AAP Updates Guidelines for Pediatric Hypertension

August 21, 2017

AAP Updates Guidelines for Pediatric Hypertension

  1. F. Bruder Stapleton, MD

The update revises the definition of prehypertension, recommends screening only at well-visits in healthy children, expands recommendations for ambulatory BP monitoring, and offers advice for evaluation and therapy.

  1. F. Bruder Stapleton, MD

Sponsoring Organization: American Academy of Pediatrics (AAP)

Target Audience: Clinicians caring for children and adolescents in outpatient settings

Background and Objective: More than 3% of otherwise healthy U.S. children have elevated blood pressure (BP), and many questions exist about best clinical practices. Based on a comprehensive literature review and consensus opinion of an expert committee, the AAP has updated its 2004 recommendations on diagnosis, evaluation, and treatment of high BP in children and adolescents.

Key Recommendations:

Diagnosis

  • Definitions in children aged 1 to 13 years:

    • Normal BP: <90th percentile (based on age, sex, and height)

    • Elevated BP (previously called prehypertension): ≥90thto <95thpercentile, or >120/80 mm Hg

    • Stage 1 hypertension: ≥95th percentile to <95th percentile +12 mm Hg, or 130/80 to 139/89 mm Hg

    • Stage 2 hypertension: BP higher than stage 1 hypertension definitions

  • Definitions in adolescents are the same as the upper limits for younger children.

Evaluation

  • BP should be checked annually during well-visits in children aged ≥3 years, or at every visit in those with obesity or other high-risk conditions.

  • Ambulatory BP monitoring should be considered in children >5 years of age if they have hypertension lasting >1 year, suspected white coat hypertension, or high-risk conditions, or are starting pharmacologic treatment.

  • Home monitoring should not be used to diagnose hypertension.

  • Extensive evaluation is not indicated in children ≥6 years of age if there is a family history of obesity, or if a secondary cause of hypertension is not suspected.

  • Electrocardiography is not recommended in the evaluation of childhood hypertension.

Management

  • Echocardiography to assess left ventricular hypertrophy is recommended when drug therapy is considered.

  • The DASH diet and a physical exercise plan should be advised at the time of diagnosis of elevated BP.

  • Pharmacologic therapy should be initiated for children and adolescents who fail lifestyle modification.

Comment

This comprehensive, evidence-based guideline provides detailed documentation to support these and other recommendations. I encourage all pediatric providers to adapt these guidelines, which are aligned with the American Heart Association's recommendations.

Tools for implementing the guideline are available here.

Editor Disclosures at Time of Publication

  • Disclosures for F. Bruder Stapleton, MD at time of publication Editorial boards UpToDate Leadership positions in professional societies American Society of Pediatric Nephrology Foundation (Chair)

Citation(s):

Reader Comments (4)

Rajeev Gupta, MD DM (Cardiology) Physician, Cardiology, Mediclinic Al Jowhara Hospital, Al Ain, UAE

The guidelines are topical. Thesedays we are finding exaggerated vascular ageing, even in children, particularly amongst obese children. Earlier HTN in Pediatric age-group means seconday, now it is primary like adults in about 50% of obese children, eye-opening indeed.

Rajeev Gupta, MD DM (Cardiology) Physician, Cardiology, Mediclinic Al Jowhara Hospital, Al Ain, UAE

I appreciate the topical guidelines. We have seen the same prevalence in UAE school children, mostly obese children with SDB with essential HTN ( no secondary cause despite extensive workup), like adults home BP monitoring is of equivocal value in initail; diagnosis. ABPM is recommended. Emphasis on lifestyle measures are of paramount importance. ECG has poor sensitivity with poor positive predictive value as well.

Francisco Quintana Physician, Nephrology, STAR MEDICA MORELIA

EXCELLENT

Joseph Alozie Resident, Gold cross hospital, Lagos, Nigeria

Hello, thanks for the article . Pls how do i use the Diastolic blood pressure to differentiate between elevated BP and stage 1 hypertension?

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