Evaluation of Pediatric Patients With Mild-to-Moderate Hypertension: Yield of Diagnostic Testing

Wiesen, Jonathan; Adkins, Matthew; Fortune, Sherwin; Horowitz, Judah; Pincus, Nava; Frank, Rachel; Vento, Suzanne; Hoffman, Cathy; Goilav, Béatrice; Trachtman, Howard

doi:10.1542/peds.2008-0365

Cited by 28 publications

(20 citation statements)

References 22 publications

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“…However, a retrospective study using a different population found that primary hypertension was the most prevalent type of hypertension in children aged 8 to 18 years and that it often coexisted with a positive family history for hypertension, an elevated BMI, and hypercholesterolemia. 27 In our study, having a borderline-high/high LDL-C level was the most prevalent CVD biological risk factor for adolescents. The AAP expert panel recommends universal lipid screening for all children aged 9 to 11 years and adolescents 17 to 21 years using nonfasting or fasting blood samples.…”

Section: Discussionmentioning

confidence: 54%

Prevalence of Cardiovascular Disease Risk Factors Among US Adolescents, 1999−2008

2012

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WHAT'S KNOWN ON THIS SUBJECT: Overweight and obese children have a higher prevalence of several cardiovascular disease (CVD) risk factors. There is growing evidence demonstrating that CVD risk factors present during childhood persist into adulthood.WHAT THIS STUDY ADDS: US adolescents had no significant change in prehypertension/hypertension and borderline-high/ high low-density lipoprotein cholesterol prevalence from 1999-2000 to 2007-2008; however, prediabetes/diabetes increased by 14%. abstract OBJECTIVE: Overweight and obesity during adolescence are associated with an increased risk for cardiovascular disease (CVD) risk factors. The objective of this study was to examine the recent trends in the prevalence of selected biological CVD risk factors and the prevalence of these risk factors by overweight/obesity status among US adolescents. METHODS:The NHANES is a cross-sectional, stratified, multistage probability sample survey of the US civilian, noninstitutionalized population. The study sample included 3383 participants aged 12 to 19 years from the 1999 through 2008 NHANES.RESULTS: Among the US adolescents aged 12 to 19 years, the overall prevalence was 14% for prehypertension/hypertension, 22% for borderline-high/high low-density lipoprotein cholesterol, 6% for low high-density lipoprotein cholesterol (,35 mg/dL), and 15% for prediabetes/diabetes during the survey period from 1999 to 2008. No significant change in the prevalence of prehypertension/hypertension (17% and 13%) and borderline-high/high low-density lipoprotein cholesterol (23% and 19%) was observed from 1999-2000 to 2007-2008, but the prevalence of prediabetes/diabetes increased from 9% to 23%. A consistent dose-response increase in the prevalence of each of these CVD risk factors was observed by weight categories: the estimated 37%, 49%, and 61% of the overweight, obese, and normal-weight adolescents, respectively, had at least 1 of these CVD risk factors during the 1999 through 2008 study period. CONCLUSIONS:The results of this national study indicate that US adolescents carry a substantial burden of CVD risk factors, especially those youth who are overweight or obese.

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Section: Discussionmentioning

confidence: 54%

Prevalence of Cardiovascular Disease Risk Factors Among US Adolescents, 1999−2008

2012

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“…In general, such testing includes a basic set of screening tests and additional, specific tests; the latter are selected on the basis of clues obtained from the history and physical examination and/or the results of the initial screening tests. 354 Table 10 provides a list of screening tests and the populations in which they should be performed.…”

Section: Laboratory Evaluationmentioning

confidence: 99%

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

et al. 2017

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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.

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“…Wiesen et al 19 retrospectively analyzed 220 patients, of whom 178 had echocardiograms, and found LVH in 11% and other cardiac anomalies in another 6%. The overall diagnostic yield in their patients was 17%.…”

Section: Discussionmentioning

confidence: 99%

Hypertension Prevalence, Cardiac Complications, and Antihypertensive Medication Use in Children

Dobson

Eide

Nylund

2015

The Journal of Pediatrics

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Evaluation of Pediatric Patients With Mild-to-Moderate Hypertension: Yield of Diagnostic Testing

Cited by 28 publications

References 22 publications

Prevalence of Cardiovascular Disease Risk Factors Among US Adolescents, 1999−2008

Prevalence of Cardiovascular Disease Risk Factors Among US Adolescents, 1999−2008

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

Hypertension Prevalence, Cardiac Complications, and Antihypertensive Medication Use in Children

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