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Current Treatment Options in Pediatrics

Erschienen in:

01.06.2019 | Pediatric Nephrology (BP Dixon and E Nehus, Section Editors)

Pediatric Hypertension

verfasst von: Kathleen E. Altemose, MD MHS, Tammy M. Brady, MD PhD

Erschienen in: Current Treatment Options in Pediatrics | Ausgabe 2/2019

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Abstract

Purpose of Review

Pediatric hypertension is an increasingly prevalent, yet underdiagnosed, problem associated with increased cardiovascular risk in adulthood. This article aims to review the diagnosis, evaluation, and management of pediatric hypertension and will include data from literature published after the new pediatric hypertension guidelines, when available.

Recent Findings

The 2017 American Academy of Pediatrics’ Clinical Practice Guidelines (CPG) for the diagnosis and management of pediatric hypertension significantly updated the approach to hypertension screening and management in youth. Many of these changes are reflective of the greater role certain conditions such as obesity, prematurity, and sleep-disordered breathing have on pediatric blood pressure. These changes, along with the expanded focus on 24-h ambulatory blood pressure monitoring (24-h ABPM) in the new guidelines, will be highlighted in this review.

Summary

Proper blood pressure measurement, including the use of 24-h ABPM, is critical for the diagnosis of hypertension in children. Treatment efforts for all children should focus on lifestyle modifications, with pharmacotherapy initiated for those who fail lifestyle modification, or for those with stage II, secondary, or symptomatic hypertension.

Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA. 2007;298(8):874–9. https://doi.org/10.1001/jama.298.8.874.CrossRefPubMed

McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr. 2007;150(6):640–644.e1. https://doi.org/10.1016/j.jpeds.2007.01.052.CrossRefPubMed

•• Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904. https://doi.org/10.1542/peds.2017-1904 This paper provides updated guidelines for the diagnosis and management of hypertension in pediatric patients, including updated definitions and normative BP tables, and increased focus on 24 hour ABPM.CrossRefPubMed

Brady TM, Neu AM, Miller ER, Appel LJ, Siberry GK, Solomon BS. Real-time electronic medical record alerts increase high blood pressure recognition in children. Clin Pediatr (Phila). 2015;54(7):667–75. https://doi.org/10.1177/0009922814559379.CrossRef

• Rinke ML, Singh H, Heo M, Adelman JS, O'Donnell HC, Choi SJ, et al. Diagnostic errors in primary care pediatrics: project RedDE. Acad Pediatr. 2018;18(2):220–7. https://doi.org/10.1016/j.acap.2017.08.005 This study highlighted the presence of a high rate of diagnostic errors and missed opportunities for diagnosis in primary care pediatrics, including under-recognition and lack of documentation of pediatric hypertension.CrossRefPubMed

• Khoury M, Khoury PR, Dolan LM, Kimball TR, Urbina EM. Clinical implications of the revised AAP Pediatric Hypertension Guidelines. Pediatrics. 2018;142(2):e20180245. https://doi.org/10.1542/peds.2018-0245 This study showed that the application of the 2017 CPG in a population of high-risk children and adolescents increased the prevalence of hypertension and may increase detection of left ventricular hypertrophy and target organ damage.CrossRefPubMedPubMedCentral

Theodore RF, Broadbent J, Nagin D, Ambler A, Hogan S, Ramrakha S, et al. Childhood to early-midlife systolic blood pressure trajectories: early-life predictors, effect modifiers, and adult cardiovascular outcomes. Hypertens (Dallas, Tex 1979). 2015;66(6):1108–15. https://doi.org/10.1161/HYPERTENSIONAHA.115.05831.CrossRef

Parker ED, Sinaiko AR, Kharbanda EO, Margolis KL, Daley MF, Trower NK, et al. Change in weight status and development of hypertension. Pediatrics. 2016;137(3):e20151662. https://doi.org/10.1542/peds.2015-1662.CrossRefPubMedPubMedCentral

Skinner AC, Perrin EM, Moss LA, Skelton JA. Cardiometabolic risks and severity of obesity in children and young adults. N Engl J Med. 2015;373(14):1307–17. https://doi.org/10.1056/NEJMoa1502821.CrossRef

10.

