American Academy of Pediatrics (AAP) Updated Guidelines on Hypertension in Children and Adolescents- Salient Features

Girish C Bhatt*

Department of Pediatrics, Pediatric Nephrology and Hypertension Unit, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India

*Corresponding Author:
Girish C Bhatt
Department of Pediatrics, Pediatric Nephrology and Hypertension Unit
All India Institute of Medical Sciences (AIIMS)
Bhopal, Madhya Pradesh, India
Tel: 91-8462002229
E-mail: [email protected]

Received date: November 11, 2017; Accepted date: November 11, 2017; Published date: November 13, 2017

Citation: Bhatt GC (2017) American Academy of Pediatrics (AAP) Updated Guidelines on Hypertension in Children and Adolescents- Salient features. J Child Obes Vol No 2 Iss No 4:e103. doi: 10.21767/2572-5394.100038

Copyright: © 2017 Bhatt GC. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

 
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Editorial

The American academy of Pediatrics (AAP) has released updated guidelines on screening and management of childhood hypertension (HTn) [1]. The guideline endorses early screening for HTn in healthy children starting at age of 3 years and then measured on yearly basis. For children who are at risk of developing hypertension, the Blood Pressure (BP) measurement should start earlier and further measurements should be done at every well child care visits.

Obesity is a modifiable rick factor for childhood hypertension and the prevalence of both of these conditions is increasing over the years [2]. Recent studies have shown that 17% of all children aged 2 to 19 years of age are obese [3]. Children with obesity are at increased risk of Cardiovascular Disease (CVD) as they have higher blood pressures, dyslipidaemias and insulin resistance [4]. The estimated prevalence of childhood hypertension ranges from approximately 4% to 25% in various studies. The present guidelines recommend BP measurement of obese (BMI ≥ 95th centile) children at every health encounter. The BP can be measured either by oscillometric device (validated for Pediatric use) or by auscultatory device. However, for confirmation of HTn the guideline endorse the use of two auscultatory BP measurements and averaged to define BP category. The following BP category has been defined:

Normal blood pressure: BP measurements <90th percentile in children aged 1-13 years and <120/80 mmHg in children ≥ 13 years.

Elevated blood pressure: Earlier pre-hypertension term was used which has been replaced by the term elevated blood pressure in the recent guideline. It is defined as BP ≥ 90th to <95th percentile or 120 mmHg to <95th percentile (whichever is lower) in children 1-13 years of age.

In children ≥ 13 years elevate blood pressure is defined as BP 120/<80 mm Hg to 129/<80 mmHg.

Stage 1 HTn: Children aged 1-13 years: BP ≥ 95th percentile to <95th percentile+12 mmHg, or 130/80 to 139/89 mm Hg (whichever is lower).

Children aged ≥ 13 years BP 130/80 to 139/89 mm Hg.

Stage II HTn: Children aged 1-13 years: BP ≥ 95th percentile +12 mm Hg, or ≥ 140/90 mm Hg (whichever is lower).

Children aged ≥ 13 years BP ≥ 140/90 mm Hg.

The new guideline endorses the use of ambulatory blood pressure monitoring (ABPM) for confirmation of the HTn in children ≥ 5 years of age, if they have hypertension lasting for >1 year or suspected white coat or high risk conditions before starting pharmacotherapy. ABPM is precious tool in evaluation of HTn in obese children because of disparity between office BP and ambulatory blood pressure and presence of masked hypertension [1]. No extensive evaluation is needed if child is ≥ 6 years with family history of obesity and no secondary cause of hypertension is suspected based on history and physical examination.

Dietary approach to stop hypertension (DASH) and exercise remains the important initial management of hypertension in children with a goal for reduction of BP <90th percentile or <130/80 whichever is lower against the previous recommendation of <95th percentile. Children who fails nonpharmacological intervention or who have symptomatic hypertension, stage 2 HTn without a clear modifiable factor such as obesity, or HTn associated with chronic kidney disease or diabetes should be treated with single dose of antihypertensive agent along with non-pharmacological measures. The dose of the antihypertensive should be titrated every 2-4 weekly and the child should be followed up in clinic every 4-6 weekly till the BP becomes normal. The preferred drug to start may be an ACE inhibitor, ARBs of thiazide diuretics based on the underlying cause of HTn [5,6].

Acknowledgement

Dr. Girish C Bhatt has received the Indian Council of Medical Research(ICMR) international fellowship (ICMR-IF) for the year 2017-2018 in young scientist category for undergoing short term training in Pediatric Nephrology at Montreal Children’s Hospital, Mc Gill University Health Centre, Canada.

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