Management Of Hypertension In Children Research Articles

Treatment of Hypertension in Children.

Hypertension is a real problem in children. It shows a tracking behaviour, representing a key risk factor for hypertension, cardiovascular disease, and end-organ failure in adulthood. However, the importance of addressing arterial hypertension in children is not limited to its risk of tracking into adulthood. Thus, early detection and management are crucial. Hypertension may be primary or due to secondary causes, and identification of this distinction is very important for the treatment setting. Importantly, the management of hypertension in children is crucial to prevent the well-known cardiovascular effects in adulthood. As demonstrated in the literature, healthy eating habits, together with regular physical activity, can have a major impact on reducing high blood pressure and preventing organ damage in children and adolescents. However, suppose these are not sufficient to treat hypertension. In that case, if patients are symptomatic and/or have additional metabolic conditions such as obesity, type diabetes mellitus, or chronic kidney disease, anti-hypertensive medication must be started. Recent guidelines have provided clear guidance on the treatment of hypertension and hypertensive crisis in pediatric age. On the other hand, there are currently few specific recommendations on the treatment of isolated nocturnal hypertension and treatment- resistant hypertension. This review aims to summarize the most recent recommendations for the treatment of hypertension and hypertensive crisis in children and the last years' knowledge and experience in treating childhood isolated nocturnal hypertension and resistant hypertension of childhood.

Screening and Management of Pediatric High Blood Pressure-Challenges to Implementing the Clinical Practice Guideline.

Elevated blood pressure (BP) and hypertension in childhood convey risk for hypertension and cardiovascular events in adulthood. Early recognition of abnormal BPs is key to preventing or lessening this risk. However, the process for making the diagnosis of hypertension is complex, and overall adherence to the 2017 American Academy of Pediatrics Clinical Practice Guidelines (CPG) is poor. We will review obstacles to adherence to the CPG and approaches designed to improve the diagnosis and management of hypertension in children. Baseline data from the multi-center quality improvement intervention, "Boosting Primary Care Awareness and Treatment of Hypertension" (BP-CATCH), demonstrate that childhood hypertension remains underdiagnosed. Other studies confirm a lack of compliance with the process outlined in the CPG. The provision of electronic prompts, coaching, and education results in modest improvements. The combination of embedded medical record tools and education seems to offer the most hope for improvement.

Real-World Prescribing Patterns for Hypertensive Children in China from 2018 to 2021: A Cross-Sectional Multicenter Study.

Pediatric hypertension become an early marker of cardiovascular diseases, but their antihypertensive drug use patterns are rarely known. To investigate the epidemiological characteristics of pediatric hypertension and the use of antihypertensive drugs in the real world in China. In this study, the demographic, diagnosis, and medication prescription data including the antihypertensive drug types and comorbidities, were analyzed. The antihypertensive drugs use were evaluated according to the Chinese guidelines for hypertension. 1301 prescriptions (number of visits) containing 1880 antihypertensive medical orders were collected. The average number of antihypertensive drugs per prescription was 1.45 (±0.75). The patients aged 16 to 18 (70.18%) accounted for the highest proportion. Kidney diseases (33.28%) were the most common comorbidities. Calcium channel blocker (CCB), angiotensin II receptor blocker (ARB), and β receptor blocker (BB) were the most used antihypertensive drugs. The most frequent monotherapy was CCB, while that of two and three drugs combination were ARB+CCB and ARB+BB+CCB, respectively. Metoprolol (11.44%), nifedipine (10.64%), amlodipine (10.59%), valsartan (6.12%) were the most commonly used antihypertensive drugs. The utilization rate of fixed compound preparations was 7.34%. However, the percentage of recommended antihypertensive drugs was just 14.20%, while the recommended drug combination was 84.93% according to the guidelines. For the first time ever we reported the antihypertensive prescription analysis in children in a large area of China. Our data provided new insights into the epidemiological characteristics and drug use in hypertensive children. We found that the guidelines for medication management in hypertensive children were not routinely followed. The wide use of antihypertensive drugs in children and those with weak clinical evidence raised concerns regarding its rational use. The findings could lead to more effective management of hypertension in children.

Prevalence of Hypertension among Children Based on the New American Academy of Pediatrics Clinical Practice Guidelines.

