Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension

Lurbe, Empar; Cífková, Renata; Cruickshank, J.; Dillon, Michael J.; Ferreira, Isabel; Invitti, Cecilia; Kuznetsova, Tatiana; Laurent, Stéphane; Mancia, Giuseppe; Morales‐Olivas, Francisco J.; Rascher, Wolfgang; Redón, Josep; Schaefer, Franz; Seeman, Tomáš; Stergiou, George S.; Wühl, Elke; Zanchetti, Alberto

doi:10.1097/hjh.0b013e32832f4f6b

Cited by 673 publications

(706 citation statements)

References 160 publications

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“…The use of ABP monitoring in children and adolescents has gained great publicity in the last years and is regarded as an indispensable method for the diagnosis of pediatric hypertension. 16,17 Reference ABP values for children adjusted for gender and height or age are available and increased ABP values have been associated with left ventricular hypertrophy, increased carotid intima-media thickness and impaired renal function in young individuals, in most cases to a higher degree compared with CBP. 9,[11][12][13]30 On the other hand, HBP monitoring in children and adolescents is feasible 19 and reference values have been recently published.…”

Section: Discussionmentioning

confidence: 99%

“…Ambulatory hypertension was defined as average 24-h systolic and/or diastolic ABP X95th percentile. 16 Before each home or ambulatory BP monitoring session, the accuracy of the device was tested against a standard mercury sphygmomanometer in each individual (Y connector, three successive readings) to ensure that there was no consistent difference of 410 mm Hg in measured BP. All clinic, home and ambulatory BP measurements were taken in the same (non-dominant) arm of each individual.…”

Section: Bp Measurementsmentioning

confidence: 99%

“…14 Thus, the diagnosis of hypertension in children is dependent on accurate clinic and out of clinic BP measurements. 15 Reference values for ambulatory BP (ABP) in children are available 16,17 and accumulating data suggest that this method is more accurate in the diagnosis of hypertension and more closely associated with target-organ damage than the conventional clinic BP (CBP) measurements. 18 On the other hand, home BP (HBP) monitoring is regarded as an easily applicable and useful adjunct to CBP for the assessment of hypertension in adults; however data in children and adolescents are limited.…”

Section: Introductionmentioning

confidence: 99%

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Relationship of home blood pressure with target-organ damage in children and adolescents

et al. 2011

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The objective of this study was to compare home blood pressure (HBP) vs. ambulatory (ABP) and clinic (CBP) measurements in terms of their association with target-organ damage in children and adolescents. A total of 81 children and adolescents (mean age 13±3 years, 53 boys) referred for elevated CBP had measurements of CBP (1 visit), HBP (6 days) and ABP (24-h). Seventy-six participants were also assessed with carotid-femoral pulse wave velocity (PWV) and 54 with echocardiography. Average CBP was 122.1 ± 15.1/71 ± 12.9 mm Hg (systolic/diastolic), HBP 121.3 ± 11.5/69.4 ± 6.6 mm Hg and 24-h ABP 118.9 ± 12/ 66.6 ± 6.1 mm Hg. Left ventricular mass (LVM) was correlated with systolic blood pressure (BP) (coefficient r¼0.55/0.54/0.45 for 24-h/daytime/nighttime ABP, 0.53 for HBP and 0.41 for CBP; all Po0.01). No significant correlations were found for diastolic BP. PWV was also significantly correlated with systolic BP (r¼0.52/0.50/0.48 for 24-h/daytime/nighttime ABP, 0.50 for HBP and 0.47 for CBP; all Po0.01). Only diastolic ABP and HBP were significantly correlated with PWV (r¼0.30 and 0.28, respectively, Po0.05). In multivariate stepwise regression analysis (with age, gender, body mass index [BMI], clinic, home and 24-h ambulatory systolic/diastolic BP and pulse pressure, clinic, home and 24-h heart rate as independent variables), PWV was best predicted by systolic HBP (R 2 ¼0.22, beta ± s.e. ¼0.06 ± 0.01), whereas LVM was determined (R 2 ¼0.67) by 24-h pulse pressure (beta¼1.21±0.41), age (beta¼2.93±1.32), 24-h heart rate (beta¼À1.27±0.41) and BMI (beta¼1.78±0.70). These data suggest that, in children and adolescents, ABP as well as HBP measurements appear to be superior to the conventional CBP measurements in predicting the presence of subclinical end-organ damage.

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Section: Discussionmentioning

confidence: 99%

Section: Bp Measurementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Relationship of home blood pressure with target-organ damage in children and adolescents

et al. 2011

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“…Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is fast becoming the gold standard for determination of hypertension in both children and adults, and seems to correlate better with outcomes [27].…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

“…The long-term effects of childhood hypertension are largely unknown, as has been detailed in the recent United States Preventative Services Task Force (USPSTF) report, which highlights the need for more evidence to fully understand the relationship between childhood hypertension and cardiovascular disease [27,28]. The development of target organ damage, including carotid intima-media thickening, left ventricular hypertrophy, hypertensive nephropathy, and retinopathy are all well-established consequences of childhood hypertension.…”

Section: Disease Management Overviewmentioning

confidence: 99%

Pharmacologic Management of Pediatric Hypertension

2015

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Screening for Elevated Blood Pressure in Children and Adolescents

Chioléro¹,

Bovet²,

Paradis³

2013

JAMA Pediatr

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Although screening for elevated blood pressure (BP) in adults is beneficial, evidence of its beneficial effects in children is not clear. Elevated BP in children is associated with atherosclerosis early in life and tracks across the life course. However, because of the high variability in BP, tracking is weak, and having an elevated BP in childhood has a low predictive value for having elevated BP later in life. The absolute risk of cardiovascular diseases associated with a given level of BP in childhood and the long-term effect of treatment beginning in childhood are not known. No study has experimentally evaluated the benefits and harm of BP screening in children. One modeling study indicates that BP screen-and-treat strategies in adolescents are moderately cost-effective but less cost-effective than population-wide interventions to decrease BP for the reduction of coronary heart diseases. The US National Heart, Lung, and Blood Institute and the European Society of Hypertension recommend that children 3 years of age and older have their BP measured during every health care visit. According to the US Preventive Services Task Force, there is no sufficient evidence to recommend for or against screening, but their recommendations have to be updated. Whether the benefits of universal BP screening in children outweigh the harm has to be determined. Studies are needed to assess the absolute risk of cardiovascular diseases associated with elevated BP in childhood, to evaluate how to simplify the identification of elevated BP, to evaluate the long-term benefits and harm of treatment beginning in childhood, and to compare universal and targeted screening strategies.

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Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension

Cited by 673 publications

References 160 publications

Relationship of home blood pressure with target-organ damage in children and adolescents

Relationship of home blood pressure with target-organ damage in children and adolescents

Pharmacologic Management of Pediatric Hypertension

Screening for Elevated Blood Pressure in Children and Adolescents

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