Materiały źródłowe

• #1 High Blood Pressure (Hypertension) in Children

  https://www.everydayhealth.com/hypertension/children-causes-diagnosis-treatment/

  While much of the conversation around hypertension focuses on adults, kids can have high blood pressure, too. […] Approximately 3.5 percent of all children in the United States have high blood pressure, according to the American Academy of Pediatrics (AAP), but the prevalence is likely higher, experts say, because many cases go undetected. […] In 2017, the AAP issued updated guidelines for pediatricians on how to diagnose pediatric hypertension. […] The new guidelines provide a table for normal blood pressure based only on a child’s gender and age. […] The American Heart Association (AHA) recommends all children have yearly blood pressure measurements starting at age 3. […] If your doctor determines your child’s blood pressure reading is high, you will need to bring your child back for a few more readings. […] Blood pressure that is consistently high will lead to a diagnosis of pediatric hypertension. […] Additional tests, like urine tests, blood tests, and an ultrasound of the kidneys, may be necessary to help determine the cause of high blood pressure in a pediatric patient.

• #1 Pediatric hypertension: Review of the definition, diagnosis, and initial management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9072228/

  Pediatric hypertension (HTN) is defined as having three elevated systolic or diastolic blood pressure (BP) readings for the subjects age, height, and sex. […] The 2017 Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents provided updated recommendations for the workup and diagnosis of pediatric HTN. […] Accurate diagnosis of HTN is essential as studies have shown that it is often missed in children and is a major risk factor for cardiovascular and renal morbidity in children and adults. […] Establishing the diagnosis of HTN requires obtaining three abnormal systolic and/or diastolic BP readings. […] Continuous ambulatory blood pressure monitoring (ABPM) is the standard for confirming the diagnosis of HTN in children. […] The initial testing recommended by the AAP was recently updated in 2017 and is largely dependent on level of suspicion.

• #1 High Blood Pressure in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p693.html

  High blood pressure in children and adolescents is a growing health problem that is often overlooked by physicians. Normal blood pressure values for children and adolescents are based on age, sex, and height, and are available in standardized tables. Prehypertension is defined as a blood pressure in at least the 90th percentile, but less than the 95th percentile, for age, sex, and height, or a measurement of 120/80 mm Hg or greater. Hypertension is defined as blood pressure in the 95th percentile or greater. […] A history and physical examination are needed for all children with newly diagnosed hypertension to help rule out underlying medical disorders. Children with hypertension should also be screened for other risk factors for cardiovascular disease, including diabetes mellitus and hyperlipidemia, and should be evaluated for target organ damage with a retinal examination and echocardiography.

• #1 High Blood Pressure in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1015/p486.html

  High blood pressure in children and adolescents is a growing health problem that is often overlooked. Children should be screened for elevated blood pressure annually beginning at three years of age or at every visit if risk factors are present. In children younger than 13 years, elevated blood pressure is defined as blood pressure in the 90th percentile or higher for age, height, and sex, and hypertension is defined as blood pressure in the 95th percentile or higher. In adolescents 13 years and older, elevated blood pressure is defined as blood pressure of 120 to 129 mm Hg systolic and less than 80 mm Hg diastolic, and hypertension is defined as blood pressure of 130/80 mm Hg or higher. Ambulatory blood pressure monitoring should be performed to confirm hypertension in children and adolescents.

• #1 High blood pressure (hypertension) in teens and kids – Children’s Health

  https://www.childrens.com/specialties-services/conditions/high-blood-pressure

  For children age 13 and up, blood pressure ranges are: Normal – Less than 120/80, Elevated blood pressure – 120-129/80, Stage 1 hypertension – 130-139/80-89, Stage 2 hypertension – 140/90 and up. […] If your child is diagnosed with stage 1 or stage 2 hypertension, the doctor will run blood and urine tests. The doctor may also perform painless imaging tests on your child’s heart or kidneys to see if the high blood pressure is affecting your child’s organs. […] You will likely be asked to keep a diary of your child’s blood pressure at home to give the doctors more information. Your child may also need to wear an ambulatory blood pressure monitor (ABPM), a device that allows our team to check blood pressures over 24 hours.

• #1 Children and High Blood Pressure | Brown University Health

  https://www.brownhealth.org/be-well/children-and-high-blood-pressure

  In 2017, the American Academy of Pediatrics (AAP) published new guidelines to provide a standardized framework for the diagnosis of hypertension in children. […] The guidelines recommend that blood pressure be measured annually in children starting at age three. […] Trained health care professionals in the office setting should make a diagnosis of hypertension if a child or adolescent has blood pressure readings 95th percentile for age, height and gender at 3 different visits. […] Based on numerous studies, ABPM has been shown to be a better method for monitoring blood pressure in children. It is more accurate in diagnosing hypertension than readings in the office, and it is more reliable in predicting future blood pressure. […] Ambulatory blood pressure monitoring is a precise and cost-effective tool to help make an accurate diagnosis of hypertension in children.

• #1 High Blood Pressure in Children and Teens | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/h/high-blood-pressure-in-children-and-adolescents.html

  High blood pressure (hypertension) means that the pressure inside the arteries is too high. This higher pressure may harm the arteries and cause the heart to work harder. […] Your child’s healthcare provider will diagnose high blood pressure by checking your child’s blood pressure. The provider will check blood pressure over several days or weeks before making the diagnosis. […] Reliable blood pressure readings taken at home can be helpful in finding out if your child truly has high blood pressure. […] The American Academy of Pediatrics (AAP) recommends children older than 3 years old have blood pressure screenings at their yearly well-child visit. It should be checked at every healthcare encounter if they are obese, are taking medicine known to increase blood pressure, have kidney disease, diabetes, or a history of aortic arch obstruction or coarctation. […] Blood pressure changes. Your child’s provider will check it over a period of days or weeks before making a diagnosis of high blood pressure.

• #1 High blood pressure in children – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/high-blood-pressure-in-children/symptoms-causes/syc-20373440

  High blood pressure (hypertension) in children is blood pressure that is at or above the 95th percentile for children who are the same sex, age and height as your child. […] Your child’s blood pressure should be checked during routine well-check appointments starting at age 3, and at every appointment if your child is found to have high blood pressure. […] If your child has a condition that can increase the risk of high blood pressure including premature birth, low birth weight, congenital heart disease and certain kidney problems blood pressure checks might begin soon after birth. […] High blood pressure in younger children is often related to other health conditions, such as heart defects, kidney disease, genetic conditions or hormonal disorders. […] Older children especially those who are overweight are more likely to have primary hypertension.

• #1 High blood pressure in children – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/high-blood-pressure-in-children/diagnosis-treatment/drc-20373446

  The doctor will perform a physical exam and ask questions about your child’s medical history, family history of high blood pressure, and nutrition and activity level. […] Your child’s blood pressure will be measured. The correct blood pressure cuff size is important for measuring accurately. It is also important that blood pressure be measured with proper technique, in a quiet environment, with the child resting comfortably. During a single visit, your child’s blood pressure might be measured two or more times for accuracy. […] For a diagnosis of high blood pressure, your child’s blood pressure must be higher than normal when measured during at least three visits to the doctor. […] If your child is diagnosed with high blood pressure, it’s important to determine whether it’s primary or secondary. These tests might be used to look for another condition that could be causing your child’s high blood pressure:

• #1 High blood pressure in children – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/high-blood-pressure-in-children/diagnosis-treatment/drc-20373446

  To confirm a diagnosis of high blood pressure, your child’s doctor might recommend ambulatory monitoring. This involves your child temporarily wearing a device that measures blood pressure throughout the day, including during sleep and various activities. […] High blood pressure is treated similarly in children and adults, usually starting with lifestyle changes. Even if your child takes medication for high blood pressure, lifestyle changes can make the medication work better. […] Your child’s blood pressure will be checked as part of a routine complete physical exam or during any pediatric doctor appointment when indicated.

