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AAP Issues New Blood Pressure Guidelines
Pediatrics; ePub 2017 Aug 21; Flynn, et al
The American Academy of Pediatrics (AAP) has issued new clinical practice guidelines for the screening and management of high blood pressure (BP) in children and adolescents. Among the changes issued in the updated guideline:
- The term “prehypertension should be replaced with the term “elevated blood pressure.”
- New normative pediatric BP tables have been published based on normal-weight children.
- A simplified screening table for identifying BPs needing further evaluation and a simplified BP classification in adolescents aged ≥13 years that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines.
- A more limited recommendation to perform screening BP measurements only at preventive care visits.
- Streamlined recommendations on the initial evaluation and management of abnormal BPs.
Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. [Published online ahead of print August 22, 2017]. Pediatrics. doi:10.1542/peds.2017-1904.
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The diagnosis of pediatric hypertension is made when a child or adolescent has BP readings ≥95th percentile at 3 different visits. The guideline recommends that blood pressure readings that remain elevated in the hypertensive range be confirmed by ambulatory blood pressure measurement. The guidelines go on to say that children and adolescents ≥6 years of age do not require an extensive evaluation for secondary causes of HTN if they have a family history of HTN, are overweight or obese, and/or do not have history or physical examination findings that suggest a secondary cause of HTN. It is recommended that an echocardiogram be done on children and adolescents who are to be started on medications for hypertension. Doppler renal ultrasonography may be used as a noninvasive screening study for the evaluation of possible renal artery stenosis in normal- weight children and adolescents ≥8 years of age who are suspected of possible renovascular HTN. —Neil Skolnik, MD