Materiały źródłowe

• #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

  Among U.S. children and adolescents, up to 5% have high blood pressure – also known as hypertension – and as many as 18% have elevated blood pressure, according to a scientific statement from the American Heart Association published recently in its journal Hypertension. […] Falkner said concerns about childhood hypertension have increased as childhood obesity levels in the U.S. have reached alarming levels. Being overweight and not getting enough physical activity are major risk factors for hypertension, along with poor diet. […] As with adults, treatment for high blood pressure in children should begin with lifestyle changes, including getting regular physical activity and improving the diet, Tran said. „We recommend dietary changes such as eating more fruits and vegetables and reducing sodium.” […] 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/2018/1015/p486.html

  High blood pressure in children and adolescents is a growing health problem that is often overlooked. […] Hypertension in children is initially treated with lifestyle changes such as weight loss if overweight or obese, a healthy diet, and regular exercise. […] Children with symptomatic hypertension (e.g., headaches, cognitive changes), stage 2 hypertension without a modifiable factor such as obesity, evidence of left ventricular hypertrophy on echocardiography, any stage of hypertension associated with chronic kidney disease or diabetes, or persistent hypertension despite a trial of lifestyle modifications require antihypertensive medications and should be evaluated for cardiovascular damage with echocardiography. […] Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide diuretics are effective, safe, and well-tolerated in children.

• #3 High Blood Pressure in Children | American Heart Association

  https://www.heart.org/en/health-topics/high-blood-pressure/know-your-risk-factors-for-high-blood-pressure/high-blood-pressure-in-children

  Children of all ages, from birth to teens, can have high blood pressure, also known as hypertension. There are often no symptoms and early diagnosis and treatment are important. […] Pediatric guidelines recommend that all children ages 3 and older have yearly blood pressure checks for early detection and treatment. Children younger than 3 may need blood pressure checks if they have a high risk condition. […] Treatment includes managing lifestyle factors, (such as diet, weight and physical activity, and medication. Read about Life’s Essential 8 for Kids, healthy habits for improving and maintaining cardiovascular health.

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

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

  For children and adolescents, the blood pressure goal is less than the 90th percentile for age, height, and sex for patients younger than 13 years, or less than 130/80 mm Hg for those 13 years and older. […] All children with elevated blood pressure or hypertension should make therapeutic lifestyle changes to lower blood pressure and reduce the risk of developing additional CVD risk factors. […] Weight loss should be encouraged for children who are overweight or obese, and those who are obese should be referred for comprehensive, intensive, family-oriented behavioral intervention programs. […] Children with symptomatic hypertension (e.g., headaches, cognitive changes), stage 2 hypertension without a modifiable factor such as obesity, evidence of left ventricular hypertrophy on echocardiography, any stage of hypertension associated with chronic kidney disease or diabetes, or persistent hypertension despite a trial of lifestyle modifications require antihypertensive medications.

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

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

  In children and adolescents, one or more medications may be recommended to reduce high blood pressure in the following circumstances: Hypertension associated with symptoms that are related to elevated blood pressure, such as headaches or seizures. […] Stage 2 hypertension, defined as blood pressure level 12 mmHg greater than the 95th percentile or ≥140/90 mmHg (whichever is lower). […] Stage 1 hypertension, defined as blood pressure level between the 95th percentile and stage 2 (or between 130/80 and 139/89, whichever is lower), that persists after four to six months of nonpharmacologic therapy. […] There are several classes of antihypertensive medications commonly used to treat children. These include thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), calcium channel blockers, and beta blockers. […] The goal blood pressure for most children with hypertension is less than the 90th percentile. If the child is obese, has high cholesterol, has diabetes, or has organ damage related to hypertension, the blood pressure goal is lower.

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

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

  Therapeutic lifestyle modifications that can help lower BP, including dietary improvement and exercise, are advised in all children with elevated BP. […] Treatment goals are typically a BP of < 90th percentile or, in older children, < 130/80, whichever is lower; sometimes the treatment goal is < 120/80. [...] Children with stage 2 hypertension, or stage 1 hypertension with symptoms, evidence of target organ damage, diabetes, or kidney disease should be referred to a specialist to begin a more rapid and/or directed therapy. [...] Immediate pharmacologic therapy is typically started (along with therapeutic lifestyle modification) for children with: symptomatic hypertension at any stage or level, stage 1 hypertension with any evidence of target organ dysfunction or damage, stage 2 hypertension even with an obvious, modifiable risk factor (eg, obesity), which should be addressed while BP is being controlled, any stage of hypertension if they have chronic kidney disease, diabetes, or cardiac disease.

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

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

  If your child is diagnosed with slightly or moderately high blood pressure (stage 1 hypertension), your child’s doctor will likely suggest trying lifestyle changes, such as a heart-healthy diet and more exercise, before prescribing medications. […] If lifestyle changes don’t help, your child’s doctor might recommend blood pressure medication. […] If your child is diagnosed with severely high blood pressure (stage 2 hypertension), your child’s doctor will likely recommend blood pressure medications. […] Medications might include: Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax your child’s blood vessels by blocking the formation of a natural chemical that narrows blood vessels. This makes it easier for your child’s blood to flow, reducing blood pressure. […] Angiotensin II receptor blockers. These medications help relax blood vessels by blocking a natural chemical that narrows your child’s blood vessels.

• #8 Treatment of hypertension in children and adolescents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2756388/

  The treatment of hypertension in children and adolescents has been markedly changed in recent years by several factors, including the publication of new consensus recommendations, the obesity epidemic, and the increased availability of information on efficacy and safety of antihypertensive medications in the young. […] After the diagnosis of hypertension has been confirmed and the underlying etiology (if any) identified, an individualized treatment regimen should be initiated. Most authorities recommend that this include non-pharmacologic measures for all patients, with addition of antihypertensive medications in a selected group of children. […] Non-pharmacologic approaches to hypertension generally consist of dietary changes, increased physical activity and weight loss in the obese. […] Antihypertensive drug prescribing in children and adolescents should generally begin with the physicians choosing an agent appropriate to the underlying etiology of the patients hypertension.

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

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

  Control your child’s weight. If your child is overweight, achieving a healthy weight or maintaining the same weight while getting taller can lower blood pressure. […] Give your child a healthy diet. Encourage your child to eat a heart-healthy diet, emphasizing fruits, vegetables, whole grains, low-fat dairy products and lean sources of protein, such as fish and beans, and limiting fat and sugar. […] Decrease salt in your child’s diet. Cutting the amount of salt (sodium) in your child’s diet will help lower his or her blood pressure. Children ages 2 to 3 shouldn’t have more than 1,200 milligrams (mg) of sodium a day, and older children shouldn’t have more than 1,500 milligrams (mg) a day. […] Encourage physical activity. All children should get 60 minutes of moderate to vigorous physical activity a day.

