Bensman A
Service de néphrologie pédiatrique, hôpital Trousseau, Paris, France.
Pediatrie. 1988;43(9):735-41.
Hypertension in children is divided in 2 groups: primary hypertension and the secondary forms which are more severe and mostly due to kidney diseases. The medical management of hypertension includes non pharmacological intervention (diet, exercise, life-style) and pharmacological agents. The children with primary and mild hypertension may need only non pharmacological strategies. The main pharmacological agents used are: diuretics, vasodilators, sympathetic blockers, centrally acting agents, converting enzyme inhibitors. Except for hypertensive emergencies, the management of children with hypertension is facilitated by a stepped-care titration approach. Step 1: beta adrenergic blockers or vaso-dilators; step 2: combine beta adrenergic blockers with vaso-dilators or with diuretics or converting enzyme inhibitors alone; step 3: combine converting enzyme inhibitors with vaso-dilators and/or diuretics and/or beta adrenergic blockers; step 4: drugs include minoxidil, prazosin, labetalol.
原发性高血压和继发性高血压，继发性高血压病情更严重，主要由肾脏疾病引起。高血压的医学治疗包括非药物干预（饮食、运动、生活方式）和药物治疗。原发性和轻度高血压儿童可能仅需非药物治疗策略。主要使用的药物有：利尿剂、血管扩张剂、交感神经阻滞剂、中枢作用药物、血管紧张素转换酶抑制剂。除高血压急症外，采用逐步治疗滴定法有助于儿童高血压的管理。第一步：β肾上腺素能阻滞剂或血管扩张剂；第二步：将β肾上腺素能阻滞剂与血管扩张剂或利尿剂或单独使用血管紧张素转换酶抑制剂联合使用；第三步：将血管紧张素转换酶抑制剂与血管扩张剂和/或利尿剂和/或β肾上腺素能阻滞剂联合使用；第四步：药物包括米诺地尔、哌唑嗪、拉贝洛尔。
