Letters to the Editor

Heavy Metal Poisoning Should Be Recognized as a Cause of Hypertension in Children



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Am Fam Physician. 2012 Sep 1;86(5):394.

Original Article: High Blood Pressure in Children and Adolescents

Issue Date: April 1, 2012

Available at: http://www.aafp.org/afp/2012/0401/p693.html

to the editor: I read this article with interest. However, the authors did not mention heavy metal poisoning as a possible etiology of elevated blood pressure in children. Elemental and inorganic mercury poisonings have been described as causes of hypertension.1,2 Less common metals, such as arsenic and thallium, can also cause hypertension.3,4 Although lead poisoning is known to cause hypertension in adults, it does not seem to do so in children.5

It is important to identify heavy metal poisoning as an etiology of elevated blood pressure because it is potentially treatable. Heavy metal intoxication can be evaluated with 24-hour urine screening. Treatment depends on the particular metal involved, but identification and removal from the source is paramount. Decisions on chelation should be made in consultation with a regional poison control center or medical toxicologist.

Author disclosure: No relevant financial affiliations to disclose.

REFERENCES

1. Torres AD, Rai AN, Hardiek ML. Mercury intoxication and arterial hypertension: report of two patients and review of the literature. Pediatrics. 2000;105(3):E34.

2. Wössmann W, Kohl M, Grüning G, Bucsky P. Mercury intoxication presenting with hypertension and tachycardia. Arch Dis Child. 1999;80(6):556–557.

3. Abhyankar LN, Jones MR, Guallar E, Navas-Acien A. Arsenic exposure and hypertension: a systematic review. Environ Health Perspect. 2012;120(4):494–500.

4. Winter ST, Laron Z, Michaelson IC. Renal and vascular disturbances in a case of thallium poisoning. Arch Dis Child. 1954;29(147):443–446.

5. Selbst SM, Sokas RK, Henretig FM, Weller SC, Tershakovec AM. The effect of blood lead on blood pressure in children. J Environ Pathol Toxicol Oncol. 1993;12(4):213–218.

in reply: We appreciate Dr. Thornton's comments on heavy metal poisoning as a possible cause of elevated blood pressure in children. Heavy metal poisoning has been described in case reports as causing hypertension in children, but this is relatively rare and does not need to be included in the standard workup for secondary etiologies of hypertension. If heavy metal intoxication is suspected based on history or physical examination findings, then a 24-hour urine sample should be considered.

MARGARET RILEY, MD

Ann Arbor, Mich.

Author disclosure: No relevant financial affiliations to disclose.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

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