Screening and Management of High BP in Children and Adolescents: An Updated Guideline from the AAP
Am Fam Physician. 2018 Apr 15;97(8):543-544.
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Key Points for Practice
• BP should be measured yearly in patients three years and older.
• BP should be measured at every visit for patients who are obese; have renal disease, diabetes mellitus, or a history of aortic obstruction or coarctation; or who are taking medications associated with elevated BP.
• Ambulatory BP monitoring should be performed in the setting of suspected white coat HTN, elevated category of blood pressure for at least one year, or with stage 1 HTN at three separate office visits.
• The goal of treatment in children should be to reduce systolic and diastolic BP to less than the 90th percentile and less than 130/80 mm Hg in those 13 years and older.
From the AFP Editors
The American Academy of Pediatrics (AAP) previously published guidance on screening for and managing high blood pressure (BP) in children and adolescents in 2004. An updated guideline was released by the AAP to address increased interest in childhood hypertension (HTN) and an updated search of the literature on the topic.
Oscillometric devices that have been validated for use in children can be used for BP screening, but if high BP is detected, this should be confirmed with auscultation measurements. Ambulatory BP monitoring should be performed in those suspected to have white coat HTN, with diagnosis confirmed by mean systolic and diastolic BPs less than the 95th percentile and systolic and diastolic BP loads less than 25%. It should also be performed in patients who have undergone coarctation repair to aid in identifying HTN. During evaluation for high BP, a perinatal, nutritional, physical activity, psychosocial, and family history should be obtained and physical examination performed to determine if there is a secondary cause. Electrocardiography should not be performed in patients with HTN undergoing an assessment for left ventricular hypertrophy because the positive predictive value for identifying this condition is low.
In patients with chronic kidney disease, evaluation for HTN should be performed at every medical visit. Those found to have HTN should be treated to lower their 24-hour mean arterial pressure to less than the 50th percentile on ambulatory BP monitoring. They should also be assessed for proteinuria, and if it is found, they should be prescribed an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. In addition, ambulatory BP monitoring should be performed at least yearly to screen for masked HTN in all patients
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
Copyright © 2018 by the American Academy of Family Physicians.
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