Choosing Wisely:

Don’t initiate an outpatient hypertension workup in asymptomatic pediatric patients prior to repeating the blood pressure measurement.

Rationale and Comments: Blood pressures in children need to be taken in accordance with standard methodology prior to the diagnosis of hypertension in order to decrease the number of false positive readings that are often seen in pediatric patients. Methodology should include assessment of blood pressure in the upper extremity, by manual auscultation, with an appropriate-sized cuff. National Heart, Lung, and Blood Institute and AAP guidelines recommend repeating blood pressures x 3 at the same visit and at two additional visits to document persistent blood pressure elevation prior to initiating a workup for pediatric hypertension due to the possibility of falsely elevated blood pressure readings in children, as the prevalence of elevated blood pressures decreases significantly on repeated measures.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Nephrology and the American Society of Pediatric Nephrology
  • Sources:
  • National Heart, Lung and Blood Institute guidelines
  • Disciplines:
  • Cardiovascular
  • Pediatric
  • References: • Sun J, Steffen LM, Ma C, Liang Y, Xi B. Definition of pediatric hypertension: are blood pressure measurements on three separate occasions necessary? Hypertens Res. 2017;40(5):496-503.
    • NHLBI guidelines 2012 https://www.nhlbi.nih.gov/files/docs/peds_guidelines_sum.pdf
    • National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 suppl 4th report):555-576.

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