• #10 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. […] Hypertension in children is initially treated with lifestyle changes such as weight loss if overweight or obese, a healthy diet, and regular exercise. […] Children with symptomatic hypertension (e.g., headaches, cognitive changes), stage 2 hypertension without a modifiable factor such as obesity, evidence of left ventricular hypertrophy on echocardiography, any stage of hypertension associated with chronic kidney disease or diabetes, or persistent hypertension despite a trial of lifestyle modifications require antihypertensive medications and should be evaluated for cardiovascular damage with echocardiography. […] Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide diuretics are effective, safe, and well-tolerated in children.

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

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

  Limit screen time. To encourage your child to be more active, limit time in front of the television, computer or other devices. […] Get the family involved. It can be hard for your child to make healthy lifestyle changes if other family members don’t eat well or exercise. Set a good example. Your whole family will benefit from eating better. Create family fun by playing together ride bikes, play catch or take a walk.

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

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

  If treating the underlying cause does not adequately reduce blood pressure, or if there is no known underlying cause (primary, formerly called „essential”, hypertension), treatments to reduce the blood pressure are recommended. […] Treatment includes lifestyle changes (diet changes, regular exercise, and, if appropriate, weight loss) and/or medications. […] Lifestyle changes are recommended for children with hypertension (defined as blood pressure >95th percentile) or those with elevated blood pressure (defined as blood pressure >90th to the 95th percentile or if blood pressure exceeds 120/80 mmHg in adolescents 13 years or older). […] Lifestyle changes include: Weight loss, Regular exercise, Dietary changes, including reducing salt intake and avoiding alcohol. […] In children who are obese or overweight, losing weight can help to lower blood pressure.

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

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

  High blood pressure in children varies based on their age, sex and height, as healthy blood pressure changes as your child grows. […] Because of this, its essential to diagnose and treat pediatric hypertension as soon as possible. […] Treatment for high blood pressure depends on your childs unique situation and the cause. In some cases, treating the underlying condition can also treat the high blood pressure. […] The main treatment options are lifestyle changes and medication. […] In most cases, healthcare providers first recommend lifestyle changes to treat high blood pressure in children, including: Eating a DASH diet: DASH stands for Dietary Approaches to Stop Hypertension. The DASH diet includes multiple servings of fresh vegetables and fruits, whole grains, nuts and legumes with some servings of lean protein foods. It involves limiting foods high in sodium, sugars and saturated fats. Your childs provider will likely refer you to a registered dietitian for help with this.

• #14 Pediatric Hypertension Treatment & Management: Approach Considerations, Nonpharmacologic Therapy, Pharmacologic Therapy

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

  In children with mild or moderate hypertension, nonpharmacologic therapy may suffice to lower blood pressure (BP) to within normal limits. This approach avoids the need for drugs that have adverse effects and that require a degree of compliance difficult to achieve in children. […] Indications for pharmacologic treatment include symptomatic hypertension, secondary hypertension, hypertensive target-organ damage, diabetes, and hypertension that persists despite nonpharmacologic measures. […] The Task Force recommends the use of ACE inhibitors or ARBs only for children with diabetes and microalbuminuria or proteinuric renal disease and recommends beta-blockers or calcium-channel blockers for children with hypertension and migraine headaches. […] In general, treatment of chronic hypertension requires expertise that is seldom available in the general pediatrician. Therefore, it is advisable to refer patients to physicians who specialize in treatment of children with high BP.

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

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

  In children and adolescents, one or more medications may be recommended to reduce high blood pressure in the following circumstances: Hypertension associated with symptoms that are related to elevated blood pressure, such as headaches or seizures. […] Stage 2 hypertension, defined as blood pressure level 12 mmHg greater than the 95th percentile or ≥140/90 mmHg (whichever is lower). […] Stage 1 hypertension, defined as blood pressure level between the 95th percentile and stage 2 (or between 130/80 and 139/89, whichever is lower), that persists after four to six months of nonpharmacologic therapy. […] There are several classes of antihypertensive medications commonly used to treat children. These include thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), calcium channel blockers, and beta blockers. […] The goal blood pressure for most children with hypertension is less than the 90th percentile. If the child is obese, has high cholesterol, has diabetes, or has organ damage related to hypertension, the blood pressure goal is lower.

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

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

  For children and adolescents, the blood pressure goal is less than the 90th percentile for age, height, and sex for patients younger than 13 years, or less than 130/80 mm Hg for those 13 years and older. […] All children with elevated blood pressure or hypertension should make therapeutic lifestyle changes to lower blood pressure and reduce the risk of developing additional CVD risk factors. […] Weight loss should be encouraged for children who are overweight or obese, and those who are obese should be referred for comprehensive, intensive, family-oriented behavioral intervention programs. […] Children with symptomatic hypertension (e.g., headaches, cognitive changes), stage 2 hypertension without a modifiable factor such as obesity, evidence of left ventricular hypertrophy on echocardiography, any stage of hypertension associated with chronic kidney disease or diabetes, or persistent hypertension despite a trial of lifestyle modifications require antihypertensive medications.

• #17 Drugs for Hypertension in Children – Pediatrics – Merck Manual Professional Edition

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

  Immediate drug treatment is typically started (along with lifestyle changes) for children with symptomatic hypertension at any stage or level. […] In children with high normal or borderline hypertension or stage 1 hypertension without symptoms or end-organ dysfunction, lifestyle changes are initiated, and if these do not sufficiently lower BP within about 6 months, drug treatment will be necessary. […] Generally, drug treatment should begin with a single drug at the low end of its dosing range and increased every 1 to 4 weeks until BP is controlled. […] Oral therapy for persistent hypertension in children should generally begin with an ACE inhibitor or a CCB. […] If initial therapy with a single drug does not achieve the target BP, a second drug should be added. […] Thiazide-type diuretics enhance the antihypertensive activity of ACE inhibitors more than that of other classes of antihypertensives.

• #18 Pediatric Hypertension Treatment & Management: Approach Considerations, Nonpharmacologic Therapy, Pharmacologic Therapy

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

  In children with mild or moderate hypertension, nonpharmacologic therapy may suffice to lower blood pressure (BP) to within normal limits. This approach avoids the need for drugs that have adverse effects and that require a degree of compliance difficult to achieve in children. […] Indications for pharmacologic treatment include symptomatic hypertension, secondary hypertension, hypertensive target-organ damage, diabetes, and hypertension that persists despite nonpharmacologic measures. […] The Task Force recommends the use of ACE inhibitors or ARBs only for children with diabetes and microalbuminuria or proteinuric renal disease and recommends beta-blockers or calcium-channel blockers for children with hypertension and migraine headaches. […] In general, treatment of chronic hypertension requires expertise that is seldom available in the general pediatrician. Therefore, it is advisable to refer patients to physicians who specialize in treatment of children with high BP.

