Updated clinical practice guidelines for childhood hypertension, the first new guidance on this topic in the United States since 2004, have just been published by The American Academy of Pediatrics (AAP).
Joseph Flynn, MD, MS, FAAP, chief, Division of Nephrology, Seattle Children’s Hospital, Seattle, Washington, reviewed the most important changes in the updated clinical practice guidelines in a session titled “What the pediatrician needs to know about the 2017 AAP Guidelines for Childhood Hypertension” at the American Academy of Pediatrics (AAP) National Conference and Exhibition on September 19.
As one of the co-chairs of the AAP committee that wrote the new guideline, Flynn emphasized that a major goal of the updated guideline was to make it easier for clinicians to use while maintaining the focus on providing proper scientific justification for the recommendations.
“We believe that it is important to look for children and adolescents with high blood pressure (BP), and that we hopefully have created something that will help the pediatrician identify those patients and then evaluate them in an appropriate manner,” he said.
To that end, one of the major changes from the previous guideline published in 2004 are new BP tables that are simplified to make it easier to recognize and identify kids with high BP, according to Flynn.
Other major changes include some modifications in the classification scheme for high BP, as well as an increased reliance on ambulatory BP monitoring (ABPM) to identify high BP in children.
For example, the updated guidelines change the definition of hypertension in children and adolescents, particularly for adolescents aged 13 years and older. In these older children, BP cut points indicative of hypertension are now identical to the cut points used to identify hypertension in adults—systolic BP of >130 mm Hg and/or diastolic BP of ≥80 mm Hg.
In children aged younger than 13 years, hypertension is defined as systolic and/or diastolic BP ≥95th percentile based on the new sex, age, and height tables.
The new guidelines also recommend the use of ABPM to:
· Confirm the diagnosis of hypertension in children with repeatedly elevated office BP readings.
· Confirm suspected white coat hypertension.
· Evaluate masked hypertension in children with a history of repaired coarctation of the aorta.
· Evaluate BP pattern and risk for hypertensive target organ damage in children with high-risk conditions.
· Evaluate possible hypertension in children with obstructive sleep apnea.
· Evaluate BP in heart and kidney transplant recipients.
· Assess treatment effectiveness in children on antihypertensive medications.
· Monitor treatment efficacy and possible masked hypertension in children with chronic kidney disease.
Flynn helped clinicians understand how these updated changes will affect the management of children and adolescents with high BP. The need for clinicians to be aware of these changes and to the guidelines in general is underscored by the many children with high BP who are not diagnosed.
“The majority of kids with high BP are not even being recognized,” Flynn said. “This is a problem that is not receiving sufficient attention in the primary care setting.”