For Kids with High BP, Surgery Can Help When Medicines Fail

High blood pressure may seem like something that only adults get, after years of smoking, overeating and little exercise. But children can develop it too - and just as in adults, uncontrolled high blood pressure can pose serious risks to children’s hearts, brains and lives.

While medications may help some children with high blood pressure, surgery is the best option for those with renal artery obstructions, causing a rare but especially dangerous form of hypertension. That’s the conclusion of a new study published in the Journal of Vascular Surgery by a University of Michigan Cardiovascular Center team that is among the world’s most experienced at treating such children.

Called pediatric renovascular hypertension, the disease is caused by narrowings, or stenoses, in the blood vessels that lead to the kidneys.

It’s often diagnosed only after children don’t respond to blood pressure medications, or after they experience symptoms such as failing to gain weight at a normal pace or having unexplained fatigue. For some kids, the diagnosis comes only after a stroke.

The condition, which is the third most common cause of serious hypertension in children, often develops as a result of developmental narrowings in the renal arteries, the name for vessels that bring blood to the kidneys. In some children, the nearby section of the aorta - the largest blood vessel in the body - also has narrowings. Children who have a genetic disease called neurofibromatosis are especially at risk.

The kidneys play a major role in regulating blood pressure, by filtering waste from the blood and releasing hormones. But if the blood vessels that feed them become narrowed or partially blocked, the kidneys retain fluids and send out a hormone called renin that causes blood vessels throughout the body to constrict, thereby increasing blood pressure.

Fortunately, the new study shows that 97 percent of children who have surgery for renovascular hypertension will respond positively, and 70 percent will be cured completely. In the hands of the right team, the researchers say, children can survive the arduous operation and go on to have a normal life.

“This is a rare condition, but one that can be catastrophic if it’s not found and treated appropriately,” says lead author James C. Stanley, M.D., a U-M vascular surgeon who has operated on dozens of children with the condition in the past 40 years. “But the good news is that it is highly treatable with the help of an experienced diagnostic, surgical, and medical team.”

Stanley, the Handleman Research Professor of Vascular Surgery at U-M and a director of the U-M Cardiovascular Center, co-authored the report with U-M pediatric kidney specialists, interventional radiologists and vascular surgeons who make up the Michigan Pediatric Renovascular Group. Together, they treat children at the clinics, operating rooms and intensive care unit of the C.S. Mott Children’s Hospital, as well as U-M Cardiovascular Center diagnostic facilities.