Management of high blood pressure in children: similarities and differences between US and European guidelines

Abstract

Over the last several decades, many seminal longitudinal cohort studies have clearly shown that the antecedents to adult disease have their origins in childhood. Hypertension (HTN), which has become increasingly prevalent in childhood, represents one of the most important risk factors for cardiovascular diseases (CVD) such as heart disease and stroke. With the risk of adult HTN much greater when HTN is manifest in childhood, the future burden of CVD worldwide is therefore concerning. In an effort to slow the current trajectory, professional societies have called for more rigorous, evidence-based guideline development to aid primary care providers and subspecialists in improving recognition, diagnosis, evaluation, and treatment of pediatric HTN. In 2016 the European Society of Hypertension and in 2017 the American Academy of Pediatrics published updated guidelines for prevention and management of high blood pressure (BP) in children. While there are many similarities between the two guidelines, important differences exist. These differences, along with the identified knowledge gaps in each, will hopefully spur clinical researchers to action. This review highlights some of these similarities and differences, focusing on several of the more important facets regarding prevalence, prevention, diagnosis, management, and treatment of childhood HTN.

Maternal Gestational Diabetes Is Associated With Offspring’s Hypertension

“…23 It is well known that pediatric hypertension has significant implication for future risk of adult hypertension and subsequent cardiovascular diseases. [24][25][26] Thus, it becomes particularly important for early diagnosis and management, especially in children with a high risk of hypertension. Several recent studies have assessed whether maternal GDM was a risk factors for children's high blood pressure, but the results were contradictory.…”

Implications of the 2017 AAP Clinical Practice Guidelines for Management of Hypertension in Children and Adolescents: a Review

“…Others are wary that HTN may be under-recognized in younger adolescent females given that the prior 95th percentile exceeds the static thresholds only in tall females for the younger adolescents [15].…”

“…She did, however, critique the extensive reliance on ABPM in the 2017 AAP CPG citing the lack of broad availability, barriers to increased availability including poor reimbursement, and the need for improved normative values used to interpret pediatric ABPMs. Brady et al echoed this critique feeling that the limited availability and reimbursement for the test render it unsuitable for such a strong recommendation [15]. In a review by Samuels and Samuel, they argue that the increased emphasis on evaluation with ABPM is supported by strong evidence and the overall key provisions of the 2017 AAP CPG are focused on simplifying and easing recognition and diagnosis of pediatric HTN [12].…”

“…However, the 2016 ESHG has also recently been published. Both Lurbe et al [25] and Brady et al [15] have written reviews discussing the major changes between the two guidelines, the most significant of which are differences in the categorization of BP between the two guidelines (see in Table 1). Other notable differences between the 2016 ESHG and 2017 AAP CPG include:…”

The associations between noise annoyance and psychological distress with blood pressure in children and adolescents: The CASPIAN‐V Study

“…Evidences suggest that elevated BP during childhood accelerates vascular stiffness and increases the risk of future hypertension, metabolic syndrome and end‐organ damage; hence, predispose the individual to cerebrovascular/ cardiovascular accidents later in life 4‐6 . Based on epidemiological studies, number of children presenting with primary HTN is seriously increasing in recent years 7 .…”