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

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

  For children and adolescents, the blood pressure goal is less than the 90th percentile for age, height, and sex for patients younger than 13 years, or less than 130/80 mm Hg for those 13 years and older. […] All children with elevated blood pressure or hypertension should make therapeutic lifestyle changes to lower blood pressure and reduce the risk of developing additional CVD risk factors. […] Weight loss should be encouraged for children who are overweight or obese, and those who are obese should be referred for comprehensive, intensive, family-oriented behavioral intervention programs. […] Children with symptomatic hypertension (e.g., headaches, cognitive changes), stage 2 hypertension without a modifiable factor such as obesity, evidence of left ventricular hypertrophy on echocardiography, any stage of hypertension associated with chronic kidney disease or diabetes, or persistent hypertension despite a trial of lifestyle modifications require antihypertensive medications.

• #20 Pediatric Hypertension: A Review of Diagnosis and Treatment

  https://www.uspharmacist.com/article/pediatric-hypertension-a-review-of-diagnosis-and-treatment

  Hypertension has become a significant pediatric health problem owing to the increased number of overweight children. […] As with adults, initial therapy for hypertension in children and adolescents includes diet and exercise. Weight loss, particularly for the obese child, often will prevent the addition of pharmacologic therapy. Nonpharmacologic dietary interventions recommended for adults (including increased intake of fruits and vegetables, consumption of low-fat dairy products, and sodium restriction) may also be beneficial for children and adolescents. […] Pharmacotherapy is indicated for patients with secondary hypertension and for those who are unable to control BP through diet and exercise. Currently recommended agents for the treatment of hypertension in pediatric patients include angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs), and diuretics.

• #21 Drugs for Hypertension in Children – Pediatrics – Merck Manual Professional Edition

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

  Immediate drug treatment is typically started (along with lifestyle changes) for children with symptomatic hypertension at any stage or level. […] In children with high normal or borderline hypertension or stage 1 hypertension without symptoms or end-organ dysfunction, lifestyle changes are initiated, and if these do not sufficiently lower BP within about 6 months, drug treatment will be necessary. […] Generally, drug treatment should begin with a single drug at the low end of its dosing range and increased every 1 to 4 weeks until BP is controlled. […] Oral therapy for persistent hypertension in children should generally begin with an ACE inhibitor or a CCB. […] If initial therapy with a single drug does not achieve the target BP, a second drug should be added. […] Thiazide-type diuretics enhance the antihypertensive activity of ACE inhibitors more than that of other classes of antihypertensives.

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

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

  There is no consensus on the best initial antihypertensive medication to use in children, and there have been no clinical trials of hypertension treatment in children that measured patient-oriented, long-term outcomes. […] Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide diuretics are effective, safe, and well tolerated in children.

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

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

  If your child is diagnosed with slightly or moderately high blood pressure (stage 1 hypertension), your child’s doctor will likely suggest trying lifestyle changes, such as a heart-healthy diet and more exercise, before prescribing medications. […] If lifestyle changes don’t help, your child’s doctor might recommend blood pressure medication. […] If your child is diagnosed with severely high blood pressure (stage 2 hypertension), your child’s doctor will likely recommend blood pressure medications. […] Medications might include: Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax your child’s blood vessels by blocking the formation of a natural chemical that narrows blood vessels. This makes it easier for your child’s blood to flow, reducing blood pressure. […] Angiotensin II receptor blockers. These medications help relax blood vessels by blocking a natural chemical that narrows your child’s blood vessels.

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

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

  If your child is diagnosed with slightly or moderately high blood pressure (stage 1 hypertension), your child’s doctor will likely suggest trying lifestyle changes, such as a heart-healthy diet and more exercise, before prescribing medications. […] If lifestyle changes don’t help, your child’s doctor might recommend blood pressure medication. […] If your child is diagnosed with severely high blood pressure (stage 2 hypertension), your child’s doctor will likely recommend blood pressure medications. […] Medications might include: Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax your child’s blood vessels by blocking the formation of a natural chemical that narrows blood vessels. This makes it easier for your child’s blood to flow, reducing blood pressure. […] Angiotensin II receptor blockers. These medications help relax blood vessels by blocking a natural chemical that narrows your child’s blood vessels.

• #25 Treatment of hypertension in children and adolescents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2756388/

  Once an initial antihypertensive agent has been chosen, a stepped-care approach should be followed. […] Therapeutic lifestyle modification is essential for any child or adolescent with hypertension and should include regular physical activity, a diet limited in sodium but rich in fresh fruits and vegetables, fiber, and low-fat dairy products, and the avoidance of excess weight gain. […] In addition to the implementation of therapeutic lifestyle changes, some athletes will require pharmacologic therapy for hypertension management. […] The NHBPEP Working Group recommended that children with chronic renal disease have a target blood pressure 90th percentile for age, gender, and height and that ACE inhibitors or ARBs should be used preferentially in children with proteinuric renal disease. […] The most recent NHBPEP Working Group guidelines, published in 2004, provide comprehensive recommendations regarding the evaluation, diagnosis, and therapy of children and adolescents with elevated blood pressure.

• #26 Hypertension | Children’s Hospital of Philadelphia

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

  Medications used to treat high blood pressure in children and adolescents include: Angiotensin-converting enzyme (ACE) inhibitors help relax and widen blood vessels by blocking the formation of a chemical that narrows them. Angiotensin II receptor blockers (ARBs) help relax and widen blood vessels by blocking the absorption of a chemical that narrows them. Long-acting calcium channel blockers help relax the muscles in blood vessels. Cardio-selective Beta blockers slow the heart rate. Diuretics (also known as water pills) help the kidney eliminate sodium and water from the bloodstream, thereby reducing blood pressure. […] If these medications do not work to reduce a childs blood pressure, some additional medications include peripheral alpha-blockers, central alpha stimulators, and direct vasodilators. Sometimes, more than one medication is needed to treat high blood pressure.

• #27 Drugs for Hypertension in Children – Pediatrics – Merck Manual Professional Edition

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

  ARBs and ACE inhibitors are equally effective as antihypertensives. […] CCBs should be used in menstruating girls if there is risk of pregnancy because ACE inhibitors and ARBs have significant effects on a fetus. […] Many antihypertensives can be obtained or prepared as oral suspensions for children who cannot take pills or capsules and when nonstandard doses are needed.

