Study review diagnosis and management of hypertension in children

1. Estimates of prevalence of hypertension in children are highly variable, from 0.3% to 4.5%, primarily due to the different standards, populations, and BP measuring techniques.

2. The most significant risk factors for pediatric hypertension reported in many studies include overweight and obesity. Other risk factors reported were dietary salt intake, male sex, older age, and ethnicity.

Evidence Rating Level: 2 (Good)

Rundown [systematic review]: While hypertension in the adult population is clearly defined with numeric values, hypertension in children is not diagnosed similarly, primarily because outcomes data (e.g. cardiovascular morbidity and mortality) is not readily available for children. Being that recognition of hypertension in children remains poor amongst clinicians, the author of this article surveyed the literature to identify prevalence, risk factors, diagnostic standards, and guidelines for management. In children, hypertension is defined as 2 SDs above the mean for both systolic and diastolic BPs. This categorizes children into the following ranges: normal, prehypertension, stage I hypertension, and stage II hypertension, where blood pressure is averaged and adjusted (to age, sex, and height) over 3 separate occasions. Prevalence of hypertension was difficult to assess, with a wide range between 0.3% – 4.5%, largely due to different standards, populations, and BP measuring techniques. The two most significant risk factors reported consistently in many studies include overweight and obesity. Other risk factors reported were dietary salt intake, male sex, older age, and ethnicity (including Hispanic and non-Hispanic black, and Asian Americans).

Results from this review suggest that pediatric hypertension is predictive of adult BP and has a significant impact on the heart and blood vessels. In many studies, pediatric hypertension was associated with left ventricular hypertrophy, carotid intima-media thickness, and microalbuminuria. The goals of evaluation of children with hypertension are three-fold: identification of end organ failure, identification of additional cardiovascular risks, and identification of secondary hypertension, if appropriate. First line treatment always included non-pharmacological lifestyle treatments. No specific medications were recommended as first-line pharmacological agents, but angiotensin converting enzyme inhibitors and calcium channel blockers were preferred by a survey of 185 nephrologists.

Despite the fact that pediatric hypertension was recognized 4 decades ago, it remains underdiagnosed and non-standardized. Implementation of national quality measures directly into electronic medical records could help increase diagnosis of pediatric hypertension. Future pediatrics research needs an accurate population-level estimate of prevalence, especially amongst specific populations. In addition, the measure of degree of risk from pediatric hypertension for adult cardiovascular outcomes also needs to be addressed.

Click to read the study, published today in Pediatrics

Relevant Reading: Childhood Blood Pressure Trends and Risk Factors for High Blood Pressure: The NHANES experience 1988–2008

Image: PD

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