These pediatric hypertension guidelines are an update to the 2004 “Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.” Significant changes in these guidelines include (1) the replacement of the term “prehypertension” with the term “elevated blood pressure,” (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.

National guidelines for the diagnosis and management of hypertension in children have been available for nearly 40 years. Unfortunately, knowledge and recognition of the problem by clinicians remain poor. Prevalence estimates are highly variable because of differing standards, populations, and blood pressure (BP) measurement techniques. Estimates in the United States range from 0.3% to 4.5%. Risk factors for primary hypertension include overweight and obesity, male sex, older age, high sodium intake, and African American or Latino ancestry. Data relating hypertension in childhood to later cardiovascular events is currently lacking. It is known that BP in childhood is highly predictive of BP in adulthood. Compelling data about target organ damage is available, including the association of hypertension with left ventricular hypertrophy, carotid-intima media thickness, and microalbuminuria. Guidelines from both the United States and Europe include detailed recommendations for diagnosis and management. Diagnostic standards are based on clinic readings, ambulatory BP monitoring is useful in confirming diagnosis of hypertension and identifying white-coat hypertension, masked hypertension, and secondary hypertension, as well as monitoring response to therapy. Research priorities include the need for reliable prevalence estimates based on diverse populations and data about the long-term impact of childhood hypertension on cardiovascular morbidity and mortality. Priorities to improve clinical practice include more education among clinicians about diagnosis and management, clinical decision support to aid in diagnosis, and routine use of ambulatory BP monitoring to aid in diagnosis and to monitor response to treatment.

https://pediatrics.aappublications.org/content/pediatrics/early/2016/07/11/peds.2015-3616.full.pdf

Diagnosis, Epidemiology, and Management of Hypertension in Children

Background Hypertension in children can be associated with adverse health outcomes and may persist into adulthood, where it presents a significant personal and public health burden. Screening asymptomatic children has the potential to detect hypertension at earlier stages, so that interventions can be initiated which, if effective, could reduce the adverse health effects of childhood hypertension in children and adults. Purpose To assess the effects of screening for hypertension in asymptomatic children and adolescents to prevent cardiovascular disease. Methods We searched the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews (through July 2012) and MEDLINE (1946–July 9, 2012) and manually reviewed reference lists of included studies. Citations were independently reviewed by two investigators, and data extraction performed by one investigator and checked by a second for accuracy. We included studies of screening for hypertension in asymptomatic children and studies of benefits and harms of treatments for children with hypertension. Diagnostic accuracy studies were included if they used a reference standard and allowed calculation of sensitivity and specificity. We excluded studies focusing on secondary hypertension. Results No studies evaluated the effect of screening asymptomatic children for hypertension on subsequent health outcomes, including onset of hypertension. Two studies that assessed accuracy of screening tests for elevated blood pressure found moderate sensitivities (0.65 and 0.72) and specificities (0.75 and 0.92) and low positive predictive values (0.37, 0.17). The association between elevated blood pressure or hypertension in childhood and hypertension in adulthood was assessed in 10 studies, with most studies finding a small but significant association. Seven fair-quality studies found drug interventions were effective at lowering blood pressure after 4 weeks, based on the proportion achieving normotensive status and/or mean reductions in blood pressure. One trial of a drug combined with lifestyle modifications found lower mean blood pressures at 30 months, and one trial of increased exercise found lower mean blood pressures at 8 months, whereas other lifestyle trials found no differences. Of 13 studies assessing harms of interventions, only one study found that adverse event rates were significantly lower for those in the intervention group; all other studies found no difference in adverse events. Conclusions Studies are needed to assess whether screening for hypertension in children and adolescents reduces adverse health outcomes or delays the onset of hypertension. Blood pressure screening may be effective at identifying children with hypertension, though evidence is limited and false-positive rates were high. The presence of hypertension in childhood is associated with hypertension in adults, but with limited evidence available for its association with end-organ damage markers in adults. Drug interventions for hypertension may be effective at lowering blood pressure with few serious side effects; however, studies of longer duration are needed to confirm results from short-term studies. Evidence on the effectiveness of childhood combination drug and lifestyle interventions and lifestyle-only interventions is sparse and mixed, with most studies showing no sustained reduction in blood pressure in childhood. Studies are needed to assess whether treating hypertension in childhood affects subsequent intermediate or clinical outcomes in adulthood.