Flynn J, Zhang Y, Solar-Yohay S, Shi V. Clinical and demographic characteristics of children with hypertension. Hypertension. 2012;60(4):1047–54. https://doi.org/10.1161/HYPERTENSIONAHA.112.197525.CrossRefPubMed

11.

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl 4th Report):555–76. http://www.ncbi.nlm.nih.gov/pubmed/15286277.CrossRef

12.

• Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension. 2018;71(6):e13–e115. https://doi.org/10.1161/HYP.0000000000000065 This paper provides the American College of Cardiology/American Heart Association guidelines after which the definition of hypertension in the 2017 CPG was modeled.CrossRefPubMed

13.

Ringrose J, Millay J, Babwick SA, Neil M, Langkaas LA, Padwal R. Effect of overcuffing on the accuracy of oscillometric blood pressure measurements. J Am Soc Hypertens. 2015;9(7):563–8. https://doi.org/10.1016/j.jash.2015.04.007.CrossRefPubMed

14.

Mourad J-J, Lopez-Sublet M, Aoun-Bahous S, Villeneuve F, Jaboureck O, Dourmap-Collas C, et al. Impact of miscuffing during home blood pressure measurement on the prevalence of masked hypertension. Am J Hypertens. 2013;26(10):1205–9. https://doi.org/10.1093/ajh/hpt084.CrossRefPubMed

15.

Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, Jacobson M, et al. Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertens (Dallas, Tex 1979). 2008;52(3):433–51. https://doi.org/10.1161/HYPERTENSIONAHA.108.190329.CrossRef

16.

Flynn JT, Daniels SR, Hayman LL, Maahs DM, McCrindle B, Mitsnefes M, et al. Update: ambulatory blood pressure monitoring in children and adolescents. Hypertension. 2014;63(5):1116–35. https://doi.org/10.1161/HYP.0000000000000007.CrossRefPubMedPubMedCentral

17.

Barker DJ. The fetal and infant origins of adult disease. BMJ. 1990;301(6761):1111. http://www.ncbi.nlm.nih.gov/pubmed/2252919.CrossRefPubMedPubMedCentral

18.

Hoy WE, Hughson MD, Bertram JF, Douglas-Denton R, Amann K. Nephron number, hypertension, renal disease, and renal failure. J Am Soc Nephrol. 2005;16(9):2557–64. https://doi.org/10.1681/ASN.2005020172.CrossRefPubMed

19.

Keller G, Zimmer G, Mall G, Ritz E, Amann K. Nephron number in patients with primary hypertension. N Engl J Med. 2003;348(2):101–8. https://doi.org/10.1056/NEJMoa020549.CrossRefPubMed

20.

Schoenardie B, Guimarães V, Procianoy R, Silveira R. Systemic arterial hypertension in childhood: a challenge related to the increasing survival of very low birth weight preterm infants. Am J Perinatol 2018. doi:https://doi.org/10.1055/s-0038-1675644.

21.

Li AM, Au CT, Ho C, Fok TF, Wing YK. Blood pressure is elevated in children with primary snoring. J Pediatr. 2009;155(3):362–368.e1. https://doi.org/10.1016/j.jpeds.2009.03.041.CrossRefPubMed

22.

Weber SAT, dos SVJB, Semenzati G de O, Martin LC. Ambulatory blood pressure monitoring in children with obstructive sleep apnea and primary snoring. Int J Pediatr Otorhinolaryngol. 2012;76(6):787–90. https://doi.org/10.1016/j.ijporl.2012.02.041.CrossRefPubMed

23.

Kang K-T, Chiu S-N, Weng W-C, Lee P-L, Hsu W-C. Comparisons of office and 24-hour ambulatory blood pressure monitoring in children with obstructive sleep apnea. J Pediatr. 2017;182:177–183.e2. https://doi.org/10.1016/j.jpeds.2016.11.032.CrossRefPubMed

24.

• Hsu W-C, Kang K-T, Chiu S-N, Weng W-C, Lee P-L, Lin C-Y. 24-hour ambulatory blood pressure after Adenotonsillectomy in childhood sleep apnea. J Pediatr. 2018;199:112–7. https://doi.org/10.1016/j.jpeds.2018.03.072 e6. This study showed that pediatric patients with sleep apnea had improvement in 24-h ABPM after tonsillectomy and adenoidectomy.CrossRefPubMed

25.