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

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

  If your child is diagnosed with slightly or moderately high blood pressure (stage 1 hypertension), your child’s doctor will likely suggest trying lifestyle changes, such as a heart-healthy diet and more exercise, before prescribing medications. […] If lifestyle changes don’t help, your child’s doctor might recommend blood pressure medication. […] If your child is diagnosed with severely high blood pressure (stage 2 hypertension), your child’s doctor will likely recommend blood pressure medications. […] Medications might include: Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax your child’s blood vessels by blocking the formation of a natural chemical that narrows blood vessels. This makes it easier for your child’s blood to flow, reducing blood pressure. […] Angiotensin II receptor blockers. These medications help relax blood vessels by blocking a natural chemical that narrows your child’s blood vessels.

• #29 Drugs for Hypertension in Children – Pediatrics – Merck Manual Professional Edition

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

  ARBs and ACE inhibitors are equally effective as antihypertensives. […] CCBs should be used in menstruating girls if there is risk of pregnancy because ACE inhibitors and ARBs have significant effects on a fetus. […] Many antihypertensives can be obtained or prepared as oral suspensions for children who cannot take pills or capsules and when nonstandard doses are needed.

• #30 Hypertension | Children’s Hospital of Philadelphia

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

  Medications used to treat high blood pressure in children and adolescents include: Angiotensin-converting enzyme (ACE) inhibitors help relax and widen blood vessels by blocking the formation of a chemical that narrows them. Angiotensin II receptor blockers (ARBs) help relax and widen blood vessels by blocking the absorption of a chemical that narrows them. Long-acting calcium channel blockers help relax the muscles in blood vessels. Cardio-selective Beta blockers slow the heart rate. Diuretics (also known as water pills) help the kidney eliminate sodium and water from the bloodstream, thereby reducing blood pressure. […] If these medications do not work to reduce a childs blood pressure, some additional medications include peripheral alpha-blockers, central alpha stimulators, and direct vasodilators. Sometimes, more than one medication is needed to treat high blood pressure.

• #31 Pediatric Hypertension Guidelines: Guidelines Summary

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

  Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) should be limited to children aged 6 years or older with creatinine clearance of 30 mL/min/1.73 m2 or greater; in black children, higher doses of fosinopril may be needed for effective blood pressure control. […] Calcium channel blockers are contraindicated in children less than 1 year old. […] Beta-blockers are contraindicated in children with asthma or insulin-dependent diabetes. […] Diuretics are useful as add-on therapy in patients being treated with drugs from other classes; however, potassium-sparing diuretics (spironolactone, triamterene, amiloride) may cause severe hyperkalemia, especially if given with an ACE inhibitor or ARB; all patients treated with diuretics should have electrolyte levels monitored shortly after initiating therapy and periodically thereafter. […] The 2009 European Hypertension Society (EHS) guidelines for blood pressure management in children are in agreement with those of the NHLBI, however, they offer more specific guidance as to the clinical conditions for which specific antihypertensive drugs are recommended or contraindicated.

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

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

  Calcium channel blockers. These medications help relax the muscles of your child’s blood vessels and may slow his or her heart rate. […] Diuretics. Also known as water pills, these act on your child’s kidneys to help your child remove sodium and water, reducing blood pressure. […] Your child’s doctor will tell you how long your child will need to stay on the medication. If your child’s high blood pressure is caused by obesity, losing weight might make medication unnecessary. Treating other medical conditions your child has might also control his or her blood pressure. […] Although little is known about the long-term effects of blood pressure medication on a child’s growth and development, many of these medications are generally considered safe to take during childhood. […] 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.

• #33 Pediatric Hypertension Treatment & Management: Approach Considerations, Nonpharmacologic Therapy, Pharmacologic Therapy

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

  In children with mild or moderate hypertension, nonpharmacologic therapy may suffice to lower blood pressure (BP) to within normal limits. This approach avoids the need for drugs that have adverse effects and that require a degree of compliance difficult to achieve in children. […] Indications for pharmacologic treatment include symptomatic hypertension, secondary hypertension, hypertensive target-organ damage, diabetes, and hypertension that persists despite nonpharmacologic measures. […] The Task Force recommends the use of ACE inhibitors or ARBs only for children with diabetes and microalbuminuria or proteinuric renal disease and recommends beta-blockers or calcium-channel blockers for children with hypertension and migraine headaches. […] In general, treatment of chronic hypertension requires expertise that is seldom available in the general pediatrician. Therefore, it is advisable to refer patients to physicians who specialize in treatment of children with high BP.

• #34 Pediatric Hypertension: A Review of Diagnosis and Treatment

  https://www.uspharmacist.com/article/pediatric-hypertension-a-review-of-diagnosis-and-treatment

  Several ACE inhibitors have been studied in children, with captopril having the most evidence. […] CCBs are also commonly prescribed for pediatric patients. […] Outside of hypertension associated with renal disease, data are extremely limited regarding the use of ARBs for the treatment of pediatric hypertension. […] Beta-blockers are used less often owing to complications with disease states such as diabetes and asthma and the development of lipid abnormalities after long-term use. […] When treatment for hypertension is initiated, a 6-month trial of nonpharmacologic interventions should be attempted. If BP goals are not met after this time, pharmacologic therapy should be started. […] The prevalence of hypertension among children has increased in response to the increased prevalence of childhood obesity.

• #35 Pediatric Hypertension Guidelines: Guidelines Summary

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

  Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) should be limited to children aged 6 years or older with creatinine clearance of 30 mL/min/1.73 m2 or greater; in black children, higher doses of fosinopril may be needed for effective blood pressure control. […] Calcium channel blockers are contraindicated in children less than 1 year old. […] Beta-blockers are contraindicated in children with asthma or insulin-dependent diabetes. […] Diuretics are useful as add-on therapy in patients being treated with drugs from other classes; however, potassium-sparing diuretics (spironolactone, triamterene, amiloride) may cause severe hyperkalemia, especially if given with an ACE inhibitor or ARB; all patients treated with diuretics should have electrolyte levels monitored shortly after initiating therapy and periodically thereafter. […] The 2009 European Hypertension Society (EHS) guidelines for blood pressure management in children are in agreement with those of the NHLBI, however, they offer more specific guidance as to the clinical conditions for which specific antihypertensive drugs are recommended or contraindicated.

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

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

  Calcium channel blockers. These medications help relax the muscles of your child’s blood vessels and may slow his or her heart rate. […] Diuretics. Also known as water pills, these act on your child’s kidneys to help your child remove sodium and water, reducing blood pressure. […] Your child’s doctor will tell you how long your child will need to stay on the medication. If your child’s high blood pressure is caused by obesity, losing weight might make medication unnecessary. Treating other medical conditions your child has might also control his or her blood pressure. […] Although little is known about the long-term effects of blood pressure medication on a child’s growth and development, many of these medications are generally considered safe to take during childhood. […] 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.

