Distinguishing clinical features between primary (essential) and secondary pediatric hypertension

Clinical features	Primary HTN	Secondary HTN
Age:
Prepubertal		Secondary HTN is more likely in younger children, especially those less than six years of age.
Postpubertal	Older children and adolescents are more likely to have primary HTN.
Diastolic HTN*		Diastolic HTN is more likely to be associated with secondary HTN.
Nocturnal HTN*		Nocturnal HTN is more likely to be associated with secondary HTN.
Overweight/obesity	Overweight or obese children/adolescents are more likely to have primary HTN.
Family history of HTN	Children with a positive family history of primary HTN are more likely to have primary HTN.	Family history may be positive in some cases of secondary HTN due to a monogenic cause (eg, autosomal dominant polycystic kidney disease).
Symptoms of underlying disorder	Patients with primary HTN are typically asymptomatic.	Patients with secondary HTN often have other symptoms related to the underlying cause (eg, headache, sweating, and tachycardia due to catecholamine excess in patients with pheochromocytoma).

HTN: hypertension; ABPM: ambulatory blood pressure monitoring.
* Nocturnal and diastolic hypertension are usually detected by ABPM.

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