New Pediatric Hypertension Guideline Released by AAP

Michael G. Leu, MD, MS, MHS, FAAP
Subcommittee on Screening and Management of High Blood Pressure in Children

In October, the American Academy of Pediatrics released a new  Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents, which updates the Fourth Report from 2004.  Some of the highlights include:

  • Hypertension should be diagnosed by auscultation (See Figure 3 in guideline)
  • New blood pressure tables and thresholds for elevated BP (90th to 95th percentile), Stage 1 HTN (95th percentile to 95th percentile + 12 mm Hg), and Stage 2 HTN
  • Confirm high blood pressures with Ambulatory Blood Pressure Monitoring (ABPM) interpreted with pediatric norms (given high prevalence of White Coat Hypertension)
  • Children 6 years or older with positive family history, or those that are overweight/obese, that do not have stigmata of hypertension may not require an extensive evaluation for secondary causes
  • Delineation of appropriate laboratory testing for underlying secondary causes of hypertension (See Table 10 in guideline)
  • Treatment may be with ACE inhibitor, angiotensin receptor blocker, long-acting calcium channel blocker, or thiazide. For African American children, a higher initial dose of ACE inhibitor may be considered, vs thiazide diuretic or long-acting calcium channel blocker (due to potential for less robust response to ACE inhibitors)
  • Treatment target lowered to < 90th percentile or < 130/80 mmHg, whichever is lower