Diagnosis of Pediatric Hypertension
Physical examination findings are normal in most children with hypertension. Body mass index should be calculated because obesity is associated with primary hypertension, and poor growth may indicate an underlying chronic illness. Blood pressure should be measured in both arms while the child is seated and in one leg while the child is in a prone position. Blood pressure should be roughly equal in both arms and is normally 10 to 20 mm Hg higher in the leg. If there is a significant difference in blood pressure between the right and left arms, if leg blood pressure is lower than arm blood pressure, or if the femoral pulses are diminished, the child may have coarctation of the aorta. An abdominal bruit may indicate renovascular disease, and ambiguous genitalia can be associated with mineralocorticoid excess. The remainder of the examination should focus on detecting physical findings associated with other underlying conditions that cause hypertension.

History
The patient's medical history, including birth, growth, and developmental history, should be obtained, and screening for previous urologic, renal, cardiac, endocrine, and neurologic diseases should be completed. Many drugs can increase blood pressure; therefore, a medication review that includes over-the-counter agents, nutritional supplements, performance-enhancing drugs, and illicit substances should be performed. Because disordered sleep is associated with hypertension, a sleep history should be completed. Patients should be screened for a family history of hypertension, other CVD risk factors, and renal or endocrine syndromes. Risk factors such as a lack of physical activity, an unhealthy diet, smoking, and alcohol use should be explored. A complete review of systems may suggest an underlying medical disorder or symptoms of hypertensive urgency (headache, vomiting) or hypertensive emergency (seizure, altered mental status), which require emergent evaluation and treatment.