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AAP Publishes New Guidelines on Identifying and Treating High Blood Pressure in Children

​The prevalence of pediatric hypertension has increased since 1988, and yet the condition often goes undiagnosed and untreated, according to a new report published by the American Academy of Pediatrics (AAP).

The report, "Clinical Practice Guideline for Screening and Mana​gement of High Blood Pressure in Children and Adolescents," is the first set of guidelines for high blood pressure in children developed by the Academy. The report will be published in the September 2017 issue of Pediatrics, and available online Aug. 21.

An estimated 3.5% of all children and adolescents have hypertension, which is when the blood pressure remains abnormally high. Although the prevalence of hypertension has plateaued in recent years, elevated blood pressure readings often go undetected and untreated, the report states.

"If there is diagnosis of hypertension, there are many ways we can treat it," said David Kaelber, MD, PhD, MPH, FAAP, co-chair of the AAP Subcommittee on Screening and Management of High Blood Pressure in Children, which developed the report. "But because the symptoms are silent, the condition is often overlooked."

The Academy convened a 20-person committee to develop the new evidence-based guidelines on pediatric hypertension, which serve as an update to the most recent set of guidelines, issued in 2004 by the National Heart, Lung, and Blood Institute that was endorsed by AAP. The committee reviewed approximately 15,000 articles published since 2004 as part of its work. The new report focuses on the diagnosis, evaluation and initial management of abnormal blood pressures in children and adolescents.

The guidelines include new blood pressure tables that are based on normal-weight children. Previously, such tables included blood pressure measurements in children and adolescents who are overweight or obese – a condition that is likely to increase blood pressure. As a result, the new blood pressure values are lower than those used in prior guidelines and allow for a more precise classification of blood pressure according to body size.

​"Prevention and early detection are key," said Joseph Flynn, MD, MS, FAAP, who co-chaired the subcommittee. "High blood pressure levels tend to carry into adulthood, raising the risks for cardiovascular disease and other problems. By catching the condition early, we are able to work with the family to manage it, whether that's through lifestyle changes, medication, or a combination of treatments."

When left untreated, uncontrolled long-standing hypertension can have damaging ef­fects on organs in the body, such as the heart, kidneys, and brain.

The AAP guidelines recommend that pediatricians:

  • Perform routine blood pressure measurements only at annual preventive care visits.

  • Follow a simpler screening table that identifies blood pressures needing further evaluation.

  • Follow a simplified blood pressure classification for adolescents age 13 or older that aligns with forthcoming guidelines from the American Heart Association and American College of Cardiology.

  • Use 24-hour ambulatory blood pressure monitoring to more exactly diagnose hypertension

  • Start blood pressure-lowering medications if lifestyle changes fail to reduce the blood pressure, or if the child has another condition like diabetes or kidney disease.

The first-line treatment remains lifestyle changes, as there is a high correlation between hypertension and obesity.

"These guidelines offer a renewed opportunity for pediatricians to identify and address this important – and often unrecognized – chronic disease in our patients," Dr. Kaelber said. "The easy part was developing the new guidelines. Now we begin the harder work of implementing them to help children and adolescents."

Published
8/21/2017 1:00 AM
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