Screening for Hypertension in Children and Adolescents to Prevent Cardiovascular Disease: Systematic Review for the U.S. Preventive Services Task Force

Concomitantly with the increasing prevalence of childhood obesity, the prevalence of metabolic syndrome (MS) is rising among children and adolescents, leading to fears for future epidemics of type 2 diabetes mellitus and cardiovascular disease in the young. This makes the accurate identification and the appropriate treatment of children and adolescents with MS an important priority for health care systems. This review will focus on the management of each component of MS, including the nonalcoholic fatty liver disease (NAFLD), which is currently considered as the hepatic component of the syndrome. The most relevant target of treatment of MS in children and adolescents is the abdominal obesity. To this end, we will discuss the efficacy of dietary approaches, possibly coupled with regular physical activity, on eliciting visceral fat reduction. We will also highlight several aspects of the treatment of the high triglyceride/low high-density lipoprotein cholesterol phenotype, including the use of non-pharmacological measures, and indications for instituting drug therapies. Part of this review will address treatment of glucose abnormalities, including the benefits of lifestyle modification alone, and the potential adjunctive role of hypoglycemic drugs. The treatment of hypertension in children with MS also requires a multifaceted approach and the available data of this topic will be examined. The remainder of this review will address treatment to reverse NAFLD and prevent progression to end-stage disease.

Management of metabolic syndrome in children and adolescents

Background
Hypertension is a major risk factor for stroke, coronary artery disease and kidney damage in adults. There is a paucity of data on the long-term sequelae of persistent hypertension in children, but it is known that children with hypertension have evidence of end organ damage and are at risk of hypertension into adulthood. The prevalence of hypertension in children is rising, most likely due to a concurrent rise in obesity rates. In children with hypertension, non-pharmacological measures are often recommended as first-line therapy, but a significant proportion of children will eventually require pharmacological treatment to reduce blood pressure, especially those with evidence of end organ damage at presentation or during follow-up. A systematic review of the effects of antihypertensive agents in children has not previously been conducted.

Objectives
To determine the dose-related effects of different classes of antihypertensive medications, as monotherapy compared to placebo; as combination therapy compared to placebo or a single medication; or in comparisons of various doses within the same class, on systolic or diastolic blood pressure (or both) in children with hypertension.

Search methods
We searched the Cochrane Hypertension Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 9), Ovid MEDLINE (1946 to October 2013), Ovid EMBASE (1974 to October 2013) and bibliographic citations.

Selection criteria
The selection criteria were deliberately broad due to there being few clinical trials in children. We included randomised controlled trials (RCTs) of at least two weeks duration comparing antihypertensive agents either as monotherapy or combination therapy with either placebo or another medication, or comparing different doses of the same medication, in children with hypertension. Hypertension was defined as an average (over a minimum of three readings) systolic or diastolic blood pressure (or both) on the 95th percentile or above for age, height and gender.

Data collection and analysis
Two authors independently selected relevant studies, extracted data and assessed risk of bias. We summarised data, where possible, using a random-effects model. Formal assessment of heterogeneity was not possible because of insufficient data.

Main results
A total of 21 trials evaluated antihypertensive medications of various drug classes in 3454 hypertensive children with periods of follow-up ranging from three to 24 weeks. There were five RCTs comparing an antihypertensive drug directly with placebo, 12 dose-finding trials, two trials comparing calcium channel blockers with angiotensin receptor blockers, one trial comparing a centrally acting alpha blocker with a diuretic and one trial comparing an angiotensin-converting enzyme inhibitor with an angiotensin receptor blocker. No randomised trial was identified that evaluated the effectiveness of antihypertensive medications on target end organ damage. The trials were of variable quality and most were funded by pharmaceutical companies.

