Modern Approaches to the Diagnosis, Treatment and Prevention of Arterial Hypertension in Children

In recent decades, arterial hypertension (AH) in children has acquired the status of a significant global health problem, with its prevalence steadily increasing. Early detection and accurate diagnosis are crucial, as elevated blood pressure (BP) in childhood is closely linked to the risk of cardiovascular, renal, and neurological complications in adulthood. A significant step forward has been the introduction of ambulatory blood pressure monitoring (ABPM), which allows for identification of white-coat and masked hypertension, as well as more accurate patient stratification. Etiologically, AH in children is divided into primary and secondary forms. The primary form is more often associated with obesity, genetic predisposition, low physical activity and high sodium intake. Secondary form is often caused by kidney, cardiovascular and endocrine disorders. It should be emphasized that hypertension is often asymptomatic in childhood, highlighting the need for regular screening starting at 3 years of age, and even earlier for children at risk. Management is based on a stepwise approach. Non-drug measures are of primary importance — dietary correction, increased physical activity, and normalization of body weight. If these measures are insufficiently effective, pharmacotherapy with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, or thiazide diuretics is prescribed, with individualization of target BP levels depending on age and comorbidities. Given the limited data on the long-term safety of antihypertensive drugs in pediatrics, prevention and early lifestyle modification remain priority areas.