Martínez-García M-A, Capote F, Campos-Rodríguez F, Lloberes P, Díaz de Atauri MJ, Somoza M, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension. JAMA. 2013;310(22):2407–15. https://doi.org/10.1001/jama.2013.281250.CrossRefPubMed

26.

Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ. 2000;320(7233):479–82 http://www.ncbi.nlm.nih.gov/pubmed/10678860. Accessed January 13, 2019.CrossRefPubMedPubMedCentral

27.

Samuels JA, Franco K, Wan F, Sorof JM. Effect of stimulants on 24-h ambulatory blood pressure in children with ADHD: a double-blind, randomized, cross-over trial. Pediatr Nephrol. 2006;21(1):92–5. https://doi.org/10.1007/s00467-005-2051-1.CrossRefPubMed

28.

Hennissen L, Bakker MJ, Banaschewski T, et al. Cardiovascular effects of stimulant and non-stimulant medication for children and adolescents with ADHD: a systematic review and meta-analysis of trials of methylphenidate, amphetamines and atomoxetine. CNS Drugs. 2017;31(3):199–215. https://doi.org/10.1007/s40263-017-0410-7.CrossRefPubMedPubMedCentral

29.

• Shin J-Y, Roughead EE, Park B-J, Pratt NL. Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study. BMJ. 2016;353:i2550. https://doi.org/10.1136/bmj.i2550 This study found that methylphenidate was not associated with hypertension in pediatric patients with ADHD, suggesting a lack of association between stimulant medication and hypertension.CrossRefPubMedPubMedCentral

30.

Rosenberg L, Palmer JR, Sands MI, Grimes D, Bergman U, Daling J, et al. Modern oral contraceptives and cardiovascular disease. Am J Obstet Gynecol. 1997;177(3):707–15 http://www.ncbi.nlm.nih.gov/pubmed/9322646. Accessed January 10, 2019.CrossRefPubMed

31.

Medical eligibility criteria for contraceptive use. World Health Organization; 2010. http://www.ncbi.nlm.nih.gov/pubmed/23741782. Accessed January 10, 2019.

32.

Lubianca JN, Moreira LB, Gus M, Fuchs FD. Stopping oral contraceptives: an effective blood pressure-lowering intervention in women with hypertension. J Hum Hypertens. 2005;19(6):451–5. https://doi.org/10.1038/sj.jhh.1001841.CrossRefPubMed

33.

Le-Ha C, Beilin LJ, Burrows S, et al. Oral contraceptive use in girls and alcohol consumption in boys are associated with increased blood pressure in late adolescence. Eur J Prev Cardiol. 2013;20(6):947–55. https://doi.org/10.1177/2047487312452966.CrossRefPubMed

34.

Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives. Results of an international, multicenter, case-control study. World Health Organization collaborative study of cardiovascular disease and steroid hormone contraception. Contraception. 1998;57(5):315–24 http://www.ncbi.nlm.nih.gov/pubmed/9673838.CrossRef

35.

Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents, national heart, lung, and blood institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128(Suppl 5 Supplement):S213–56. https://doi.org/10.1542/peds.2009-2107C.CrossRefPubMedCentral

36.

McCambridge TM, Benjamin HJ, Brenner JS, et al. Athletic participation by children and adolescents who have systemic hypertension. Pediatrics. 2010;125(6):1287–94. https://doi.org/10.1542/peds.2010-0658.CrossRefPubMed

37.

Black HR, Sica D, Ferdinand K, White WB. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 6: hypertension. J Am Coll Cardiol. 2015;66(21):2393–7. https://doi.org/10.1016/j.jacc.2015.09.038.CrossRefPubMed

Titel: Pediatric Hypertension
verfasst von: Kathleen E. Altemose, MD MHS
Tammy M. Brady, MD PhD
Publikationsdatum: 01.06.2019
Verlag: Springer International Publishing
Erschienen in: Current Treatment Options in Pediatrics / Ausgabe 2/2019
Elektronische ISSN: 2198-6088
DOI: https://doi.org/10.1007/s40746-019-00151-w

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