Evaluation and Management of Stage 2 Hypertension in Pediatric Patients

Pediatric Hypertension and End-Stage Renal Disease

Pediatric hypertension is not an uncommon diagnosis, affecting about 3.5% of all children. Most childhood hypertension is associated with obesity, but elevated blood pressure can also be the presenting symptom of a secondary disease process. Moreover, no matter the cause of hypertension, early identification can improve long-term health outcomes as childhood hypertension predicts hypertension in adulthood. In 2017, the American Academy of Pediatrics revised their 2004 guidelines regarding blood pressure screening for all children. Here, we discuss an illustrative case of a 16-year-old girl with hypertension and underlying nephrotic syndrome whose diagnosis was delayed due to inadequate blood pressure screening. Given the varying practices regarding the interpretation of blood pressure data in the outpatient setting, it is important for primary care providers to understand the updated guidelines and the indications for referral. [Pediatr Ann. 2020;49(6):e258-e261.].

Implications of the 2017 AAP Clinical Practice Guidelines for Management of Hypertension in Children and Adolescents: a Review

PURPOSE OF REVIEW

To evaluate the impact of the 2017 American Academy of Pediatrics Clinical Practice Guideline (2017 AAP CPG) for Screening and Management of High Blood Pressure in Children and Adolescents.

RECENT FINDINGS

The 2017 AAP CPG had several significant changes compared to the 2004 Fourth Report. This review will focus on the emerging evidence from the first studies to apply the 2017 AAP CPG and the simplified table it contains on the overall prevalence of HTN and on recognition among children and adolescents at a higher cardiovascular risk. Recent evidence suggests that use of the 2017 AAP CPG will result in an overall increase in prevalence of HTN, particularly in youth who are obese or who have other cardiovascular risk factors. The change in prevalence likely differs based on sex, age, and height. The ability for the 2017 AAP CPG to detect an association with hypertension and target organ damage requires further study. Continued study is required to assess long-term implications of the 2017 AAP CPG with the goal of a more meaningful HTN definition in the young.