In 2017, the American Academy of Pediatrics (AAP) updated clinical practice guidelines for the diagnosis and management of hypertension in children. The present study aimed to assess the prevalence of hypertension in Iranian children based on the latest guidelines. Data on 7301 student participants (3589 boys and 3712 girls) aged between 7-12 yr were assessed. The data were extracted from the fifth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN V) school-based study conducted in the 30 provinces of Iran in 2015. Blood pressure (BP) was classified as normal, elevated BP, and stage 1 and 2 hypertension using weighted analysis and the 2017 AAP guidelines. All analyses were performed in STATA 14.0 statistical software, with findings presented in terms of prevalence. The overall prevalence of high BP in Iranian children was 14.7%. In addition, 15.1% of boys had high BP, with 9.4% and 1.7% of them with stage 1 and 2 hypertension, respectively. Moreover, 14.3% of girls had high BP, of which 10% had stage 1 and 1.3% with stage 2 hypertension. For elevated hypertension, it was observed in 4% of boys and 3% of girls. Using the 2017 AAP guidelines demonstrated a higher prevalence of hypertension in children (14.7%) in Iran. The prevalence of hypertension in boys was slightly higher compared to girls.

Recognition and management of hypertension in children and young people with diabetes

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Hypertension in Children and Adolescents with Turner Syndrome (TS), Neurofibromatosis 1 (NF1), and Williams Syndrome (WS).

Turner syndrome (TS), neurofibromatosis type 1(NF1), and William Syndrome (WS) are 3 genetic conditions that are all associated with a substantial increase in risk of hypertension. In this review, we focus on factors leading to hypertension and on clinical manifestations and management of hypertension in children and adolescents with these genetic conditions RECENT FINDINGS: In most instances, hypertension is secondary. There is a high prevalence of masked hypertension in TS; however, the extent to which control of the BP helps reduce the risk of aortic dissection/aneurysm in TS is not yet fully elucidated. Vasculopathies are the least emphasized but most important manifestation of NF1. Of note, routine screening for pheochromocytoma in NFI is not recommended as it is not cost-effective. Cardiovascular complications are the major cause of death in patients with WBS. ABPM identifies patients without overt aortic or renovascular narrowing. Antihypertensive agents such as ARBs that have direct vascular wall effects and agents that inhibit oxidative stress (minoxidil) should be considered, even in those who do not exhibit overt hypertension. Elevated blood pressure in children and adolescence manifests early with end-organ changes and when left untreated, increases risk for premature onset of cardiovascular disease. Vigilant monitoring of the blood pressure is recommended. Accurate early diagnosis and management of hypertension will delay or prevent target organ damage and ensure a healthier transition to adulthood among children afflicted with these conditions.

Native nephrectomy in the management of hypertension in children with kidney disease: a tool to improve blood pressure control.

Hypertension in children with abnormal kidneys often requires multiple antihypertensive agents (complex), or could present with complications (e.g. hypertensive encephalopathy). Our objective in this report is to evaluate blood pressure control following unilateral or bilateral laparoscopic native nephrectomy in children with renal hypertension. Single-centre retrospective review of all children who underwent nephrectomy for management of hypertension over a recent study period (2008-2017) with post-operative follow-up of at least 3years. We describe the association of age, primary kidney disease and blood pressure and its management including time to resolution following unilateral or bilateral nephrectomy. During the 9-year study period, 21 of 215 (9.8%) children underwent nephrectomy for management of hypertension. We included 19 children [6 with unilateral native nephrectomy (UNN) and 13 with bilateral native nephrectomy (BNN)] in this study as they continued with their follow-up at our centre. Out of the 19 children, 15 had laparoscopic retroperitoneoscopic nephrectomies and 4 had laparoscopic transperitoneal nephrectomies. Six children had unilateral nephrectomy and 13 children had bilateral nephrectomies [7 were pre-transplant (haemodialysis-6, peritoneal dialysis-1) and 6 were post-kidney transplant]. Fifteen of 19 children (79%) had complete resolution [5 UNN and 10 BNN] and 3 (16%) partial resolution [1 UNN and 2 BNN]. One patient with BNN was observed to have no change in blood pressure control. Our data demonstrate improved management of hypertension in 95% of the children. Nephrectomy could offer a reasonable treatment option for selected group of complex and complicated renal hypertension.