• #37 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. […] Hypertension in children is initially treated with lifestyle changes such as weight loss if overweight or obese, a healthy diet, and regular exercise. […] Children with symptomatic hypertension (e.g., headaches, cognitive changes), stage 2 hypertension without a modifiable factor such as obesity, evidence of left ventricular hypertrophy on echocardiography, any stage of hypertension associated with chronic kidney disease or diabetes, or persistent hypertension despite a trial of lifestyle modifications require antihypertensive medications and should be evaluated for cardiovascular damage with echocardiography. […] Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide diuretics are effective, safe, and well-tolerated in children.

• #38 Drugs for Hypertension in Children – Pediatrics – Merck Manual Professional Edition

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

  Immediate drug treatment is typically started (along with lifestyle changes) for children with symptomatic hypertension at any stage or level. […] In children with high normal or borderline hypertension or stage 1 hypertension without symptoms or end-organ dysfunction, lifestyle changes are initiated, and if these do not sufficiently lower BP within about 6 months, drug treatment will be necessary. […] Generally, drug treatment should begin with a single drug at the low end of its dosing range and increased every 1 to 4 weeks until BP is controlled. […] Oral therapy for persistent hypertension in children should generally begin with an ACE inhibitor or a CCB. […] If initial therapy with a single drug does not achieve the target BP, a second drug should be added. […] Thiazide-type diuretics enhance the antihypertensive activity of ACE inhibitors more than that of other classes of antihypertensives.

• #39 Pediatric Hypertension Guidelines: Guidelines Summary

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

  Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) should be limited to children aged 6 years or older with creatinine clearance of 30 mL/min/1.73 m2 or greater; in black children, higher doses of fosinopril may be needed for effective blood pressure control. […] Calcium channel blockers are contraindicated in children less than 1 year old. […] Beta-blockers are contraindicated in children with asthma or insulin-dependent diabetes. […] Diuretics are useful as add-on therapy in patients being treated with drugs from other classes; however, potassium-sparing diuretics (spironolactone, triamterene, amiloride) may cause severe hyperkalemia, especially if given with an ACE inhibitor or ARB; all patients treated with diuretics should have electrolyte levels monitored shortly after initiating therapy and periodically thereafter. […] The 2009 European Hypertension Society (EHS) guidelines for blood pressure management in children are in agreement with those of the NHLBI, however, they offer more specific guidance as to the clinical conditions for which specific antihypertensive drugs are recommended or contraindicated.

• #40 Pediatric Hypertension: A Review of Diagnosis and Treatment

  https://www.uspharmacist.com/article/pediatric-hypertension-a-review-of-diagnosis-and-treatment

  Several ACE inhibitors have been studied in children, with captopril having the most evidence. […] CCBs are also commonly prescribed for pediatric patients. […] Outside of hypertension associated with renal disease, data are extremely limited regarding the use of ARBs for the treatment of pediatric hypertension. […] Beta-blockers are used less often owing to complications with disease states such as diabetes and asthma and the development of lipid abnormalities after long-term use. […] When treatment for hypertension is initiated, a 6-month trial of nonpharmacologic interventions should be attempted. If BP goals are not met after this time, pharmacologic therapy should be started. […] The prevalence of hypertension among children has increased in response to the increased prevalence of childhood obesity.

• #41 Pediatric Hypertension Guidelines: Guidelines Summary

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

  Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) should be limited to children aged 6 years or older with creatinine clearance of 30 mL/min/1.73 m2 or greater; in black children, higher doses of fosinopril may be needed for effective blood pressure control. […] Calcium channel blockers are contraindicated in children less than 1 year old. […] Beta-blockers are contraindicated in children with asthma or insulin-dependent diabetes. […] Diuretics are useful as add-on therapy in patients being treated with drugs from other classes; however, potassium-sparing diuretics (spironolactone, triamterene, amiloride) may cause severe hyperkalemia, especially if given with an ACE inhibitor or ARB; all patients treated with diuretics should have electrolyte levels monitored shortly after initiating therapy and periodically thereafter. […] The 2009 European Hypertension Society (EHS) guidelines for blood pressure management in children are in agreement with those of the NHLBI, however, they offer more specific guidance as to the clinical conditions for which specific antihypertensive drugs are recommended or contraindicated.

• #42 Pediatric Hypertension Guidelines: Guidelines Summary

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

  Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) should be limited to children aged 6 years or older with creatinine clearance of 30 mL/min/1.73 m2 or greater; in black children, higher doses of fosinopril may be needed for effective blood pressure control. […] Calcium channel blockers are contraindicated in children less than 1 year old. […] Beta-blockers are contraindicated in children with asthma or insulin-dependent diabetes. […] Diuretics are useful as add-on therapy in patients being treated with drugs from other classes; however, potassium-sparing diuretics (spironolactone, triamterene, amiloride) may cause severe hyperkalemia, especially if given with an ACE inhibitor or ARB; all patients treated with diuretics should have electrolyte levels monitored shortly after initiating therapy and periodically thereafter. […] The 2009 European Hypertension Society (EHS) guidelines for blood pressure management in children are in agreement with those of the NHLBI, however, they offer more specific guidance as to the clinical conditions for which specific antihypertensive drugs are recommended or contraindicated.

• #43 Treatment of hypertension in children and adolescents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2756388/

  Once an initial antihypertensive agent has been chosen, a stepped-care approach should be followed. […] Therapeutic lifestyle modification is essential for any child or adolescent with hypertension and should include regular physical activity, a diet limited in sodium but rich in fresh fruits and vegetables, fiber, and low-fat dairy products, and the avoidance of excess weight gain. […] In addition to the implementation of therapeutic lifestyle changes, some athletes will require pharmacologic therapy for hypertension management. […] The NHBPEP Working Group recommended that children with chronic renal disease have a target blood pressure 90th percentile for age, gender, and height and that ACE inhibitors or ARBs should be used preferentially in children with proteinuric renal disease. […] The most recent NHBPEP Working Group guidelines, published in 2004, provide comprehensive recommendations regarding the evaluation, diagnosis, and therapy of children and adolescents with elevated blood pressure.

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

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

  When antihypertensive therapy is indicated, a stepped-care approach to the initiation and escalation of drug dosing is typically recommended. […] Most clinicians begin with an angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), a calcium channel blocker, or a thiazide diuretic. […] Classes of oral medications used to treat hypertension include: Adrenergic modifiers (beta- and alpha-antagonist, alpha-2-agonist, beta-blocker), Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin II receptor blockers (ARBs), Calcium channel blockers, Thiazide diuretics, Vasodilators.

