Hypertension in Children and Adolescents: A Position Statement From a Panel of Multidisciplinary Experts Coordinated by the French Society of Hypertension

Abstract

Hypertension is much less common in children than in adults. The group of experts decided to perform a review of the literature to draw up a position statement that could be used in everyday practice. The group rated recommendations using the GRADE approach. All children over the age of 3 years should have their blood pressure measured annually. Due to the lack of data on cardiovascular morbidity and mortality associated with blood pressure values, the definition of hypertension in children is a statistical value based on the normal distribution of blood pressure in the paediatric population, and children and adolescents are considered as having hypertension when their blood pressure is greater than or equal to the 95th percentile. Nevertheless, it is recommended to use normative blood pressure tables developed according to age, height and gender, to define hypertension. Measuring blood pressure in children can be technically challenging and several measurement methods are listed here. Regardless of the age of the child, it is recommended to carefully check for a secondary cause of hypertension as in 2/3 of cases it has a renal or cardiac origin. The care pathway and principles of the therapeutic strategy are described here.

Pharmacological Treatment of Arterial Hypertension in Children and Adolescents in Lithuania

“…Non-pharmacological management consists of weight loss, regular physical activity, and reduced sodium intake. The implementation of these strategies is recommended in all children with AH [ 15 , 16 ]. Non-pharmacological treatment is frequently initiated in children with non-severe primary AH without target organ damage, while these measures are usually insufficient in those with secondary AH [ 1 , 17 ].…”

Evaluation of Health-Promoting Behaviors in the Prevention of Cardiovascular Diseases in the Preschool Children of Polish Health Care Professionals

“…A balanced diet, followed from an early childhood, is believed to be very beneficial for health [ 28 ]. It decreases the risk of CVDs by preventing obesity, hypertension, and diabetes [ 2 ]. The AHA has created a recommendation for a well-balanced diet among children with regard to cardiovascular health [ 15 ].…”

“…According to the data provided by the Central Statistical Office, CVDs are responsible for 46% of deaths in the adult population of Poland [ 1 ]. The development of CVDs in the adult population is highly correlated with cardiovascular risk factors that may first occur in childhood and then progress towards more severe forms [ 2 ]. Despite the fact that the clinical symptoms of CVDs and the associated complications rarely manifest themselves in children, it should be remembered that even preschool children are exposed to CVD risk factors [ 3 , 4 ].…”

Primary and secondary paediatric hypertension

“…16 Due to the lack of data on cardiovascular morbidity and mortality correlated with high BP in children, the definition of hypertension in paediatric age is a statistical value based on the normal distribution of BP values in the paediatric population. 17 Measuring BP in a medical setting has its own limitations, including the option of missing the 'white-coat HTN' (i. e. not only BP 958 when measured by a physician, but also <958 when checked at home with a less than 25% difference between the two measurements) as well as the 'masked HTN' (i.e. not only BP <958 when measured by a physician, but also 958 when checked at home with a more than 25% difference between the two measurements).…”