• #1

  https://link.springer.com/article/10.1007/s11906-001-0017-7

  In conclusion, ambulatory BP monitoring has become a useful tool for the proper assessment of hypertension and should be performed as part of the initial evaluation in older children with persistent mild hypertension. The accurate diagnosis of whether or not hypertension is present in children may both prevent unnecessary diagnostic evaluation as well as allow early intervention so as to prevent the development of persistent hypertension and its sequelae.

• #1 Screening and Management of High Blood Pressure in Children and Adolescents

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/08/25/10/39/clinical-practice-guideline-for-screening-and-management-of-hbp

  Screening and Management of High Blood Pressure in Children and Adolescents […] 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. […] The new guidelines include an expanded role for ambulatory blood pressure monitoring (ABPM) in the diagnosis and management of pediatric hypertension. ABPM should be performed for confirmation of hypertension in children with office blood pressure measurements in the elevated blood pressure category for a year or more or with stage I hypertension over three clinic visits. […] The recommendations as to indications for echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients have been updated. It is recommended that echocardiography be performed to assess for cardiac target organ damage at the time of consideration of pharmacologic treatment for hypertension.

• #1 High Blood Pressure in Children and Teens – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=high-blood-pressure-in-children-and-teens-90-P01609

  High blood pressure (hypertension) means that the pressure inside the arteries is too high. This higher pressure may harm the arteries and cause the heart to work harder. […] One high blood pressure reading does not mean that your child has high blood pressure. Your child’s healthcare provider will want to check your child’s blood pressure over a period of days or weeks. When blood pressure stays high, it may be a problem. […] Your child’s healthcare provider will diagnose high blood pressure by checking your child’s blood pressure. The provider will check blood pressure over several days or weeks before making the diagnosis. […] Reliable blood pressure readings taken at home can be helpful in finding out if your child truly has high blood pressure. Ambulatory blood pressure monitoring uses a device that can be worn for 24 hours. It takes multiple blood pressure readings and can help get a more accurate reading of overall blood pressure.

• #1

  https://journals.lww.com/jhypertension/fulltext/2008/08000/diagnosis_of_hypertension_in_children_and.10.aspx

  To investigate the usefulness of home blood pressure measurements in comparison with ambulatory monitoring in the diagnosis of sustained, white-coat hypertension and masked hypertension in children and adolescents. […] In children and adolescents, there is a reasonable agreement between home and ambulatory blood pressure measurements as diagnostic methods in hypertension. Home blood pressure appears to be a useful diagnostic test in this population, particularly for the detection of white-coat hypertension.

• #1 Hypertension in Children – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/hypertension-in-children/hypertension-in-children

  If BP remains elevated after 6 months, lifestyle changes (eg, diet, activity, weight loss if needed) should be recommended and upper and lower extremity BP measurements should be taken. […] If BP remains elevated over the next 6 months, 24-hour ambulatory BP monitoring could be performed, if possible, or the patient could be referred to a specialist. […] If measurements are consistently ≥ 95th percentile but < 95th percentile + 12 mm Hg, children should be considered to have stage 1 hypertension. [...] Measurements that are ≥ 95th percentile + 12 mm Hg or ≥ 140/90, whichever is lower, represent stage 2 hypertension. [...] Children with stage 1 hypertension should be rechecked within 1 to 2 weeks. [...] If BP remains at stage 1, upper and lower extremity BP measurements should be taken, a urinalysis performed, and lifestyle changes recommended. [...] Children with stage 2 hypertension or stage 1 hypertension with symptoms should be referred immediately to an emergency department or a pediatric specialist for possible hospitalization.

• #1 Blood Pressure Z-Score Application

  https://www.bcm.edu/bodycomplab/BPappZjs/BPvAgeAPPz.html

  Hypertension (high blood pressure) is an important health issue in children, because of its association with obesity. […] Elevated BP readings should be repeated and confirmed over several visits before a child is identified as having hypertension. The most precise measure of a child’s BP is an average of multiple measurements taken over several weeks (or even months) by a health professional. […] It is important to use the values in the BP reference tables or tools such as the calculators on this page to diagnose elevated BP or HTN.

• #1 Hypertension in children and adolescents

  https://www.rch.org.au/clinicalguide/guideline_index/hypertension/

  Hypertension in childhood is a key predictor of risk for hypertension, cardiovascular disease and end organ damage in adulthood. […] All hypertension in children requires monitoring and follow-up. […] Blood pressure should be measured annually in healthy children. […] Where possible, abnormal machine BP measurement should be confirmed, preferably with a manual BP, ensuring appropriately sized cuff is used for accurate measurement. […] An online blood pressure centile calculator specific for gender, age and height can be used to determine the severity of hypertension. […] Medical management should only be commenced in consultation with a general or renal paediatrician. […] Long-acting calcium channel blockers such as amlodipine are recommended as first line therapy. Other medication may be preferred in children with BMI 95th centile, diabetes or proteinuria.

• #1 Patient education: High blood pressure in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/high-blood-pressure-in-children-beyond-the-basics/print

  If a child is diagnosed with high blood pressure, the next step is to determine if a cause of the hypertension can be determined. […] Patients in whom no cause can be identified by history, physical examination or laboratory tests have primary hypertension (formerly called „essential” hypertension), and those with an identifiable cause have secondary hypertension.

• #1 High blood pressure in children – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/high-blood-pressure-in-children/symptoms-causes/syc-20373440

  Primary hypertension occurs on its own, without an identifiable cause. […] Secondary hypertension is caused by another condition. […] Children who have high blood pressure are likely to continue to have high blood pressure as adults unless they begin treatment. […] High blood pressure can be prevented in children by making the same lifestyle changes that can help treat it controlling your child’s weight, providing a healthy diet low in salt (sodium) and encouraging your child to exercise.

• #1 High Blood Pressure in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p693.html

  Normal blood pressure values in children vary by age, sex, and height; therefore, increased awareness about how to diagnose and treat hypertension in children is needed to combat this increasingly common condition. […] The NHBPEP recommends measuring blood pressure at every office visit beginning at three years of age. Ideally, measurements should be performed using auscultation, which is what standardized blood pressure tables are based on. […] After prehypertension or hypertension is diagnosed, a history and physical examination can help determine if the child has primary or secondary hypertension. […] Initial laboratory studies are performed to evaluate for an underlying etiology, identify other CVD risk factors, and detect target organ damage. […] Children with symptomatic hypertension, secondary hypertension, target organ damage, diabetes, or persistent hypertension despite nonpharmacologic measures require antihypertensive medications. […] Thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta blockers, and calcium channel blockers are safe, effective, and well tolerated in children.

• #1 The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents | NHLBI, NIH

  https://www.nhlbi.nih.gov/health-topics/fourth-report-on-diagnosis-evaluation-treatment-high-blood-pressure-in-children-and-adolescents

  Revised recommendations for use of antihypertensive drug therapy are provided. […] The evaluation of hypertensive children should include assessment for additional risk factors. […] Secondary hypertension is more common in children than in adults. […] Children or adolescents with stage 2 hypertension, and very young children with stage 1 or stage 2 hypertension should be evaluated more completely. […] Echocardiography is the recommended primary tool for detection of target-organ abnormalities. […] Children and adolescents with established hypertension should have an echocardiogram to determine if LVH is present. […] Indications for antihypertensive drug therapy in children include secondary hypertension and insufficient response to lifestyle modifications.

