Hypertension in the Pediatric Population

Hypertension in the Pediatric Population Posted By:
...

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.

Share

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

Related
Phase III FLOW Trial Results Establishes Semaglutide’s Role in Treating T2D and CKD

Phase III FLOW Trial Results Establishes Semagluti ...

The highly anticipated results of the FLOW (Evaluate Renal Function with Semaglutide Once Weekly) tr ...

Filed under: Cardiometabolic, NPs & PAs


Continue Reading
The Gift of Time and Key Connection Between Diabetes Mellitus and Autoimmune Disorders

The Gift of Time and Key Connection Between Diabet ...

Are you aware that approximately 64,000 Americans are diagnosed with type 1 diabetes (T1D) each year ...

Filed under: Cardiometabolic


Continue Reading
The Importance of Shared Decision-making in Obesity

The Importance of Shared Decision-making in Obesit ...

Many areas of healthcare are starting to talk about the importance of shared decision-making (SDM), ...

Filed under: Cardiometabolic, NPs & PAs


Continue Reading
Addressing ASCVD Risk in HIV: An Update to the DHHS HIV Guidelines

Addressing ASCVD Risk in HIV: An Update to the DHH ...

The incidence of atherosclerotic cardiovascular disease (ASCVD) is estimated to be twice as high in ...

Filed under: Infectious Diseases, Preventive Medicine, Public Health, Cardiometabolic, NPs & PAs


Continue Reading
Understanding the Multifactorial Etiology of Obesity and the Metabolic Adaptations to Weight Loss

Understanding the Multifactorial Etiology of Obesi ...

Obesity Causes Overeating, Not the Other Way AroundOne of my favorite quotes from Dr Lee Kaplan is, ...

Filed under: Cardiometabolic, NPs & PAs


Continue Reading
Atrial Fibrillation: Optimizing Outcomes by Addressing Social Determinants of Health and Implicit Bias

Atrial Fibrillation: Optimizing Outcomes by Addres ...

Atrial fibrillation (AF) is the most common sustained arrhythmia diagnosed, and its prevalence is ex ...

Filed under: Cardiometabolic, NPs & PAs


Continue Reading