Abstract P194: Compliance With 2017 AAP Guidelines For Childhood Hypertension: Diagnosis And Management Of Pediatric Hypertension

Background: Hypertension (HTN) is an important modifiable risk factor for cardiovascular disease that is becoming more prevalent in children. HTN in children is historically under-diagnosed (23-26%). Objective: Our objective was to evaluate the rate of recognition and compliant management of childhood HTN in the primary care setting based upon the latest 2017 AAP Guidelines. Methods: A single-center retrospective chart review was conducted of pediatric well-child encounters over a period of 12 months (March 2018 - April 2019). Children aged 3 to 17 years and those 1 to 2 years of age with risk factors for HTN were included in the study. Results: A total of 100,512 well-child encounters were included in the analysis. 69.3% had blood pressure (BP) screening during the encounter. Of those, 9.9% were classified as elevated, 7.6% as stage 1, 0.6% as stage 2, and 0.02% as severe HTN. In a representative subgroup of children with elevated BP or higher (n = 200), a proper diagnosis was documented in only 3 patients (1.5%). The documented plan of care was fully consistent with the 2017 AAP guidelines in only 1 patient (0.5%). In another subgroup of patients with 3 sequential elevated BPs (or higher) (n = 100), a proper diagnosis was documented in 12 patients (12%). The plan of care was partially consistent with the 2017 AAP guidelines in 9 patients (9%) and completely compliant in 1 patient (1%). Rates of compliance by age, weight, BP class, and presence of risk factors for HTN are summarized in Figure 1. Conclusions: HTN remains under-recognized in the pediatric population. In this primary-care single-center cohort of children with elevated BP, the latest guidelines were not commonly followed.

Clinical Decision Support for the Diagnosis and Management of Adult and Pediatric Hypertension.

Purpose of ReviewTo review literature from 2016 to 2019 on clinical decision support (CDS) for diagnosis and management of hypertension in children and adults.Recent FindingsTen studies described hypertension CDS systems. Novel advances included the integration of patient-collected blood pressure data, automated information retrieval and management support, and use of CDS in low-resource/developing-world settings and in pediatrics. Findings suggest that CDS increases hypertension detection/control, yet many children and adults with hypertension remain undetected or undercontrolled. CDS challenges included poor usability (from lack of health record integration, excessive data entry requests, and wireless connectivity challenges) and lack of clinician trust in blood pressure measures.SummaryHypertension CDS has improved but not closed gaps in the detection and control of hypertension in children and adults. The studies reviewed indicate that the usability of CDS and the system where CDS is deployed (e.g., commitment to high-quality blood pressure measurement/infrastructure) may impact CDS’s ability to increase hypertension detection and control.

Paediatric hypertension for the primary care provider: What you need to know.

The prevalence of hypertension has increased in the paediatric and adolescent populations, and is estimated between 1% and 2% in Canada. Paediatric and adolescent hypertension differs from adult hypertension in many ways, and primary care providers may not be up to date with current guidelines and recommendations. Recently, the American Academy of Pediatrics updated and published guidelines on the diagnosis, evaluation, and management of hypertension in children and adolescents. This paper summarizes these new guidelines in addition to the existing Canadian guidelines in a simple four-step approach, catered to a primary care setting, detailing the diagnosis, evaluation, workup, and management of hypertension in children and adolescents.

A Clinical Update on Childhood Hypertension.

Hypertension is one of the leading morbid factors in adults but often a less noticeable concern in childhood age group. Young population is now more vulnerable to lifestyle disorders leading to early chronic diseases if not addressed due to presence of ignorance and inadequate assessment. To label hypertension in pediatric age group, blood pressure should be ≥ 95th percentile for age, height and sex in small children. Purpose of review is to unfurl the knowledge for monitoring and management of hypertension in children. We emphasize the need to spread awareness in community, especially in rural areas of low and middle economy nations, which is surely lacking despite available tools for more then 60-70 years. Comprehensive clinical update on recent information on epidemiology, the diagnosis, evaluation and management of pediatric hypertension for outpatient clinic practice.

Secondary Hypertension in Children and Adolescents: Novel Insights.