• #1 High Blood Pressure in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1015/p486.html

  Despite the increasing prevalence and potential risks of hypertension in children, the diagnosis is often overlooked. One study revealed that only 26% of children with high blood pressure consistent with hypertension documented in an electronic medical record were subsequently diagnosed as having hypertension. […] In 2017, the American Academy of Pediatrics (AAP) updated its clinical practice guideline for the screening and management of high blood pressure in children and adolescents. A 2018 study has already demonstrated a significant increase in hypertension diagnoses using the updated guideline. […] Following the diagnosis of elevated blood pressure or hypertension, a careful history and physical examination can help determine if the child has primary or secondary hypertension. Very young children, children or adolescents with normal weight and no family history of hypertension, and children and adolescents with signs and symptoms suggesting an additional underlying systemic disorder require a more extensive evaluation for secondary hypertension. […] Children with persistently elevated blood pressure despite nonpharmacologic measures, stage 2 hypertension without a modifiable underlying factor, or comorbid diabetes or chronic kidney disease should be evaluated for cardiovascular damage with echocardiography.

• #1 High blood pressure – children Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/high-blood-pressure-children

  High blood pressure in children up to age 13 is defined differently than in adults. […] A child’s blood pressure numbers are compared with the blood pressure measurements of other children the same age, height, and sex. […] Abnormal blood pressure readings are described as follows: Elevated blood pressure, Stage 1 high blood pressure, Stage 2 high blood pressure. […] The provider will measure your child’s blood pressure many times before diagnosing your child with high blood pressure. […] The provider will also do a physical exam to look for signs of heart disease, damage to the eyes, and other changes in your child’s body. […] The goal of treatment is to reduce high blood pressure so that your child has a lower risk of complications. […] If your child has elevated high blood pressure, your provider will recommend lifestyle changes to help lower your child’s blood pressure.

• #1 Diagnosing Hypertension in Children | NYU Langone Health

  https://nyulangone.org/conditions/hypertension-in-children/diagnosis

  If your childs blood pressure is higher than normal during more than one checkup, the doctor may recommend using an ambulatory blood pressure monitor. […] A urinalysis test can help to identify kidney conditions that can increase blood pressure and monitor the kidneys in children with severe hypertension. […] The doctor may suggest blood tests to look for signs of conditions that can cause hypertension, such as type 2 diabetes and Graves disease, an autoimmune condition that increases the production of thyroid hormones. […] A doctor may want to take a picture of a childs kidneys to see if they are enlarged or have any blockages or other structural problems that may lead to hypertension. […] An echocardiogram is an imaging test that may be used to look for signs of congenital heart conditions such as coarctation of the arteries, which means a portion of the main artery in the heart has narrowed.

• #1 Pediatric Hypertension Workup: Laboratory Studies, Echocardiography and Ultrasonography, Angiography

  https://emedicine.medscape.com/article/889877-workup

  In patients with hypertension, proceed from simple tests that can be performed in an ambulatory setting to complex noninvasive tests and finally to invasive tests. Findings from the patients history and physical examination dictate the appropriate choice of tests. […] Blood hormone levels may be measured. High plasma renin activity indicates renal vascular hypertension, including coarctation of the aorta, whereas low activity indicates glucocorticoid-remediable aldosteronism, Liddle syndrome, or apparent mineralocorticoid excess. A high plasma aldosterone concentration is diagnostic of hyperaldosteronism. High values of catecholamines (eg, epinephrine, norepinephrine, or dopamine) are diagnostic of pheochromocytoma or neuroblastoma. […] Echocardiography is essential in the evaluation of suspected aortic coarctation. The aortic arch and its branches must be examined in precise anatomic detail.

• #1 High Blood Pressure in Teens & Kids (Pediatric Hypertension)

  https://my.clevelandclinic.org/health/diseases/21150-high-blood-pressure-in-children

  To check blood pressure, a healthcare provider wraps a cuff called a sphygmomanometer on your childs arm and places a stethoscope underneath it. […] Providers take several measurements before making a diagnosis of high blood pressure. […] Your childs healthcare provider will also try to determine the underlying cause of their high blood pressure. […] They may order certain tests to confirm or rule out underlying causes, such as blood tests, electrocardiogram (EKG) to assess your childs heart health, and imaging tests to look at your childs heart and/or kidneys. […] Whats considered high blood pressure in children 12 or younger depends on their age and other factors. […] If the blood pressure is high enough or if lifestyle changes dont lower your childs blood pressure, your childs provider may refer your child to a specialist or recommend medication to manage the condition. […] High blood pressure in children can have many causes and may need quick treatment.

• #1

  https://link.springer.com/article/10.1007/s00467-023-06127-1

  Global estimates of childhood hypertension show a prevalence of 4%, peaking in young adolescents aged 13-15 years old at 7.1-7.9%. […] The diagnostic evaluation of the hypertensive child, a key issue in all documents, includes screening for secondary causes of hypertension, assessment of cardiovascular risk, and hypertension mediated organ damage (HMOD). […] Secondary hypertension was found in about half (56.3%) of the children in the study by Ding et al. diagnosed with hypertension based on office or ambulatory blood pressure measurements. […] Indications for further evaluation of hypertensive children and adolescents for underlying disorders and proper diagnostic evaluation are similar among different scientific organizations for children younger than 6 years. […] History and clinical examination are recommended to guide patient-specific diagnostic evaluation beyond initial laboratory tests including creatinine, blood urea nitrogen (BUN), electrolytes, and urinalysis that should be offered to all children.

• #1 Hypertension Diagnosis Often Missed in Children | MDedge

  https://blogs.the-hospitalist.org/content/hypertension-diagnosis-often-missed-children

  A diagnosis of hypertension was missed in 85% of children with high blood pressure in a study of 287 youngsters who were examined at two university-based, pediatric clinics. […] The problem with diagnosing hypertension in kids is that there are too many threshold pressures for most physicians to keep straight, Charlene K. Mitchell, M.D., said at the annual meeting of the Southern Society for Pediatric Research. […] Because the threshold for diagnosing hypertension varies by age, height, and gender, there are a total of 420 different diastolic and systolic pressures that determine whether a particular child has high blood pressure, said Dr. Mitchell, a pediatrician and internist at the University of Louisville (Ky.). […] The threshold criteria for borderline hypertension would add another 120 pressure thresholds for diagnosing hypertension.

• #1 Hypertension Diagnosis Often Missed in Children | MDedge

  https://blogs.the-hospitalist.org/content/hypertension-diagnosis-often-missed-children

  The numbers are chopped up too much. It’s far too complex for easy management, Dr. Mitchell said. If physicians must always look on a table every time they check a blood pressure, we’ll continue to see underdiagnosis. […] If the diagnostic criteria are simplified, physicians will be much more likely to identify hypertension in children much more often, Dr. Mitchell said. […] We need to be much more aggressive about recognizing hypertension in children than we are now, she added. […] Of the 287 children examined, 90 (31%) had hypertension by current standards, and 35 (12%) had borderline hypertension. But only 15% of those with hypertension were diagnosed by their examining physicians. […] The results also showed that physicians were more likely to diagnose hypertension in children with a higher body mass index (BMI). The children who were correctly diagnosed as hypertensive were, on average, in the 92nd percentile for BMI. Those who had unrecognized blood pressure elevations were, on average, in the 76th percentile for BMI.

