Abstract
Hypertension in obese children may require a different diagnostic and treatment approach from that for children with secondary hypertension, yet there is neither consensus nor a clear guideline. The aim of this study was to assess how obese children with hypertension are currently diagnosed and treated by paediatric nephrologists, what obstacles exist and what can be improved. In the period May–November 2014, an online questionnaire was sent to all members of the European Society for Paediatric Nephrology (n = 2148). Questions focused on current practices and obstacles regarding screening, diagnosis and treatment of hypertension in obese children. A total of 214 paediatric nephrologists responded. Although nearly 100 % agreed that screening of obese children for hypertension is indicated, it was current practice in only 56 % of participating countries; 88 % of respondents diagnosed hypertension with 24-h ambulatory blood pressure measurement. Diagnostics used to rule out causes or consequences of hypertension varied among the respondents; they included, in particular, the use of serum renin/aldosterone, urine sodium/potassium, and dimercaptosuccinic acid scan. Concerning treatment, 45 % of respondents preferred to start treatment with a lifestyle program, 2 % with antihypertensive medication, and 40 % with both. For 73 % of respondents, angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers were the drugs of first choice. The findings of this study emphasize the urgent need for an international guideline for screening, diagnosis and treatment of hypertension in obese children.
Highlights
Overweight and obesity in children continues to be an increasing public health problem
A total of 214 paediatric nephrologists filled out the questionnaire
According to 97 % (203/209) of the respondents, all obese children should be screened for hypertension; the remaining 3 % (6/209) felt this should be done only in specific situations, e.g. when there is need to see a doctor, or if risk factors such as a positive family history for hypertension or metabolic syndrome are present
Summary
Overweight and obesity in children continues to be an increasing public health problem. As overweight and obesity are important risk factors for elevated blood pressure, hypertension is increasingly diagnosed in children as well. The prevalence of hypertension in (non-selected) schoolchildren aged 3–18 years of normal weight is 3–5 %, with overweight 4–14 %, and in obese children 11–33 % [1,2,3,4,5,6]. The (US) National High Blood Pressure Education Program (NHBPEP) Working group on High Blood Pressure in Children and Adolescents (Fourth Report) as well as the European Society of Hypertension have provided guidelines for the diagnosis and treatment of hypertension [8, 9]. Hypertension in obese children may need a different diagnostic and treatment approach from that for children with secondary hypertension.
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