Hypertension is a significant risk factor for cardiovascular morbidity and mortality, not only in adults, but in youths also, as it is associated with long-term negative health effects. The predominant type of hypertension in children is the secondary hypertension, with the chronic kidney disease being the most common cause, however, nowadays, there is a rising incidence of primary hypertension due to the rising incidence of obesity in children. Although office blood pressure has guided patient management for many years, ambulatory blood pressure monitoring provides useful information, facilitates the diagnosis and management of hypertension in children and adolescents, by monitoring treatment and evaluation for secondary causes or specific phenotypes of hypertension. In the field of secondary hypertension, there are numerous studies, which have reported a strong association between different determinants of 24-hour blood pressure profile and the underlying cause. In addition, in children with secondary hypertension, ambulatory blood pressure monitoring parameters offer the unique advantage to identify pediatric low- and high-risk children for target organ damage. Novel insights in the pathogenesis of hypertension, including the role of perinatal factors or new cardiovascular biomarkers, such as fibroblast growth factor 23, need to be further evaluated in the near future.

Blood hypertension in children. Guideliness for diagnosis and treatment. Part 2 Pediatric Nephrology Branch, Chilean Pediatric Society

Hypertension (HTN) in children and adolescents is an important pathology, of, guarded prognosis, associated with modifiable and non-modifiable factors. The estimated prevalence is around 3.5% which increases progressively with age. The ideal method for its diagnosis is the measurement of blood pressure (BP) with auscultatory instruments. According to the American Academy of Pedia trics (AAP), BP should be measured in children older than three years of age once a year, and in children younger than three years of age if they present risk factors. Once the HTN is confirmed, the evaluation should be directed towards the detection of a causative disease and/or the search for risk factors associated with a primary HTN. The objective of treating primary and secondary HTN in pediatrics is to achieve a BP level that decreases the risk of target organ damage. Therapeutic op tions include treatment according to specific etiology, non-pharmacological and pharmacological one. This paper presents the position of the Chilean Society of Pediatrics Nephrology Branch with the aim of guiding pediatricians and pediatric nephrologists in the correct management of HTN in childhood. In this second part, recommendations on antihypertensive treatment are presented with an emphasis on lifestyle changes.

Implications of the 2017 AAP Clinical Practice Guidelines for Management of Hypertension in Children and Adolescents: a Review.

To evaluate the impact of the 2017 American Academy of Pediatrics Clinical Practice Guideline (2017 AAP CPG) for Screening and Management of High Blood Pressure in Children and Adolescents. The 2017 AAP CPG had several significant changes compared to the 2004 Fourth Report. This review will focus on the emerging evidence from the first studies to apply the 2017 AAP CPG and the simplified table it contains on the overall prevalence of HTN and on recognition among children and adolescents at a higher cardiovascular risk. Recent evidence suggests that use of the 2017 AAP CPG will result in an overall increase in prevalence of HTN, particularly in youth who are obese or who have other cardiovascular risk factors. The change in prevalence likely differs based on sex, age, and height. The ability for the 2017 AAP CPG to detect an association with hypertension and target organ damage requires further study. Continued study is required to assess long-term implications of the 2017 AAP CPG with the goal of a more meaningful HTN definition in the young.

The population-based prevalence of hypertension and correlates of blood pressure among Australian children.

Hypertension is increasingly recognized as a disease spanning the entire life course. Continued efforts to refine the diagnosis and management of hypertension in children are highlighted by the recent American Academy of Pediatrics (AAP) guidelines, which include lower threshold values than the previous reference standard (Fourth Report). We aimed to determine the population-based prevalence of children exceeding thresholds for hypertension using these two guidelines. We also sought to identify the correlates of blood pressure (BP) among Australian children. Cross-sectional data from the Growing Up in Australia: Longitudinal Survey of Australian Children were analyzed. Blood pressure was measured in 7139 Australian children aged 10-12years and sampled using population-based methodology. The association between BP and explanatory variables linked to BP in other populations was examined using multiple linear regression with fractional polynomial terms for continuous, non-linear relationships. The threshold for hypertension was exceeded in 3.1% and 5.4%, and prehypertension in 3.0% and 3.7% of children, using the Fourth Report and AAP guidelines respectively. Children at the threshold for obesity had a 9.1mmHg higher adjusted BP than those on the 50th centile for body mass index (BMI) (95% CI 8.4 to 9.9). BMI had a non-linear relationship with BP, and the magnitude of association between BMI and BP increased with BMI. Socioeconomic status, hypertension during pregnancy, birth weight, and sports participation were also independently associated with BP. Using the AAP guidelines is likely to substantially increase the population prevalence of hypertension. The association between BMI and BP was strongest and non-linear for obese children, who should be the focus of interventional trials.