Among the angiotensin receptor blockers, candesartan (one trial, n = 240), when compared to placebo, reduced systolic blood pressure by 6.50 mmHg (95% confidence interval (CI) −9.44 to −3.56) and diastolic blood pressure by 5.50 mmHg (95% CI −9.62 to −1.38) (low-quality evidence). High dose telmisartan (one trial, n = 76), when compared to placebo, reduced systolic blood pressure by −8.50 (95% CI −13.79 to −3.21) but not diastolic blood pressure (−4.80, 95% CI −9.50 to 0.10) (low-quality evidence). Beta blocker (metoprolol, one trial, n = 140), when compared with placebo , significantly reduced systolic blood pressure by 4.20 mmHg (95% CI −8.12 to −0.28) but not diastolic blood pressure (−3.20 mmHg 95% CI −7.12 to 0.72) (low-quality evidence). Beta blocker/diuretic combination (Bisoprolol/hydrochlorothiazide, one trial, n = 94)when compared with placebo , did not result in a significant reduction in systolic blood pressure (−4.0 mmHg, 95% CI −8.99 to −0.19) but did have an effect on diastolic blood pressure (−4.50 mmHg, 95% CI −8.26 to −0.74) (low-quality evidence). Calcium channel blocker (extended-release felodipine,one trial, n = 133) was not effective in reducing systolic blood pressure (−0.62 mmHg, 95% CI −2.97 to 1.73) or diastolic blood pressure (−1.86 mmHg, 95% CI −5.23 to 1.51) when compared with placebo. Further, there was no consistent dose response observed among any of the drug classes. The adverse events associated with the antihypertensive agents were mostly minor and included headaches, dizziness and upper respiratory infections.

Authors' conclusions
Overall, there are sparse data informing the use of antihypertensive agents in children, with outcomes reported limited to blood pressure and not end organ damage. The most data are available for candesartan, for which there is low-quality evidence of a modest lowering effect on blood pressure. We did not find evidence of a consistent dose response relationship for escalating doses of angiotensin receptor blockers, calcium channel blockers or angiotensin-converting enzyme inhibitors. All agents appear safe, at least in the short term.

PLAIN LANGUAGE SUMMARY
Medications for high blood pressure in children

Hypertension (high blood pressure) is known to increase the risk of heart disease, stroke and kidney failure. The prevalence of hypertension in children is rising. A significant proportion of children with hypertension require medication to reduce blood pressure and medication use has increased significantly over the past several years.

This systematic review includes 21 trials, involving 3454 children, which evaluated different medications to lower blood pressure among children with hypertension. This evidence is up to date as of October 2013. Most trials were of very short duration with the average being seven weeks. The studies were of variable quality and mostly industry funded. Not all studies compared the effect of medication on blood pressure lowering to a placebo. Only a few classes of the commonly prescribed drugs have been evaluated and most had a modest effect on blood pressure, but it is uncertain whether this results in improved long-term outcomes for children. Higher doses of medication did not result in greater reduction of blood pressure. All of the drugs studied were safe for use, at least in the short term.

Pharmacological interventions for hypertension in children

This 4-week randomized, double blind, placebo-controlled study (N=240), 1-year open label trial (N=233), and single-dose pharmacokinetic study (N=22) evaluated candesartan cilexetil (3 doses) in hypertensive children aged 6 to 17 years. Seventy-one percent were 12 years of age or older, 71% were male, and 47% were black. Systolic (SBP)/diastolic (DBP) blood pressure declined 8.6/4.8-11.2/8.0 mm Hg with candesartan and 3.7/1.8 mm Hg with placebo (P .05). The response rate (SBP and DBP <95th percentile) after 1 year was 53%. The pharmacokinetic profiles in 6- to 12- and 12- to 17-year-olds were similar and were comparable to adults. Eight candesartan patients discontinued treatment because of an adverse event. Candesartan is an effective, well-tolerated antihypertensive agent for children aged 6 to 17 years and has a pharmacokinetic profile that is similar to that in adults.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1751-7176.2008.00022.x

Efficacy, safety, and pharmacokinetics of candesartan cilexetil in hypertensive children aged 6 to 17 years.

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Eva Marova

Author Tools

Chat about Author

Papers

Efficacy, safety, and pharmacokinetics of candesartan cilexetil in hypertensive children aged 6 to 17 years.