• #1 Hypertension Detection and Treatment Program | Children’s National | Children’s National Hospital

  https://www.childrensnational.org/get-care/departments/hypertension-detection-and-treatment-program

  High blood pressure in children is an increasing public health concern. Left untreated, children are at a higher risk for serious complications affecting the heart, kidneys, and overall health. Children with high blood pressure are more likely to have hypertension as adults. […] Because the cause of hypertension in young patients is often different from adults, it is important that your child sees a pediatric specialist with the expertise and experience to diagnose and treat the condition in children. […] The program team works closely with Children’s Nuclear Medicine Program and the Division of Cardiology to perform a comprehensive diagnostic evaluation to understand the cause of your child’s elevated blood pressure. […] As part of the diagnostic evaluation, we offer ambulatory blood pressure monitoring (ABPM) for patients suspected to have „white coat hypertension” – when a visit to the doctor’s causes an elevation in blood pressure. […] Understanding your child’s condition is an important step on your treatment journey.

• #1 Pediatric Hypertension Workup: Laboratory Studies, Echocardiography and Ultrasonography, Angiography

  https://emedicine.medscape.com/article/889877-workup

  Angiography may reveal differences in the structure (diameter) of the renal vessels. Sampling of blood from renal arteries, renal veins, and aorta may reveal differences in renin secretion between the kidneys. A renin activity ratio of 3:1 between the kidneys is considered diagnostic of renal vascular hypertension. […] Ambulatory blood pressure monitoring (ABPM) shows blood pressure (BP) changes associated with physiologic activity and environmental stimuli during sleep as well as while awake, and it may serve to better assess the BP. The mean 24-hour BP (systolic and diastolic) is compared with gender- and height-specific 99th percentiles-based data. ABPM is useful in the initial evaluation of elevated BP, to recognize subjects at risk, and in evaluating response to treatment. […] Monitoring of BP on a 24-hour basis may help in diagnosing so-called white-coat hypertension and provides information about the risk of target end-organ damage.

• #1 Hypertension in Children – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/hypertension-in-children/hypertension-in-children

  Hypertension is sustained elevation of resting systolic blood pressure, diastolic blood pressure, or both. […] Diagnosis is by sphygmomanometry, including ambulatory blood pressure monitoring. […] Thus, it is important to identify and treat hypertension in children. […] Hypertension should typically not be diagnosed until high BP values (as defined in table Classification of Blood Pressure in Children) have been identified on 3 separate visits in order to exclude transient causes of BP elevation, such as recent consumption of caffeinated beverages or white coat hypertension (ie, BP elevation due to the anxiety of a doctor visit). […] BP must be measured using proper technique. […] Children with BP between the 90th and 95th percentiles should be rechecked by auscultation within 6 months because in 50 to 70% BP returns to the normal range.

• #1 High Blood Pressure in Children – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/high-blood-pressure-in-children/high-blood-pressure-in-children

  Because the definition of high blood pressure in children under 13 years old depends on a child’s age, sex, and height, there is no one value that is considered high. Consequently, doctors use charts or online calculators that enable them to diagnose high blood pressure and to classify how severe it is. In adolescents, doctors diagnose high blood pressure using the same values as are used in adults. […] To be sure that high blood pressure is not a temporary condition (such as after consumption of caffeine), doctors measure blood pressure at least 2 times during 3 separate visits. […] Doctors recommend that routine blood pressure measurements be taken at annual health screening visits beginning when children are 3 years old. […] If elevated blood pressure is diagnosed, doctors recheck blood pressure within 6 months. […] If stage 1 hypertension is diagnosed, doctors recheck blood pressure within 1 to 2 weeks. […] If stage 2 hypertension is diagnosed and confirmed, diagnostic evaluations should be undertaken and initiation of treatment should be considered, or the child should see a specialist within 1 week.

• #1 Hypertension | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/hypertension-in-children

  High blood pressure in infants and young children, and in older children whose high blood pressure is not resolved with lifestyle changes, maybe a sign of other medical conditions, such as kidney disease, a heart defect, or hormonal disorders. […] Early diagnosis of hypertension can lead to better long-term outcomes.

• #1 Hypertension Screening in Children and Adolescents — National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, and Medical Expenditure Panel Survey, United States, 2007–2010

  https://www.cdc.gov/mmwr/preview/mmwrhtml/su6302a8.htm

  Hypertension and prehypertension have been increasing among children and adolescents since the 1990s. During 2003-2006, among children and adolescents aged 8-17 years, the prevalence of prehypertension was approximately 14% in boys and approximately 6% in girls, and the prevalence of hypertension was estimated to be 3%-4% in various studies. During 1997-2006, hospitalization rates for children and adolescents with a diagnosis of hypertension doubled, from approximately 18 cases per 100,000 pediatric hospital discharges in 1997 to approximately 35 cases per 100,000 in 2006. Among children and adolescents with hypertension, as many as one in three has target organ damage, especially left ventricular hypertrophy. Accumulating evidence supports the theory that elevated blood pressure levels in adolescence are a precursor of elevated blood pressure in adulthood, making it important to identify elevated blood pressure in childhood. An analysis of the National Childhood Blood Pressure database found that 14% of adolescents with prehypertension developed elevated blood pressure within 2 years.

• #1 My Child Has High Blood Pressure, Now What?

  https://blog.cincinnatichildrens.org/rare-and-complex-conditions/heart-conditions/my-child-has-high-blood-pressure-now-what/

  Hypertension, or high blood pressure, in children has been on the rise for the last three decades. In fact, 3.5% of children and adolescents have high blood pressure. […] This is why kids should have their blood pressure measured every year starting at age 3. It is particularly important for this screening to happen if your child has risk factors such as obesity, kidney disease or diabetes. If your child does have high blood pressure at more than one visit, further evaluation is necessary to establish a diagnosis of hypertension. This usually requires an appointment with a blood pressure specialist. […] If a diagnosis of hypertension is made, a blood pressure specialist may decide to do the following: […] If your child’s blood pressure is determined to be normal, it is still important to establish healthy habits to ward off heart disease in adulthood. If he or she has a confirmed diagnosis of hypertension, the good news is that early detection and treatment can prevent the progression of heart disease, and in some cases, may even reverse changes that have already occurred.

• #1 High Blood Pressure in Kids – Children’s Health

  https://www.childrens.com/health-wellness/high-blood-pressure-and-kids

  You may think that hypertension, or high blood pressure, is a condition that affects only adults. However, according to the American Academy of Pediatrics (AAP), an estimated 3.5% of children and teens have high blood pressure. When left untreated, this condition can cause serious complications, such as heart disease, kidney failure, stroke and vision loss. […] However, regular screenings can help identify high blood pressure in children. Learn more about what is considered high blood pressure for a child and ways you can help keep your child healthy. […] A child’s blood pressure should be checked once a year at their annual exam starting at the age of 3. […] If a child has a health condition that increases their risk for high blood pressure, such as obesity or kidney disease, their blood pressure will be checked at every doctor visit.

• #1

  https://www.healio.com/news/cardiology/20230420/high-blood-pressure-in-children-underdiagnosed-undertreated-in-safetynet-clinics

  The underdiagnosis and undertreatment of elevated BP among children, particularly children from minoritized populations, will contribute to the burden of hypertension and heart disease among adults. […] Carroll said further research is needed to identify and test strategies to equitably implement the clinical practice guideline and evidence-based innovations, such as clinical decision supports, to increase the rates of guideline-adherent diagnosis, treatment and follow-up of elevated BP and pediatric hypertension.