• #45 Drugs for Hypertension in Children – Pediatrics – Merck Manual Professional Edition

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

  Immediate drug treatment is typically started (along with lifestyle changes) for children with symptomatic hypertension at any stage or level. […] In children with high normal or borderline hypertension or stage 1 hypertension without symptoms or end-organ dysfunction, lifestyle changes are initiated, and if these do not sufficiently lower BP within about 6 months, drug treatment will be necessary. […] Generally, drug treatment should begin with a single drug at the low end of its dosing range and increased every 1 to 4 weeks until BP is controlled. […] Oral therapy for persistent hypertension in children should generally begin with an ACE inhibitor or a CCB. […] If initial therapy with a single drug does not achieve the target BP, a second drug should be added. […] Thiazide-type diuretics enhance the antihypertensive activity of ACE inhibitors more than that of other classes of antihypertensives.

• #46 Hypertension in children

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-8/Hypertension-in-Children

  The four drug classes which are to be used in paediatric hypertension are beta-blockers, calcium antagonists, ACE-inhibitors and angiotensin II receptor blockers, starting with low-dose monotherapy and, if necessary, implementing the dose or, preferentially, making use of low dose combination treatment in order to avoid the occurrence of side-effects. […] A key but still unanswered question is temporal duration of antipertensive drug treatment in children. The suggestion, also from the ESH Guidelines, is not to stop treatment in childhood, even when blood pressure displays a good control and no target organ damage is present (low risk category).

• #47 Pediatric Hypertension Treatment & Management: Approach Considerations, Nonpharmacologic Therapy, Pharmacologic Therapy

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

  In children with mild or moderate hypertension, nonpharmacologic therapy may suffice to lower blood pressure (BP) to within normal limits. This approach avoids the need for drugs that have adverse effects and that require a degree of compliance difficult to achieve in children. […] Indications for pharmacologic treatment include symptomatic hypertension, secondary hypertension, hypertensive target-organ damage, diabetes, and hypertension that persists despite nonpharmacologic measures. […] The Task Force recommends the use of ACE inhibitors or ARBs only for children with diabetes and microalbuminuria or proteinuric renal disease and recommends beta-blockers or calcium-channel blockers for children with hypertension and migraine headaches. […] In general, treatment of chronic hypertension requires expertise that is seldom available in the general pediatrician. Therefore, it is advisable to refer patients to physicians who specialize in treatment of children with high BP.

• #48 Treatment of hypertension in children and adolescents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2756388/

  The treatment of hypertension in children and adolescents has been markedly changed in recent years by several factors, including the publication of new consensus recommendations, the obesity epidemic, and the increased availability of information on efficacy and safety of antihypertensive medications in the young. […] After the diagnosis of hypertension has been confirmed and the underlying etiology (if any) identified, an individualized treatment regimen should be initiated. Most authorities recommend that this include non-pharmacologic measures for all patients, with addition of antihypertensive medications in a selected group of children. […] Non-pharmacologic approaches to hypertension generally consist of dietary changes, increased physical activity and weight loss in the obese. […] Antihypertensive drug prescribing in children and adolescents should generally begin with the physicians choosing an agent appropriate to the underlying etiology of the patients hypertension.

• #49 Treatment of hypertension in children and adolescents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2756388/

  Once an initial antihypertensive agent has been chosen, a stepped-care approach should be followed. […] Therapeutic lifestyle modification is essential for any child or adolescent with hypertension and should include regular physical activity, a diet limited in sodium but rich in fresh fruits and vegetables, fiber, and low-fat dairy products, and the avoidance of excess weight gain. […] In addition to the implementation of therapeutic lifestyle changes, some athletes will require pharmacologic therapy for hypertension management. […] The NHBPEP Working Group recommended that children with chronic renal disease have a target blood pressure 90th percentile for age, gender, and height and that ACE inhibitors or ARBs should be used preferentially in children with proteinuric renal disease. […] The most recent NHBPEP Working Group guidelines, published in 2004, provide comprehensive recommendations regarding the evaluation, diagnosis, and therapy of children and adolescents with elevated blood pressure.

• #50 Pediatric Hypertension Guidelines: Guidelines Summary

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

  Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) should be limited to children aged 6 years or older with creatinine clearance of 30 mL/min/1.73 m2 or greater; in black children, higher doses of fosinopril may be needed for effective blood pressure control. […] Calcium channel blockers are contraindicated in children less than 1 year old. […] Beta-blockers are contraindicated in children with asthma or insulin-dependent diabetes. […] Diuretics are useful as add-on therapy in patients being treated with drugs from other classes; however, potassium-sparing diuretics (spironolactone, triamterene, amiloride) may cause severe hyperkalemia, especially if given with an ACE inhibitor or ARB; all patients treated with diuretics should have electrolyte levels monitored shortly after initiating therapy and periodically thereafter. […] The 2009 European Hypertension Society (EHS) guidelines for blood pressure management in children are in agreement with those of the NHLBI, however, they offer more specific guidance as to the clinical conditions for which specific antihypertensive drugs are recommended or contraindicated.

• #51 Pediatric Hypertension Treatment & Management: Approach Considerations, Nonpharmacologic Therapy, Pharmacologic Therapy

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

  In children with mild or moderate hypertension, nonpharmacologic therapy may suffice to lower blood pressure (BP) to within normal limits. This approach avoids the need for drugs that have adverse effects and that require a degree of compliance difficult to achieve in children. […] Indications for pharmacologic treatment include symptomatic hypertension, secondary hypertension, hypertensive target-organ damage, diabetes, and hypertension that persists despite nonpharmacologic measures. […] The Task Force recommends the use of ACE inhibitors or ARBs only for children with diabetes and microalbuminuria or proteinuric renal disease and recommends beta-blockers or calcium-channel blockers for children with hypertension and migraine headaches. […] In general, treatment of chronic hypertension requires expertise that is seldom available in the general pediatrician. Therefore, it is advisable to refer patients to physicians who specialize in treatment of children with high BP.

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

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

  Calcium channel blockers. These medications help relax the muscles of your child’s blood vessels and may slow his or her heart rate. […] Diuretics. Also known as water pills, these act on your child’s kidneys to help your child remove sodium and water, reducing blood pressure. […] Your child’s doctor will tell you how long your child will need to stay on the medication. If your child’s high blood pressure is caused by obesity, losing weight might make medication unnecessary. Treating other medical conditions your child has might also control his or her blood pressure. […] Although little is known about the long-term effects of blood pressure medication on a child’s growth and development, many of these medications are generally considered safe to take during childhood. […] 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.

