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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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Children and adolescents who have undergone coarctation repair should undergo ABPM for the detection of HTN (including masked hypertension [MH]). (BStrong)
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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)
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Clinicians should not perform electrocardiography in hypertensive children and adolescents being evaluated for LVH. (BStrong)
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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/m2. (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)
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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)
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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)
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Routine testing for MA is not recommended for children and adolescents with primary HTN. (CModerate)
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Overview

Title

Screening and Management of High Blood Pressure in Children and Adolescents

Authoring Organization

American Academy of Pediatrics