• #1 High blood pressure – children – UF Health

  https://ufhealth.org/conditions-and-treatments/high-blood-pressure-children

  Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. High blood pressure (hypertension) is an increase in this force. This article focuses on high blood pressure in children, which is often a result of being overweight. […] High blood pressure in children up to age 13 is measured differently than in adults. This is because what is considered normal blood pressure changes as a child grows. A child’s blood pressure numbers are compared with the blood pressure measurements of other children the same age, height, and sex. […] Abnormal blood pressure readings are described as follows: Elevated blood pressure, Stage 1 high blood pressure, Stage 2 high blood pressure. […] Children older than age 13 follow the same guidelines for high blood pressure as adults.

• #1 Children can have high blood pressure, too. Here’s what to know. | American Heart Association

  https://www.heart.org/en/news/2023/04/13/children-can-have-high-blood-pressure-too-heres-what-to-know

  For children under 13, hypertension is diagnosed if either systolic or diastolic blood pressure is at or above the 95th percentile, meaning 95% of other kids of the same age, sex and height have a lower blood pressure. Normal blood pressure is defined as being below the 90th percentile. […] Taking blood pressure measurements in a child is done much the same as it is for an adult, Tran said. […] American Academy of Pediatrics guidelines call for an appropriately sized cuff placed on bare skin of the right arm and supported so that the middle of the cuff is at heart level. […] If blood pressure is confirmed to be very high or remains high despite lifestyle changes, medication may be needed, Tran said.

• #1 Definition of pediatric hypertension: are blood pressure measurements on three separate occasions necessary? | Hypertension Research

  https://www.nature.com/articles/hr2016179

  The present meta-analysis underlines the necessity of measuring BP on at least three separate occasions to identify a hypertensive child in clinical practice or to accurately estimate the true prevalence of hypertension in a pediatric population. […] In conclusion, the true prevalence of hypertension in children and adolescents is ~3% over three different visits. […] the present meta-analysis provides evidence-based results in support of the recommendation of the US Fourth Report by NHBPEP in 2004 that the definition of pediatric hypertension should be based on BP measurements on at least three occasions in clinical practice or epidemiological studies to avoid false positive cases.

• #1 High Blood Pressure in Kids – Children’s Health

  https://www.childrens.com/health-wellness/high-blood-pressure-and-kids

  Your child’s pediatrician will track trends in blood pressure over time, not just the initial screening, to accurately identify a diagnosis of hypertension. […] A healthy blood pressure for a child depends on their age, height and gender. […] A child is considered to have an elevated blood pressure if their blood pressure falls above the 90th percentile, and hypertension if they are above the 95th percentile. […] If your child’s pediatrician notices a trend of high blood pressure readings, they will closely monitor your child’s blood pressure or refer you to a specialist to address any health concerns. […] Hypertension is often a silent condition. Typically, there aren’t obvious symptoms to let parents know their child has high blood pressure; it is often diagnosed when the doctor discovers it during an exam. This is why regular blood pressure screening is so important.

• #2 Children with high blood pressure often become adults with high blood pressure | American Heart Association

  https://newsroom.heart.org/news/children-with-high-blood-pressure-often-become-adults-with-high-blood-pressure

  High blood pressure in youth and the need for appropriate diagnosis, treatment and reduction of lifestyle risk factors outlined in a new American Heart Association scientific statement. […] Regular and appropriate assessment of blood pressure levels in children is important, as there are often no symptoms of high blood pressure. […] An estimated 2-5% of children have hypertension, or high blood pressure, and primary hypertension indicating it is not due to an underlying medical condition is now the most common type of high blood pressure in kids, especially in adolescents. […] Since kids with high blood pressure levels tend to maintain high blood pressure into adulthood, diagnosing and appropriately addressing high blood pressure in youth is imperative to ensure improved lifetime health as early as possible.

• #2 High blood pressure – children – UF Health

  https://ufhealth.org/conditions-and-treatments/high-blood-pressure-children

  Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. High blood pressure (hypertension) is an increase in this force. This article focuses on high blood pressure in children, which is often a result of being overweight. […] High blood pressure in children up to age 13 is measured differently than in adults. This is because what is considered normal blood pressure changes as a child grows. A child’s blood pressure numbers are compared with the blood pressure measurements of other children the same age, height, and sex. […] Abnormal blood pressure readings are described as follows: Elevated blood pressure, Stage 1 high blood pressure, Stage 2 high blood pressure. […] Children older than age 13 follow the same guidelines for high blood pressure as adults.

• #2 Definition of pediatric hypertension: are blood pressure measurements on three separate occasions necessary? | Hypertension Research

  https://www.nature.com/articles/hr2016179

  The US Fourth Report (2004) recommended that elevated blood pressure (BP) on at least three occasions should be used to define hypertension in children and adolescents. […] However, there is no sufficient evidence to support this decision. […] Therefore, early accurate detection and effective control of high BP in children and adolescents are crucial to reduce the risk of target organ damage in children and the long-term risk of cardiovascular diseases in adults. […] Similarly, hypertension in children is defined as elevated BP (systolic BP/diastolic BP (SBP/DBP)95th percentile by sex, age and height) on at least three separate occasions. […] The BP measurements on a single occasion can result in an overestimated prevalence of true hypertension. […] Therefore, repeated readings on several occasions may be necessary for the diagnosis of true hypertension.

• #2 High blood pressure (hypertension) in teens and kids – Children’s Health

  https://www.childrens.com/specialties-services/conditions/high-blood-pressure

  For children age 13 and up, blood pressure ranges are: Normal – Less than 120/80, Elevated blood pressure – 120-129/80, Stage 1 hypertension – 130-139/80-89, Stage 2 hypertension – 140/90 and up. […] If your child is diagnosed with stage 1 or stage 2 hypertension, the doctor will run blood and urine tests. The doctor may also perform painless imaging tests on your child’s heart or kidneys to see if the high blood pressure is affecting your child’s organs. […] You will likely be asked to keep a diary of your child’s blood pressure at home to give the doctors more information. Your child may also need to wear an ambulatory blood pressure monitor (ABPM), a device that allows our team to check blood pressures over 24 hours.

• #2 Pediatric Hypertension: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/889877-overview

  Hypertension in the pediatric population is now commonly observed. Hypertension is known to be a major cause of morbidity and mortality in the United States and in many other countries, and the long-term health risks to children with hypertension may be substantial. In the United States, extensive normative data on blood pressure (BP) in children are available. […] The Fourth Report introduced a new category, prehypertension, which is diagnosed when a child’s average BP is above the 90th percentile but below the 95th. […] Stage I hypertension is diagnosed if a child’s BP is greater than the 95th percentile but less than or equal to the 99th percentile plus 5 mm Hg. Stage II hypertension is diagnosed if a child’s BP is greater than the 99th percentile plus 5 mm Hg. […] A secondary cause of hypertension is most likely to be found before puberty; after puberty, hypertension is likely to be essential.

• #2 Children can have high blood pressure, too. Here’s what to know. | American Heart Association

  https://www.heart.org/en/news/2023/04/13/children-can-have-high-blood-pressure-too-heres-what-to-know

  For children under 13, hypertension is diagnosed if either systolic or diastolic blood pressure is at or above the 95th percentile, meaning 95% of other kids of the same age, sex and height have a lower blood pressure. Normal blood pressure is defined as being below the 90th percentile. […] Taking blood pressure measurements in a child is done much the same as it is for an adult, Tran said. […] American Academy of Pediatrics guidelines call for an appropriately sized cuff placed on bare skin of the right arm and supported so that the middle of the cuff is at heart level. […] If blood pressure is confirmed to be very high or remains high despite lifestyle changes, medication may be needed, Tran said.