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

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

  For children and adolescents, the blood pressure goal is less than the 90th percentile for age, height, and sex for patients younger than 13 years, or less than 130/80 mm Hg for those 13 years and older. […] All children with elevated blood pressure or hypertension should make therapeutic lifestyle changes to lower blood pressure and reduce the risk of developing additional CVD risk factors. […] Weight loss should be encouraged for children who are overweight or obese, and those who are obese should be referred for comprehensive, intensive, family-oriented behavioral intervention programs. […] Children with symptomatic hypertension (e.g., headaches, cognitive changes), stage 2 hypertension without a modifiable factor such as obesity, evidence of left ventricular hypertrophy on echocardiography, any stage of hypertension associated with chronic kidney disease or diabetes, or persistent hypertension despite a trial of lifestyle modifications require antihypertensive medications.

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

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

  For children and adolescents, the blood pressure goal is less than the 90th percentile for age, height, and sex for patients younger than 13 years, or less than 130/80 mm Hg for those 13 years and older. […] All children with elevated blood pressure or hypertension should make therapeutic lifestyle changes to lower blood pressure and reduce the risk of developing additional CVD risk factors. […] Weight loss should be encouraged for children who are overweight or obese, and those who are obese should be referred for comprehensive, intensive, family-oriented behavioral intervention programs. […] Children with symptomatic hypertension (e.g., headaches, cognitive changes), stage 2 hypertension without a modifiable factor such as obesity, evidence of left ventricular hypertrophy on echocardiography, any stage of hypertension associated with chronic kidney disease or diabetes, or persistent hypertension despite a trial of lifestyle modifications require antihypertensive medications.

• #55

  https://www.healthychildren.org/English/health-issues/conditions/heart/Pages/High-Blood-Pressure-in-Children.aspx

  If lifestyle changes do not work, or if the blood pressure is very high, a more aggressive approach is needed. The AAP guidelines recommend pediatricians start blood pressure-lowering medications if lifestyle changes fail to reduce your child’s blood pressure, or your child has another condition like diabetes or kidney disease. […] There are a variety of anti-hypertensive medications that have been tested and proven to be safe in the short- and long-term. The number of children who will end up with prescriptions for anti-hypertensive medications is small, about 1% or less. […] Once your pediatrician knows your child has high blood pressure, he or she will want to check it frequently to make sure the hypertension is not becoming more severe.

• #56 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 […] 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.

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

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

  Calcium channel blockers. These medications help relax the muscles of your child’s blood vessels and may slow his or her heart rate. […] Diuretics. Also known as water pills, these act on your child’s kidneys to help your child remove sodium and water, reducing blood pressure. […] Your child’s doctor will tell you how long your child will need to stay on the medication. If your child’s high blood pressure is caused by obesity, losing weight might make medication unnecessary. Treating other medical conditions your child has might also control his or her blood pressure. […] Although little is known about the long-term effects of blood pressure medication on a child’s growth and development, many of these medications are generally considered safe to take during childhood. […] 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.

• #58 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 […] 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.

• #59 Hypertension in Children | Causes, Symptoms & Treatment

  https://www.cincinnatichildrens.org/health/h/hypertension

  All children with blood pressure over 120 / 80 need monitoring, as they are at risk for developing hypertension (also known as elevated blood pressure). […] The guidelines published by the U.S. government in 2017 recommended an echocardiogram (heart test) on all children before starting hypertension medicine due to the risk for organ damage. […] If blood pressure is high, measuring it again is important. If the blood pressure remains high, we recommend the following changes: Achieving the proper weight through diet and exercise for patients who are overweight, cutting down on salt in the diet. […] When all else fails or if blood pressure is moderate to severe, then antihypertensive medication may be used. […] Finding it early allows us to find the appropriate ways to address it and lower the blood pressure.

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

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

  Calcium channel blockers. These medications help relax the muscles of your child’s blood vessels and may slow his or her heart rate. […] Diuretics. Also known as water pills, these act on your child’s kidneys to help your child remove sodium and water, reducing blood pressure. […] Your child’s doctor will tell you how long your child will need to stay on the medication. If your child’s high blood pressure is caused by obesity, losing weight might make medication unnecessary. Treating other medical conditions your child has might also control his or her blood pressure. […] Although little is known about the long-term effects of blood pressure medication on a child’s growth and development, many of these medications are generally considered safe to take during childhood. […] 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.

• #61 Drugs for Hypertension in Children – Pediatrics – Merck Manual Professional Edition

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

  ARBs and ACE inhibitors are equally effective as antihypertensives. […] CCBs should be used in menstruating girls if there is risk of pregnancy because ACE inhibitors and ARBs have significant effects on a fetus. […] Many antihypertensives can be obtained or prepared as oral suspensions for children who cannot take pills or capsules and when nonstandard doses are needed.

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

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

  Calcium channel blockers. These medications help relax the muscles of your child’s blood vessels and may slow his or her heart rate. […] Diuretics. Also known as water pills, these act on your child’s kidneys to help your child remove sodium and water, reducing blood pressure. […] Your child’s doctor will tell you how long your child will need to stay on the medication. If your child’s high blood pressure is caused by obesity, losing weight might make medication unnecessary. Treating other medical conditions your child has might also control his or her blood pressure. […] Although little is known about the long-term effects of blood pressure medication on a child’s growth and development, many of these medications are generally considered safe to take during childhood. […] 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.

• #63 Treatment of hypertension in children and adolescents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2756388/

  The treatment of hypertension in children and adolescents has been markedly changed in recent years by several factors, including the publication of new consensus recommendations, the obesity epidemic, and the increased availability of information on efficacy and safety of antihypertensive medications in the young. […] After the diagnosis of hypertension has been confirmed and the underlying etiology (if any) identified, an individualized treatment regimen should be initiated. Most authorities recommend that this include non-pharmacologic measures for all patients, with addition of antihypertensive medications in a selected group of children. […] Non-pharmacologic approaches to hypertension generally consist of dietary changes, increased physical activity and weight loss in the obese. […] Antihypertensive drug prescribing in children and adolescents should generally begin with the physicians choosing an agent appropriate to the underlying etiology of the patients hypertension.

• #64 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. […] Lifestyle changes, such as eating a heart-healthy diet low in salt (sodium) and exercising more, can help reduce high blood pressure in children. But for some children, medications may be necessary. […] 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. […] Children who have high blood pressure are likely to continue to have high blood pressure as adults unless they begin treatment.

