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