• #2 High Blood Pressure in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p693.html

  Normal blood pressure values in children vary by age, sex, and height; therefore, increased awareness about how to diagnose and treat hypertension in children is needed to combat this increasingly common condition. […] The NHBPEP recommends measuring blood pressure at every office visit beginning at three years of age. Ideally, measurements should be performed using auscultation, which is what standardized blood pressure tables are based on. […] After prehypertension or hypertension is diagnosed, a history and physical examination can help determine if the child has primary or secondary hypertension. […] Initial laboratory studies are performed to evaluate for an underlying etiology, identify other CVD risk factors, and detect target organ damage. […] Children with symptomatic hypertension, secondary hypertension, target organ damage, diabetes, or persistent hypertension despite nonpharmacologic measures require antihypertensive medications. […] Thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta blockers, and calcium channel blockers are safe, effective, and well tolerated in children.

• #2 Diagnosing Hypertension in Children | NYU Langone Health

  https://nyulangone.org/conditions/hypertension-in-children/diagnosis

  Specialists at Hassenfeld Childrens Hospital at NYU Langone are experienced in diagnosing children with hypertension, or chronic high blood pressure. […] A child has prehypertension when a blood pressure reading is above the 90th percentile compared with other children of the same age, sex, and height. That means that 90 percent of comparable children have a lower blood pressure. Children with a blood pressure reading equal to or above the 95th percentile have hypertension. […] Our doctors may recommend measuring your childs blood pressure during well visits, particularly if your child has risk factors for hypertension. If your child has hypertension, our doctors use additional tests to monitor the condition during treatment and to identify underlying conditions. […] Blood pressure readings that are higher than the 95th percentile for children of the same age, sex, and height during several different appointments confirm a diagnosis of hypertension.

• #2 Improving Guidelines for Pediatric Hypertension Diagnosis – Pediatrics Nationwide

  https://pediatricsnationwide.org/2020/09/01/improving-guidelines-for-pediatric-hypertension-diagnosis/

  It is vital to accurately recognize and diagnose hypertension in children to avoid long term morbidity and allow for appropriate treatment. […] Pediatric hypertension, or high blood pressure (BP), has become increasingly common and now affects over 3% of children and adolescents. […] To avoid underdiagnosis, evaluation of BP percentiles should be a routine part of pediatric practice, but hypertension is more challenging to diagnose in children because of age-, sex-, and height-related variability in BP norms. […] Instead, over the last decade, ambulatory BP monitoring (ABPM) has become the standard for diagnosing hypertension in children. […] „Without using ABPM, the chance of making an error in your diagnosis is close to 40%, so the guidelines strongly recommend using ABPM,” says Mahmoud Kallash, MD, a physician in the Division of Pediatric Nephrology and Hypertension at Nationwide Children’s Hospital.

• #2 Pediatric Hypertension Workup: Laboratory Studies, Echocardiography and Ultrasonography, Angiography

  https://emedicine.medscape.com/article/889877-workup

  Angiography may reveal differences in the structure (diameter) of the renal vessels. Sampling of blood from renal arteries, renal veins, and aorta may reveal differences in renin secretion between the kidneys. A renin activity ratio of 3:1 between the kidneys is considered diagnostic of renal vascular hypertension. […] Ambulatory blood pressure monitoring (ABPM) shows blood pressure (BP) changes associated with physiologic activity and environmental stimuli during sleep as well as while awake, and it may serve to better assess the BP. The mean 24-hour BP (systolic and diastolic) is compared with gender- and height-specific 99th percentiles-based data. ABPM is useful in the initial evaluation of elevated BP, to recognize subjects at risk, and in evaluating response to treatment. […] Monitoring of BP on a 24-hour basis may help in diagnosing so-called white-coat hypertension and provides information about the risk of target end-organ damage.

• #2

  https://journals.lww.com/jhypertension/fulltext/2008/08000/diagnosis_of_hypertension_in_children_and.10.aspx

  To investigate the usefulness of home blood pressure measurements in comparison with ambulatory monitoring in the diagnosis of sustained, white-coat hypertension and masked hypertension in children and adolescents. […] In children and adolescents, there is a reasonable agreement between home and ambulatory blood pressure measurements as diagnostic methods in hypertension. Home blood pressure appears to be a useful diagnostic test in this population, particularly for the detection of white-coat hypertension.

• #2 High Blood Pressure in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1015/p486.html

  High blood pressure in children and adolescents is a growing health problem that is often overlooked. Children should be screened for elevated blood pressure annually beginning at three years of age or at every visit if risk factors are present. In children younger than 13 years, elevated blood pressure is defined as blood pressure in the 90th percentile or higher for age, height, and sex, and hypertension is defined as blood pressure in the 95th percentile or higher. In adolescents 13 years and older, elevated blood pressure is defined as blood pressure of 120 to 129 mm Hg systolic and less than 80 mm Hg diastolic, and hypertension is defined as blood pressure of 130/80 mm Hg or higher. Ambulatory blood pressure monitoring should be performed to confirm hypertension in children and adolescents.

• #2 Pediatric Blood Pressure Reference

  https://www.bcm.edu/bodycomplab/Flashapps/BPVAgeChartpage.html

  Hypertension (high blood pressure) is an important health issue in children, because of its association with obesity. High blood pressure is considered a risk factor for heart disease and stroke, and high BP in childhood has been linked to high BP in adulthood. […] This calculator can help to determine whether a child has a healthy blood pressure for his/her height, age and gender. In boys and girls, the normal range of blood pressure varies based on height percentile and age. This calculator automatically adjusts for differences in height, age and gender, calculating a child’s height percentile along with blood pressure percentile. The normal blood pressure range, while steadily increasing with age, will shift based on the child’s height. […] Blood pressure is not always consistent, and can vary even when the child is resting. Thus, elevated BP readings should be repeated and confirmed over several visits before a child is identified as having hypertension. The most precise measure of a child’s BP is an average of multiple measurements taken over several weeks (or even months) by a health professional. […] To be accurately diagnosed with hypertension, a child must have systolic or diastolic blood pressure equal to or greater than the 95th percentile on three separate occasions.

• #2 High blood pressure in children – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/high-blood-pressure-in-children/diagnosis-treatment/drc-20373446

  The doctor will perform a physical exam and ask questions about your child’s medical history, family history of high blood pressure, and nutrition and activity level. […] Your child’s blood pressure will be measured. The correct blood pressure cuff size is important for measuring accurately. It is also important that blood pressure be measured with proper technique, in a quiet environment, with the child resting comfortably. During a single visit, your child’s blood pressure might be measured two or more times for accuracy. […] For a diagnosis of high blood pressure, your child’s blood pressure must be higher than normal when measured during at least three visits to the doctor. […] If your child is diagnosed with high blood pressure, it’s important to determine whether it’s primary or secondary. These tests might be used to look for another condition that could be causing your child’s high blood pressure:

• #2 High blood pressure in children – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/high-blood-pressure-in-children/symptoms-causes/syc-20373440

  High blood pressure (hypertension) in children is blood pressure that is at or above the 95th percentile for children who are the same sex, age and height as your child. […] Your child’s blood pressure should be checked during routine well-check appointments starting at age 3, and at every appointment if your child is found to have high blood pressure. […] If your child has a condition that can increase the risk of high blood pressure including premature birth, low birth weight, congenital heart disease and certain kidney problems blood pressure checks might begin soon after birth. […] High blood pressure in younger children is often related to other health conditions, such as heart defects, kidney disease, genetic conditions or hormonal disorders. […] Older children especially those who are overweight are more likely to have primary hypertension.

