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AAP updates pediatric hypertension guidelines to address rising prevalence
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The AAP recently issued revised clinical practice guidelines — including new normative blood pressure tables, updated screening protocols, and streamlined medication recommendations — for the diagnosis and management of pediatric hypertension.
In its report, the AAP Subcommittee on Screening and Management of High Blood Pressure in Children noted that the rates of pediatric hypertension and elevated blood pressure have increased in prevalence since 1988, with higher blood pressure rates in boys, adolescents, Hispanics and blacks than in girls, young children or whites.
According to the organization, nearly 3.5% of children in the United States have high blood pressure. The researchers note that although no large studies have analyzed the number of children who are undiagnosed and untreated, the rates of untreated or undiagnosed hypertension, or both, may be comparable to those of U.S. adults. Of this population (32.6% of all adults), 17.2% were unaware of their status, and only 54.1% had controlled blood pressure.
“Prevention and early detection are key,” Joseph T. Flynn, MD, MS, FAAP, from the division of nephrology in the department of pediatrics at the University of Washington and Seattle Children’s Hospital, said in a press release. “High blood pressure levels tend to carry into adulthood, raising the risks for cardiovascular disease and other problems. By catching the condition early, we are able to work with the family to manage it, whether that’s through lifestyle changes, medication or a combination of treatments.”
This report serves as an update to the 2004 guidelines issued by the National Heart, Lung and Blood Institute and includes new tables for normal weight children and new blood pressure values.
The AAP committee also recommends several steps for pediatricians to assist their patients in managing high blood pressure:
- Perform routine blood pressure measurements only at annual preventive care visits;
- Follow a simpler screening table that identifies blood pressures needing further evaluation;
- Follow a simplified blood pressure classification for adolescents aged 13 years or older that aligns with forthcoming guidelines from the American Heart Association and American College of Cardiology;
- Use 24-hour ambulatory blood pressure monitoring to more exactly diagnose hypertension; and
- Start blood pressure-lowering medications if lifestyle changes fail to reduce the blood pressure, or if the child has another condition like diabetes or kidney disease.
“These guidelines offer a renewed opportunity for pediatricians to identify and address this important — and often unrecognized — chronic disease in our patients,” David Kaelber, MD, PhD, MPH, FAAP, co-chair of the AAP Subcommittee on Screening and Management of High Blood Pressure in Children, said in the press release. “The easy part was developing the new guidelines. Now we begin the harder work of implementing them to help children and adolescents.” – by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures.
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