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

Abstract

A substantial body of clinical data on elevated blood pressure (BP) in children and adolescents have been published during the past decade. In response to the need to update management guidelines on pediatric hypertension, the American Academy of Pediatrics (AAP) supported development and publication of a new clinical practice guideline on high BP in childhood. Before 1977, there was no consistent definition of hypertension in childhood, and BP was not commonly measured in asymptomatic children or adolescents. Consequently, childhood hypertension had been considered rare and, if detected, the assumption was that it would be secondary to an underlying disorder. In the mid-1970s, the National High Blood Pressure Education (NHBPEP) of the National Heart Lung and Blood Institute (NHLBI) convened a task force to examine available BP data on healthy children to determine the normal BP distribution in children and define the upper limits of BP according to age. Although available BP data at that time were limited by current standards, it was clear that BP levels in children were related to age, with a progressive increase from early childhood through adolescence. In the absence of longterm outcome data, it was not possible to link a level of childhood BP to risk of later cardiovascular events. Therefore, the task force defined hypertension as the BP level that exceeded the 95th percentile on age-related BP distribution curves. The recommendations of this task force on detection, evaluation, and management of hypertension in children and adolescents were published in 1977.1 In addition to providing a framework on diagnosis of hypertension, the publication included information on proper BP measurement in children, diagnostic evaluation for children with elevated BP, and management of BP in hypertensive children.That report of that NHBPEP Task Force 1 constituted the first clinical practice guideline (CPG) for childhood hypertension. Major updates were published in 1987, 1996, and 2004. 2-4 Minor updating of antihypertensive drug dosing for children, but no new recommendations related to evaluation or management of high childhood BP, was incorporated into the 2011 NHLBI integrated guideline on pediatric cardiovascular health.5 Since the 2004 Working Group report, findings of many new studies related to childhood hypertension have been published, including data on epidemiology, hypertension-related risk factors, BP management, and target organ damage (TOD). The childhood obesity epidemic during this time period also lead to increased recognition of obesity-associated hypertension in childhood. Considering the knowledge gained from the body of publications since 2004, it was recognized that the pediatric hypertension guidelines needed to be updated.Several prominent investigators in the field of pediatric hypertension began developing the case with the NHLBI to support an update of the pediatric hypertension CPG. However, the 2013 announcement by the NHLBI 6 that it would no longer sponsor the development of new CPGs pro...

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