Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

Abstract

These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.

Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

“…between 90 th and 95 th percentile) in childhood and adolescence compared with those who in childhood and adolescence had blood pressure below 90 th percentile [23]. In the AAP [24] recommendations published in 2017, based on the results of the SPRINT study, new AH definitions were proposed. Lower blood pressure targets (below 90 th percentile or below 130/80 mmHg) were also recommended in children with primary AH, arguing that lowering blood pressure below these values leads to a further reduction in left www.ah.viamedica.pl ventricular hypertrophy.…”

“…Reduction of the mean 24-hour MAP below the 90 th percentile (range 50 th -90 th percentile) is recommended in children with chronic kidney disease without proteinuria or with proteinuria below 0.5 g per day, and in children with proteinuria over 0.5 g per day 24-hour MAP should be lower than the 50 th percentile [44,45]. However, because there is linear relationship between proteinuria and progression of CKD, it is also recommended to try to lower 24h MAP values below 50 th percentile in all children with CKD if such treatment is well tolerated [24].…”

“…Scintigraphy is not recommended in AAP guidelines or in clinical guidelines for adult patients, including the guidelines of the Polish Society of Hypertensions, in the diagnostic algorithm for renovascular hypertension in adults [4,24]. However, in our opinion the assessment of split renal function and analysis of perfusion curves helps in deciding on surgical treatment in difficult cases (young children in whom percutaneous treatment is impossible), allows the evaluation of the treatment effects after interventional procedures (percutaneous treatment/surgery) and is an additional criterion for the diagnosis of hypertensive nephropathy in a kidney with normal renal artery and exposed to high blood pressure before treatment [71].…”

Порушення Ниркової Й Периферичної Гемодинаміки В Розвитку Серцево-Судинних Розладів У Дітей Із Хронічним Пієлонефритом

“…У цілому поширеність клінічної АГ у дітей та підлітків становить близько 3,5 %, при цьому майже 20 % педіатричної АГ пов'язують з хронічною хворобою нирок (ХХН) [2]. У кожної другої дитини або підлітка ХХН перебігає з АГ [2].…”

“…У цілому поширеність клінічної АГ у дітей та підлітків становить близько 3,5 %, при цьому майже 20 % педіатричної АГ пов'язують з хронічною хворобою нирок (ХХН) [2]. У кожної другої дитини або підлітка ХХН перебігає з АГ [2]. Необхідно також відзначити, що АГ при хронічно-му пієлонефриті (ХПН), навіть при ще збереженій функції нирок, спостерігається у 2-4 рази часті-ше, ніж у загальній популяції, і в 12-20 % випадків має зло якісний перебіг [3].…”