Children and Adolescents
Considerable advances have been made in the detection, evaluation, and management of hypertension in children and adolescents. Current evidence indicates that primary hypertension in young individuals occurs more commonly than previously recognized and has substantial long-term health implications. There is little doubt that obesity in young people is a predictor for developing hypertension as well as associated metabolic risk factors. Hypertension in individuals aged 3–18 years is defined as average systolic BP and/or diastolic BP that is in the 95th percentile or higher for sex, age, and height, taken on 3 or more occasions. BP between the 90th percentile and the 95th percentile in childhood is designated as elevated and is an indication for lifestyle modifications. It is recommended that children older than 3 years have their BP measured when they are examined in a medical setting.
Children and adolescents who are hypertensive are frequently overweight, and some may have sleep disorders. Secondary hypertension occurs more commonly in children than in adults.
Indications for initiating antihypertensive drug therapy in children include uncontrolled hypertension despite nonpharmacologic measures, symptomatic hypertension, secondary hypertension, hypertensive target-organ damage, and hypertension in patients with diabetes mellitus. Acceptable drug choices for treating hypertension in children include diuretics, β-blockers, ACE inhibitors, ARBs, and CCBs.
Flynn JT, Kaelber DC, Baker-Smith CM, et al; Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):ii.
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):555–576.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.