• #2 Final Recommendation Statement: High Blood Pressure in Children and Adolescents: Screening | United States Preventive Services Taskforce

  https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/blood-pressure-in-children-and-adolescents-hypertension-screening

  Best practice is to measure blood pressure by auscultation of the upper right arm with an appropriately sized cuff at 3 different visits. […] There is no good evidence about how often blood pressure should be measured in children and adolescents. […] Hypertension in children is often treated with lifestyle and pharmacologic interventions. […] Important risk factors for primary hypertension in children and adolescents are higher body mass index and a family history of hypertension. […] Clinic-based screening for high blood pressure could result in false-positive results. […] Current practice for blood pressure screening typically involves measurement in office-based health care settings as part of well child or sports participation examinations, often in conjunction with other vital signs and growth parameters.

• #2 Final Recommendation Statement: High Blood Pressure in Children and Adolescents: Screening | United States Preventive Services Taskforce

  https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/blood-pressure-in-children-and-adolescents-hypertension-screening

  Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. […] The USPSTF concludes that the evidence to support screening for high blood pressure in children and adolescents aged 3 to 18 years is insufficient and that the balance of benefits and harms cannot be determined. […] This recommendation applies to children and adolescents not known to have hypertension. […] Primary hypertension has no known cause. Secondary hypertension in children is most commonly caused by renal or renovascular disease. Other causes of secondary hypertension include congenital cardiovascular abnormalities, genetic disorders, and endocrine disorders.

• #2 How to Diagnose and Treat Pediatric Hypertension

  https://www.rupahealth.com/post/how-to-diagnose-and-treat-pediatric-hypertension

  Pediatric hypertension refers to elevated blood pressure in children and adolescents. The definition of pediatric hypertension consists of systolic and/or diastolic blood pressure levels that exceed the 95th percentile for age, sex, and height. […] Early identification of at-risk children is important for effective prevention and intervention strategies. Regular blood pressure screenings should be performed during pediatric check-ups starting at 3 years of age, especially in children with known risk factors such as obesity or family history of hypertension and other risk factors as described above. […] Routine blood pressure screenings during pediatric check-ups are key for identifying hypertension in children, especially those at higher risk due to family history or obesity. […] Diagnostic criteria for pediatric hypertension begin with obtaining an accurate history and clinical examination. The history should include information about any pre-natal and gestational events, social and lifestyle factors (e.g., activity, diet, screen time, sleeping habits), medical conditions, past or current medication use, and family history. […] Accurate diagnosis and comprehensive evaluation of pediatric hypertension are essential for guiding appropriate management strategies and minimizing long-term cardiovascular risks in affected children.

• #2 Pediatric hypertension: Review of the definition, diagnosis, and initial management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9072228/

  Pediatric hypertension (HTN) is defined as having three elevated systolic or diastolic blood pressure (BP) readings for the subjects age, height, and sex. […] The 2017 Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents provided updated recommendations for the workup and diagnosis of pediatric HTN. […] Accurate diagnosis of HTN is essential as studies have shown that it is often missed in children and is a major risk factor for cardiovascular and renal morbidity in children and adults. […] Establishing the diagnosis of HTN requires obtaining three abnormal systolic and/or diastolic BP readings. […] Continuous ambulatory blood pressure monitoring (ABPM) is the standard for confirming the diagnosis of HTN in children. […] The initial testing recommended by the AAP was recently updated in 2017 and is largely dependent on level of suspicion.

• #2

  https://link.springer.com/article/10.1007/s00467-023-06127-1

  Global estimates of childhood hypertension show a prevalence of 4%, peaking in young adolescents aged 13-15 years old at 7.1-7.9%. […] The diagnostic evaluation of the hypertensive child, a key issue in all documents, includes screening for secondary causes of hypertension, assessment of cardiovascular risk, and hypertension mediated organ damage (HMOD). […] Secondary hypertension was found in about half (56.3%) of the children in the study by Ding et al. diagnosed with hypertension based on office or ambulatory blood pressure measurements. […] Indications for further evaluation of hypertensive children and adolescents for underlying disorders and proper diagnostic evaluation are similar among different scientific organizations for children younger than 6 years. […] History and clinical examination are recommended to guide patient-specific diagnostic evaluation beyond initial laboratory tests including creatinine, blood urea nitrogen (BUN), electrolytes, and urinalysis that should be offered to all children.

• #2

  https://link.springer.com/article/10.1007/s00467-023-06127-1

  The study by Ding et al. emphasizes the high diagnostic utility of kidney ultrasound in the initial evaluation of hypertension underlying etiology, as well as echocardiography for the assessment of HMOD, drawing attention to related controversial issues among guidelines. […] While strong recommendations on the basis of robust, high-quality data from multiple randomized controlled trials showing evidence of benefit that outweighs harm from diagnostic tests are desperately needed, efforts may focus on the implementation of diagnostic approaches with the intent of identifying and managing underlying etiology in asymptomatic hypertensive children, limiting or preventing cardiovascular or kidney complications for the best health care of children and adolescents with high blood pressure.

• #2 The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents | NHLBI, NIH

  https://www.nhlbi.nih.gov/health-topics/fourth-report-on-diagnosis-evaluation-treatment-high-blood-pressure-in-children-and-adolescents

  Revised recommendations for use of antihypertensive drug therapy are provided. […] The evaluation of hypertensive children should include assessment for additional risk factors. […] Secondary hypertension is more common in children than in adults. […] Children or adolescents with stage 2 hypertension, and very young children with stage 1 or stage 2 hypertension should be evaluated more completely. […] Echocardiography is the recommended primary tool for detection of target-organ abnormalities. […] Children and adolescents with established hypertension should have an echocardiogram to determine if LVH is present. […] Indications for antihypertensive drug therapy in children include secondary hypertension and insufficient response to lifestyle modifications.

• #2 Underdiagnosis of hypertension in children and adolescents. | PSNet

  https://psnet.ahrq.gov/issue/underdiagnosis-hypertension-children-and-adolescents

  In this study, only one-quarter of children with high blood pressure were correctly diagnosed with hypertension. The authors attribute this to two factors: pediatricians’ lack of knowledge of the normal blood pressure range for different ages and lack of awareness of patients’ previous blood pressure measurements.

• #2 Hypertension Diagnosis Often Missed in Children | MDedge

  https://blogs.the-hospitalist.org/content/hypertension-diagnosis-often-missed-children

  The numbers are chopped up too much. It’s far too complex for easy management, Dr. Mitchell said. If physicians must always look on a table every time they check a blood pressure, we’ll continue to see underdiagnosis. […] If the diagnostic criteria are simplified, physicians will be much more likely to identify hypertension in children much more often, Dr. Mitchell said. […] We need to be much more aggressive about recognizing hypertension in children than we are now, she added. […] Of the 287 children examined, 90 (31%) had hypertension by current standards, and 35 (12%) had borderline hypertension. But only 15% of those with hypertension were diagnosed by their examining physicians. […] The results also showed that physicians were more likely to diagnose hypertension in children with a higher body mass index (BMI). The children who were correctly diagnosed as hypertensive were, on average, in the 92nd percentile for BMI. Those who had unrecognized blood pressure elevations were, on average, in the 76th percentile for BMI.

• #2 Get Care for High Blood Pressure in Children | Cleveland Clinic Children’s

  https://my.clevelandclinic.org/pediatrics/services/high-blood-pressure-treatment

  Your child may have: 24-hour ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension and rule out white coat hypertension. […] Your childs treatment plan centers around their diagnosis and needs. […] In most cases, their provider will recommend lifestyle changes. […] If your child needs to take blood pressure medication, they may take: ACE inhibitors, Angiotensin II receptor blockers (ARBs), Calcium channel blockers, Beta-blockers, Diuretics. […] The good news is that its treatable.

