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Hypertension in the Pediatric Population

Hypertension in the Pediatric Population

The prevalence of systemic hypertension (HTN) in the pediatric population is now commonly observed to be increasing, especially in view of the growing population of children with obesity. It is well known that HTN is a major cause of morbidity and mortality in the United States, and the long-term health risks to children with HTN may be substantial. In the United States, extensive normative data on blood pressure (BP) in children are available. However, the true incidence of HTN in the pediatric population is not known. Evaluation of the frequency of HTN screening revealed that only two thirds of routine pediatric visits included BP measurements, and there was no BP screening in 20% of overweight or obese children during their routine visits. Furthermore, 75% cases of HTN and 90% cases of prehypertension were not further investigated.

When HTN is diagnosed in children, therapeutic decisions are dependent upon severity, underlying cause, and presence of other cardiovascular disease (CVD) risk factors. It is essential to recognize remediable causes of HTN, especially coarctation of the aorta in a symptomatic infant. Therapeutic modalities may be reserved for those children who have irremediable causes of HTN or essential HTN. Nonpharmacologic measures are important in the initial treatment of all patients with HTN, regardless of its etiology or severity.

Nonpharmacologic therapy (ie, lifestyle changes) includes weight reduction for children who are overweight and a regular aerobic exercise regimen. Aerobic and isotonic exercises have a direct beneficial effect on BP. They help in reducing excess weight or maintaining appropriate body weight. Also encourage participation in sports. Dietary measures include diets rich in fruits and vegetables, and reduced fat and salt—though it may only yield a 4% reduction of the elevated pressure—and avoidance of excess alcohol, caffeine, and energy drinks.

Indications for pharmacologic treatment include symptomatic HTN, secondary HTN, hypertensive target-organ damage, diabetes, and HTN that persists despite nonpharmacologic measures. Pharmacologic agents used frequently in children that are efficacious and safe include thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, and beta blockers.

The target BP goal for children diagnosed with HTN is a reduction of systolic BP and diastolic BP below the 90th percentile or <120/80 mmHg in adolescents 13 years or older.

References
  • Bloetzer C, Bovet P, Paccaud F, Burnier M, Chiolero A. Performance of targeted screening for the identification of hypertension in children. Blood Press. 2017;26:87-93.
  • U.S. Preventive Services Task Force. Final recommendation statement: blood pressure in children and adolescents (hypertension): screening. www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/blood-pressure-in-children-and-adolescents-hypertension-screening. Accessed May 6, 2019.
  • Xi B, Zhang T, Li S, et al. Can pediatric hypertension criteria be simplified? A prediction analysis of subclinical cardiovascular outcomes from the Bogalusa Heart Study. Hypertension. 2017;69:691-696.
  • Sezer SS, Narin N, Ozyurt A, et al. Cardiovascular changes in children with coarctation of the aorta treated by endovascular stenting. J Hum Hypertens. 2014;28:372-7.
  • Dhuper S, Buddhe S, Patel S. Managing cardiovascular risk in overweight children and adolescents. Paediatr Drugs. 2013;3:181-90.

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Filed under: Cardiometabolic, Health Policy and Trends, Preventive Medicine

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