Hypertension Diagnosis and Management in Children and Adolescents: Important Updates

This review aims to examine new literature and clinical practice guidelines on the diagnosis and management of hypertension in children along with the potential impact on clinical practice of the new recommendations. Hypertension is underrecognized and underdiagnosed in clinical practice. Tools for improving diagnosis may include prompts in electronic medical records, use of a blood pressure screening table, and standardized blood pressure thresholds for adolescents. The recent AAP clinical practice guideline on the management of hypertension in children developed new blood pressure tables with lower norms that may increase the percentage of children diagnosed with elevated blood pressure and hypertension. In this high cardiovascular-risk population, therapeutic lifestyle modifications remain a fundamental management strategy. There is more evidence demonstrating the importance of identification and management of elevated blood pressure in childhood. New tools and strategies may improve recognition and treatment of hypertension as the number of children at risk increases.

Ambulatory Blood Pressure Monitoring in Children and Adolescents: a Review of Recent Literature and New Guidelines.

This is a review of ambulatory blood pressure monitoring (ABPM) use in pediatrics, focusing on research published in the last 3 to 4years. Recent data has shown that ABPM is more strongly associated with end-organ damage than casual BP, and that obesity and secondary causes of hypertension are strongly associated with nocturnal hypertension. There is evidence that ABPM is useful in management of a larger variety of diagnoses than previously thought. New guidelines from the American Academy of Pediatrics recognize the importance of ABPM in the management of pediatric hypertension. ABPM has an important and growing role in the diagnosis and management of hypertension in children and adolescents. Future efforts should include developing more generalizable normative data and investigating associations between pediatric ABPM results and adult outcomes.

New Clinical Practice Guideline for the Management of High Blood Pressure in Children and Adolescents.

A substantial body of clinical data on elevated blood pressure (BP) in children and adolescents have been published during the past decade. In response to the need to update management guidelines on pediatric hypertension, the American Academy of Pediatrics (AAP) supported development and publication of a new clinical practice guideline on high BP in childhood. Before 1977, there was no consistent definition of hypertension in childhood, and BP was not commonly measured in asymptomatic children or adolescents. Consequently, childhood hypertension had been considered rare and, if detected, the assumption was that it would be secondary to an underlying disorder. In the mid-1970s, the National High Blood Pressure Education (NHBPEP) of the National Heart Lung and Blood Institute (NHLBI) convened a task force to examine available BP data on healthy children to determine the normal BP distribution in children and define the upper limits of BP according to age. Although available BP data at that time were limited by current standards, it was clear that BP levels in children were related to age, with a progressive increase from early childhood through adolescence. In the absence of long-term outcome data, it was not possible to link a level of childhood BP to risk of later cardiovascular events. Therefore, the task force defined hypertension as the BP level that exceeded the 95th percentile on age-related BP distribution curves. The recommendations of this task force on detection, evaluation, and management of hypertension in children and adolescents were published in 1977.1 In addition to providing a framework on diagnosis of hypertension, the publication included information on proper BP measurement in children, diagnostic evaluation for children with elevated BP, and management of BP in hypertensive children. That report of that NHBPEP Task Force1 constituted the first clinical practice guideline (CPG) for childhood hypertension. Major …

Outcomes of ventriculoperitoneal shunt insertion in the management of idiopathic intracranial hypertension in children

PurposeThe ventriculoperitoneal (VP) shunt has become the procedure of choice for treatment of idiopathic intracranial hypertension (IIH). We aimed to assess the efficacy of frameless stereotactic placement of VP shunts for the management of medically resistant IIH in children and to assess the role of gender and obesity in the aetiology of the condition.MethodsThis is a retrospective analysis of the case notes of 10 patients treated surgically at the University Hospital of Wales in Cardiff, from May 2006 to September 2012.ResultsVP shunts were successful in relieving headache, papilloedema and stabilising vision. No sex predilection was identified, and increased BMI was a feature throughout the population, regardless of age.ConclusionsNeuronavigated VP shunt insertion is an effective mode of treatment for medically resistant IIH in children. The aetiological picture in children does not seem to be dominated by obesity, as in adults. Literature on childhood IIH is sparse, and larger scale, comparative studies would be of benefit to treating clinicians.

P210 Modern management of portopulmonary hypertension in children : experience of an expert center

P210 Modern management of portopulmonary hypertension in children : experience of an expert center