• #65 Pediatric Hypertension Treatment & Management: Approach Considerations, Nonpharmacologic Therapy, Pharmacologic Therapy

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

  In children with mild or moderate hypertension, nonpharmacologic therapy may suffice to lower blood pressure (BP) to within normal limits. This approach avoids the need for drugs that have adverse effects and that require a degree of compliance difficult to achieve in children. […] Indications for pharmacologic treatment include symptomatic hypertension, secondary hypertension, hypertensive target-organ damage, diabetes, and hypertension that persists despite nonpharmacologic measures. […] The Task Force recommends the use of ACE inhibitors or ARBs only for children with diabetes and microalbuminuria or proteinuric renal disease and recommends beta-blockers or calcium-channel blockers for children with hypertension and migraine headaches. […] In general, treatment of chronic hypertension requires expertise that is seldom available in the general pediatrician. Therefore, it is advisable to refer patients to physicians who specialize in treatment of children with high BP.

• #66 Pediatric hypertension treatment and management strategies – Norton Healthcare Provider Louisville, Ky.

  https://nortonhealthcareprovider.com/news/pediatric-hypertension-treatment-and-management-strategies/

  Pediatric hypertension treatment and management strategies […] Proper management of pediatric hypertension can prevent long-term complications, with a potential to reverse the disease. […] Early diagnosis and management of hypertension in the pediatric population is necessary to prevent long-term complications, with a potential to reverse the disease. […] „Primary care providers should emphasize lifestyle modifications, such as a low-sodium diet and exercise, and recheck blood pressure in three months. If blood pressure is still hypertensive or prehypertensive, the next step should be referral,” said Malavika Prasad, M.D., pediatric nephrologist with Norton Children’s Nephrology, affiliated with the UofL School of Medicine. […] Managing pediatric hypertension involves lifestyle modifications and pharmacological interventions when necessary. […] Pharmacological treatment is warranted when Stage 1 hypertension has not been resolved with lifestyle modifications, if a patient has Stage 2 hypertension, and/or when symptomatic hypertension (i.e., headache, shortness of breath, chest pain, vertigo, vision change) is present. […] Identifying etiology is critical. […] Lifestyle changes: Dietary changes: The American Academy of Pediatrics (AAP) recommends following the Dietary Approaches to Stop Hypertension (DASH) diet, which promotes low sodium (recommended about 2 grams of sodium intake per day), increased fruits and vegetables and high fiber intake. […] Exercise: Regular physical activity must be implemented. […] Children may find it difficult to adhere to daily medication routines, particularly when asymptomatic. […] „There is no one single medication drug of choice as the starting line for treatment for hypertension, because children have been shown to respond very differently to each class of medication,” Dr. Prasad said. […] In Stage 1 hypertension, ACE inhibitors or calcium channel blockers may be initiated when lifestyle changes do not improve blood pressure upon follow-up or if symptoms are present. […] Pediatric hypertension, if left untreated, can lead to organ damage, including cardiovascular, renal and ocular issues. […] However, early detection, lifestyle modifications and timely interventions can help prevent long-term complications in pediatric patients. […] Collaborative care between the primary care providers, nephrologists and cardiologists is key to successful management and follow-up.

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

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

  Calcium channel blockers. These medications help relax the muscles of your child’s blood vessels and may slow his or her heart rate. […] Diuretics. Also known as water pills, these act on your child’s kidneys to help your child remove sodium and water, reducing blood pressure. […] Your child’s doctor will tell you how long your child will need to stay on the medication. If your child’s high blood pressure is caused by obesity, losing weight might make medication unnecessary. Treating other medical conditions your child has might also control his or her blood pressure. […] Although little is known about the long-term effects of blood pressure medication on a child’s growth and development, many of these medications are generally considered safe to take during childhood. […] 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.

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

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

  Limit screen time. To encourage your child to be more active, limit time in front of the television, computer or other devices. […] Get the family involved. It can be hard for your child to make healthy lifestyle changes if other family members don’t eat well or exercise. Set a good example. Your whole family will benefit from eating better. Create family fun by playing together ride bikes, play catch or take a walk.

• #69 Pediatric Hypertension Treatment at Columbia | ColumbiaDoctors

  https://www.columbiadoctors.org/specialties/cardiology-cardiac-surgery/our-services/hypertension-center/pediatric-hypertension-treatment-columbia

  High blood pressure is often shared by more than one member of a family. Columbias Hypertension Center is designed to provide care for the whole family. This might include genetic testing when we suspect an inherited condition, or diet and lifestyle changes that benefit all family members. […] Our pediatric specialists will work with your family to understand the cause of your childs high blood pressure and create a plan to treat it. Your childs treatment plan will depend on two things: The cause of your childs high blood pressure, The severity of your childs high blood pressure. […] Your childs treatment plan may include: Ambulatory blood pressure monitoring, Genetic testing, Medication, Lifestyle and diet changes. […] High blood pressure can run in families. We may recommend genetic testing. Genetic testing looks for genes specific to certain conditions that cause high blood pressure.

• #70 Hypertension | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/hypertension

  For children with pre-hypertension or stage 1 hypertension, changing to a more healthful diet and exercising more is often enough to manage the hypertension. For children with more severe hypertension, medication is often necessary. […] Medication may be necessary to treat hypertension. Whether your child is prescribed medication for hypertension depends on a few things: How high is her blood pressure? How long has it been present? Does it appear to be causing problems with her organs? Has it responded to diet and exercise modification? If so, how well? […] Not necessarily. If there’s an underlying cause for the hypertension and its treatment is successful, she may not have to stay on medication. If your child has primary hypertension, increased exercise and appropriate changes to her diet may allow her to be taken off of medication. […] Infants may be treated with doses of liquid medication or with medicines given through an IV if they are hospitalized. […] Most primary hypertension can be treated with changes in diet and exercise habits, and if necessary, there are medications that can help, too.

• #71 Hypertension: treatment | infoKID

  https://infokid.org.uk/conditions/hypertension/hypertension-treatment/

  It is important that your child continues taking the prescribed medicine. […] Contact your doctor straight away if your child is vomiting (being sick) and cannot take their medicine for more than 24 hours. […] Your child’s doctors will check the side-effects and if the medicine is working. They may need to change the medicine so that it is right for your child. […] Hypertension can be a serious condition if it is not well controlled. Hypertension increases the risk of other diseases, especially if it continues into adulthood. […] Your child’s blood pressure will need to be carefully controlled to reduce the risk of other diseases. If your child has an underlying condition, they will also need treatment for that. […] If you have any concerns or need additional support, speak with your doctor or nurse.

• #72 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. […] If a diagnosis of hypertension is made, a blood pressure specialist may decide to do the following: […] Start medications Depending on the results of the work up for high blood pressure, medication may be necessary. Studies have shown medications to be effective and safe to use in kids and adolescents to lower blood pressure. […] 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.

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