Screening and Management of High Blood Pressure in Children and Adolescents

Publication Date: September 1, 2017

Last Updated: March 14, 2022

Recommendations

Assessment

BP should be measured annually in children and adolescents ≥3 years of age. (CModerate)

328602

BP should be checked in all children and adolescents ≥3 years of age at every health care encounter if they have obesity, are taking medications known to increase BP, have renal disease, a history of aortic arch obstruction or coarctation, or diabetes. (CModerate)

328602

Trained health care professionals in the office setting should make a diagnosis of HTN if a child or adolescent has auscultatory-confirmed BP readings ≥95th percentile on 3 different visits. (CModerate)

328602

Organizations with EHRs used in an office setting should consider including flags for abnormal BP values both when the values are being entered and when they are being viewed. (CWeak)

328602

Oscillometric devices may be used for BP screening in children and adolescents. When doing so, providers should use a device that has been validated in the pediatric age group. If elevated BP is suspected on the basis of oscillometric readings, confirmatory measurements should be obtained by auscultation. (BStrong)

328602

ABPM should be performed for the confirmation of HTN in children and adolescents with office BP measurements in the elevated BP category for 1 year or more or with stage 1 HTN over 3 clinic visits. (CModerate)

328602

The routine performance of ABPM should be strongly considered in children and adolescents with high-risk conditions to assess HTN severity and determine if abnormal circadian BP patterns are present, which may indicate increased risk for target organ damage. (BModerate)

328602

ABPM should be performed by using a standardized approach with monitors that have been validated in a pediatric population, and studies should be interpreted by using pediatric normative data. (CModerate)

328602

Children and adolescents with suspected WCH should undergo ABPM. Diagnosis is based on the presence of mean SBP and DBP <95th percentile and SBP and DBP load <25%. (BStrong)

328602

Home BP monitoring should not be used to diagnose HTN, MH, or WCH but may be a useful adjunct to office and ambulatory BP measurement after HTN has been diagnosed. (CModerate)

328602

Children and adolescents ≥6 years of age do not require an extensive evaluation for secondary causes of HTN if they have a positive family history of HTN, are overweight or obese, and/or do not have history or physical examination findings suggestive of a secondary cause of HTN. (CModerate)

328602

Children and adolescents who have undergone coarctation repair should undergo ABPM for the detection of HTN (including masked hypertension [MH]). (BStrong)

328602

In children and adolescents being evaluated for high BP, the provider should obtain a perinatal history, appropriate nutritional history, physical activity history, psychosocial history, and family history and perform a physical examination to identify findings suggestive of secondary causes of HTN (BStrong)

328602

Clinicians should not perform electrocardiography in hypertensive children and adolescents being evaluated for LVH. (BStrong)

328602

It is recommended that echocardiography be performed to assess for cardiac target organ damage (LV mass, geometry, and function) at the time of consideration of pharmacologic treatment of HTN;

LVH should be defined as LV mass >51 g/m^2. (boys and girls) for children and adolescents older than 8 years and defined by LV mass >115 g/BSA for boys and LV mass >95 g/BSA for girls;
Repeat echocardiography may be performed to monitor improvement or progression of target organ damage at 6- to 12-month intervals. Indications to repeat echocardiography include persistent HTN despite treatment, concentric LV hypertrophy, or reduced LV ejection fraction; and
In patients without LV target organ injury at initial echocardiographic assessment, repeat echocardiography at yearly intervals may be considered in those with stage 2 HTN, secondary HTN, or chronic stage 1 HTN incompletely treated (noncompliance or drug resistance) to assess for the development of worsening LV target organ injury.

(CModerate)

328602

Doppler renal ultrasonography may be used as a noninvasive screening study for the evaluation of possible RAS in normal-weight children and adolescents ≥8 years of age who are suspected of having renovascular HTN and who will cooperate with the procedure. (CModerate)

328602

In children and adolescents suspected of having renal artery stenosis (RAS), either CTA or MRA may be performed as a noninvasive imaging study. Nuclear renography is less useful in pediatrics and should generally be avoided. (DWeak)

328602

Routine testing for MA is not recommended for children and adolescents with primary HTN. (CModerate)

Screening and Management of High Blood Pressure in Children and Adolescents

Recommendations

Assessment

Overview

Title

Authoring Organization