Hypertension in children is not just a specialty problem. It's much more common in general pediatrics than community pediatricians might realize, said Joseph T Flynn, MD, MS, FAAP.
In his talk "Pediatric hypertension: A rising problem. The role of ambulatory BP monitoring and medication management" given at the American Academy of Pediatrics 2016 National Conference, Flynn pointed out that in a typical general pediatrics practice, around 3% to 4% of patients are hypertensive, but more than 10% of children will have an elevated blood pressure (BP) reading at some point.
Many community pediatricians do not know what to do with a BP measurement. It is well-documented: Misdiagnoses occur frequently because clinicians are not recognizing when children have high BP in the first place.1 Various authors have speculated that perhaps some clinicians don't understand the complex criteria for hypertension, or they lack the time to apply them properly.
The fact that most CME lectures regarding pediatric hypertension all but ignore management, focusing almost exclusively on evaluation, has not helped matters. Community pediatricians are seeking this information, as evidenced by the number and specificity of management-related questions they typically ask after these lectures.
When a child in the office has hypertension, deciding whether to use medication management or lifestyle change depends on the individual clinical situation. For a child with obesity and hypertension—a common clinical scenario—lifestyle change might not be enough. Diet and exercise alone may not bring some children's BP into the desired range. A child with secondary hypertension might require frequent changes in management after treatment has been initiated if, say, the initial dose or medication fails to control the hypertension.
In such clinical scenarios, ambulatory blood pressure monitoring (ABPM) can help not only with diagnosis, but also with management, as it provides an objective assessment of BP for tracking response to antihypertensive medications and/or lifestyle changes. Additional conditions in which ABPM can prove particularly helpful include chronic kidney disease, diabetes, sleep apnea, and genetic syndromes. The American Heart Association recently updated its guidelines for using and interpreting ABPM.2
1. Brady TM, Solomon BS, Neu AM, Siberry GK, Parekh RS. Patient-, provider-, and clinic-level predictors of unrecognized elevated blood pressure in children. Pediatrics. 2010;125(6):e1286-e1293.
2. Flynn JT, Daniels SR, Hayman LL, et al; American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young. Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension. 2014;63(5):1116-1135.