percentiles · Renal artery stenosis · Coarctation of aorta · CKD · Obesity · Pheochromocytoma

Select BP values (percentile), age, symptoms (headache, epistaxis, seizure), exam (femoral pulses, abdominal bruit, café‑au‑lait spots), and lab clues (renin, aldosterone, urinalysis) → differentiate primary vs secondary hypertension (renal, renovascular, coarctation, endocrine).
⚠️ Red flags: hypertensive emergency (encephalopathy, seizures, heart failure) → admit, IV labetalol/nicardipine, avoid rapid BP drop.

📋 Step 1 — BP & clinical features
📌 Diagnostic impressions
📖 Schwartz Ch 43

Select BP percentile (≥95th), age (<6y vs adolescent), obesity, reduced femoral pulses, abdominal bruit, sweating/palpitations, and lab clues (urinalysis, renin, aldosterone) → differentiate primary (obesity‑related) from secondary (renal parenchymal, renovascular, coarctation, pheochromocytoma, hyperaldosteronism).

✔️ Coarctation: BP higher in arms than legs, delayed femoral pulses.
✔️ Renovascular: abdominal bruit, young age, refractory hypertension.
✔️ CKD: elevated creatinine, urinalysis abnormalities, small kidneys on US.
✔️ Primary HTN: older, obese, family history, no secondary signs.
📘 Schwartz pearls (Chapter 43)
• Confirm elevated BP on 3 separate occasions.
• Hypertensive emergency: lower BP by 25% over first 8h, then gradually.
• First‑line meds: ACE inhibitors (renal disease, proteinuria), amlodipine (obesity), beta‑blockers (coarctation post‑repair).
• Renal artery stenosis: captopril renal scan, CTA or MRA.