• #2 Hypertension in Children – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/hypertension-in-children/hypertension-in-children

  If BP remains elevated after 6 months, lifestyle changes (eg, diet, activity, weight loss if needed) should be recommended and upper and lower extremity BP measurements should be taken. […] If BP remains elevated over the next 6 months, 24-hour ambulatory BP monitoring could be performed, if possible, or the patient could be referred to a specialist. […] If measurements are consistently ≥ 95th percentile but < 95th percentile + 12 mm Hg, children should be considered to have stage 1 hypertension. [...] Measurements that are ≥ 95th percentile + 12 mm Hg or ≥ 140/90, whichever is lower, represent stage 2 hypertension. [...] Children with stage 1 hypertension should be rechecked within 1 to 2 weeks. [...] If BP remains at stage 1, upper and lower extremity BP measurements should be taken, a urinalysis performed, and lifestyle changes recommended. [...] Children with stage 2 hypertension or stage 1 hypertension with symptoms should be referred immediately to an emergency department or a pediatric specialist for possible hospitalization.

• #2 Children with high blood pressure often become adults with high blood pressure | American Heart Association

  https://newsroom.heart.org/news/children-with-high-blood-pressure-often-become-adults-with-high-blood-pressure

  Recognizing high blood pressure in children and adolescents who are otherwise healthy and without symptoms may be challenging. […] Current pediatric guidelines from the American Academy of Pediatrics, European Society of Hypertension and Hypertension Canada define a diagnosis of childhood-onset high blood pressure to be systolic and/or diastolic blood pressure levels that are greater than the 95th percentile of blood pressure values in healthy children, based on age, sex and height. […] When high blood pressure is diagnosed in youth, treatment may include dietary changes, increased physical activity, a reduction in screen time (television or other digital devices) and in some cases medication. […] Future studies to improve both the recognition and diagnosis of high blood pressure in this age group, as well as clinical trials to evaluate medical treatment and recommend public health initiatives, are all vital to improving the increase we are seeing in hypertension in children.

• #2 High Blood Pressure in Children – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/high-blood-pressure-in-children/high-blood-pressure-in-children

  Because the definition of high blood pressure in children under 13 years old depends on a child’s age, sex, and height, there is no one value that is considered high. Consequently, doctors use charts or online calculators that enable them to diagnose high blood pressure and to classify how severe it is. In adolescents, doctors diagnose high blood pressure using the same values as are used in adults. […] To be sure that high blood pressure is not a temporary condition (such as after consumption of caffeine), doctors measure blood pressure at least 2 times during 3 separate visits. […] Doctors recommend that routine blood pressure measurements be taken at annual health screening visits beginning when children are 3 years old. […] If elevated blood pressure is diagnosed, doctors recheck blood pressure within 6 months. […] If stage 1 hypertension is diagnosed, doctors recheck blood pressure within 1 to 2 weeks. […] If stage 2 hypertension is diagnosed and confirmed, diagnostic evaluations should be undertaken and initiation of treatment should be considered, or the child should see a specialist within 1 week.

• #2 High Blood Pressure in Kids – Children’s Health

  https://www.childrens.com/health-wellness/high-blood-pressure-and-kids

  When high blood pressure has no disease-related cause, it’s called primary hypertension. Primary hypertension is more common in older children and teens and is commonly related to obesity or to a family history of hypertension. […] If your child is diagnosed with hypertension, your pediatrician may recommend certain lifestyle changes to lower their blood pressure, such as a healthy diet, regular exercise or weight loss. […] If needed, your child’s physician may prescribe medications to control blood pressure.

• #3 Definition of pediatric hypertension: are blood pressure measurements on three separate occasions necessary? | Hypertension Research

  https://www.nature.com/articles/hr2016179

  The present meta-analysis underlines the necessity of measuring BP on at least three separate occasions to identify a hypertensive child in clinical practice or to accurately estimate the true prevalence of hypertension in a pediatric population. […] In conclusion, the true prevalence of hypertension in children and adolescents is ~3% over three different visits. […] the present meta-analysis provides evidence-based results in support of the recommendation of the US Fourth Report by NHBPEP in 2004 that the definition of pediatric hypertension should be based on BP measurements on at least three occasions in clinical practice or epidemiological studies to avoid false positive cases.

• #3 Pediatric Hypertension: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/889877-overview

  The prevalence of systemic hypertension in children appears to be increasing, especially in view of the growing population of children with obesity. […] In children, the definition of hypertension is based exclusively on frequency-distribution curves for BP. […] High blood pressure is a precursor of heart attacks and strokes, as has been well established in the adult literature. […] Parents, caregivers, and children themselves must be properly advised about restriction of exercise, when appropriate.

• #3 High blood pressure – children – UF Health

  https://ufhealth.org/conditions-and-treatments/high-blood-pressure-children

  Most of the time, no cause of high blood pressure is found. This is called primary (essential) hypertension. […] In most children, high blood pressure is related to being overweight. […] High blood pressure can be caused by another health problem. It can also be caused by a medicine your child is taking. Secondary causes are more common in infants and young children. […] The healthiest blood pressure for children is based on a child’s sex, height, and age. Your health care provider can tell you what your child’s blood pressure should be. […] Most children do not have any symptoms of high blood pressure. High blood pressure is often discovered during a checkup when a provider checks your child’s blood pressure. […] In most cases, the only sign of high blood pressure is the blood pressure measurement itself.

• #3 Pediatric Hypertension Workup: Laboratory Studies, Echocardiography and Ultrasonography, Angiography

  https://emedicine.medscape.com/article/889877-workup

  In patients with hypertension, proceed from simple tests that can be performed in an ambulatory setting to complex noninvasive tests and finally to invasive tests. Findings from the patients history and physical examination dictate the appropriate choice of tests. […] Blood hormone levels may be measured. High plasma renin activity indicates renal vascular hypertension, including coarctation of the aorta, whereas low activity indicates glucocorticoid-remediable aldosteronism, Liddle syndrome, or apparent mineralocorticoid excess. A high plasma aldosterone concentration is diagnostic of hyperaldosteronism. High values of catecholamines (eg, epinephrine, norepinephrine, or dopamine) are diagnostic of pheochromocytoma or neuroblastoma. […] Echocardiography is essential in the evaluation of suspected aortic coarctation. The aortic arch and its branches must be examined in precise anatomic detail.

• #3 High Blood Pressure in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1015/p486.html

  Despite the increasing prevalence and potential risks of hypertension in children, the diagnosis is often overlooked. One study revealed that only 26% of children with high blood pressure consistent with hypertension documented in an electronic medical record were subsequently diagnosed as having hypertension. […] In 2017, the American Academy of Pediatrics (AAP) updated its clinical practice guideline for the screening and management of high blood pressure in children and adolescents. A 2018 study has already demonstrated a significant increase in hypertension diagnoses using the updated guideline. […] Following the diagnosis of elevated blood pressure or hypertension, a careful history and physical examination can help determine if the child has primary or secondary hypertension. Very young children, children or adolescents with normal weight and no family history of hypertension, and children and adolescents with signs and symptoms suggesting an additional underlying systemic disorder require a more extensive evaluation for secondary hypertension. […] Children with persistently elevated blood pressure despite nonpharmacologic measures, stage 2 hypertension without a modifiable underlying factor, or comorbid diabetes or chronic kidney disease should be evaluated for cardiovascular damage with echocardiography.

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