Screening, diagnosis and treatment of hypertension in obese children: an international policy comparison

Abstract

Hypertension in obese children may require a different diagnostic and treatment approach from that for children with secondary hypertension, yet there is neither consensus nor a clear guideline. The aim of this study was to assess how obese children with hypertension are currently diagnosed and treated by paediatric nephrologists, what obstacles exist and what can be improved. In the period May–November 2014, an online questionnaire was sent to all members of the European Society for Paediatric Nephrology (n = 2148). Questions focused on current practices and obstacles regarding screening, diagnosis and treatment of hypertension in obese children. A total of 214 paediatric nephrologists responded. Although nearly 100 % agreed that screening of obese children for hypertension is indicated, it was current practice in only 56 % of participating countries; 88 % of respondents diagnosed hypertension with 24-h ambulatory blood pressure measurement. Diagnostics used to rule out causes or consequences of hypertension varied among the respondents; they included, in particular, the use of serum renin/aldosterone, urine sodium/potassium, and dimercaptosuccinic acid scan. Concerning treatment, 45 % of respondents preferred to start treatment with a lifestyle program, 2 % with antihypertensive medication, and 40 % with both. For 73 % of respondents, angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers were the drugs of first choice. The findings of this study emphasize the urgent need for an international guideline for screening, diagnosis and treatment of hypertension in obese children.Electronic supplementary materialThe online version of this article (doi:10.1007/s40620-016-0277-6) contains supplementary material, which is available to authorized users.

Renin-angiotensin system gene polymorphisms and high blood pressure in Lithuanian children and adolescents

“…As compared to the data published in other countries, Lithuania still has the lowest prevalence of overweight and obesity among 7–17 year-old children and adolescents in Europe, being similar to Poland [ 41 ] and Latvia [ 37 ] in this respect. The present study and other epidemiological studies indicate that the prevalence of HBP is higher among overweight and obese children compared to children with normal weight [ 42 , 43 ]. Studies have shown that overweight, obesity, and high waist circumference were significantly associated with hypertension or HBP (≥90th percentile) among children and adolescents [ 44 – 46 ].…”

Elevated blood pressure in youth in pediatric weight management programs in the Pediatric Obesity Weight Evaluation Registry (POWER)

“…5,8,18 In this report and prior POWER reports severe obesity status was reported for threequarters of the patients 11,18 ; among youth with most severe (class 3) obesity ∼60% had high BP. Youth with hypertension and obesity are often referred for PWM services due to the need for a multidisciplinary team approach available in these centers, 19,20 and that may also have been a contributing factor to the high rates of high BP observed in this sample.…”

Diagnostic Yield of Kidney Ultrasound in Children Evaluated for Hypertension

“…1 Nevertheless, many clinicians order this study for all children and adolescents with hypertension, particularly in the subspecialty setting. 2,3 Although kidney ultrasound is considered a safe and non-invasive test, there is a risk of finding an incidental abnormality unrelated to hypertension that may require further evaluation. Below, we present the case of an adolescent with hypertension who had an incidental finding on kidney ultrasound that triggered a cascade of care.…”