AAP issues new pediatric hypertension clinical practice guideline
David C.Kaelber, M.D., Ph.D., M.P.H., M.S., FAAP and Joseph T.Flynn, M.D., M.S., FAAP
New blood pressure tables and streamlined recommendations are among the changes in
new pediatric hypertension guidelines that can help pediatricians identify and address
this generally asymptomatic and often-unrecognized chronic disease.
The evidence-based clinical practice guideline (CPG) focuses on the diagnosis, evaluation
and initial management of abnormal blood pressures in the ambulatory setting. Clinical PracticeGuideline for Screening and Management of High Blood Pressure in Children and Adolescents, from the AAP CPG Subcommittee on Screening and Management of High Blood Pressure
in Children, is available at http://pediatrics.aappublications.org/content/early/2017/08/21/peds.2017-1904 and is published in the September issue of Pediatrics. The guideline updates the 2004 The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure
in Children and Adolescents from the National Heart, Lung, and Blood Institute (NHLBI).
Pediatric hypertension, occurring in 2%–5% of all pediatric patients, is one of the
top five chronic diseases in children and adolescents. The diagnosis is missed in
up to 75% of pediatric patients in primary care settings, and appropriate medication
initiation occurs much less frequently than is indicated, according to current guidelines.
Beginning in 2014, the multidisciplinary subcommittee, which included a parent representative,
reviewed approximately 15,000 articles published since the prior guideline was issued.
Highlights of the new pediatric hypertension guideline include:
development based on a strict evidence-based approach as recommended by the National
Academy of Medicine and the NHLBI;
replacement of the term “prehypertension” with “elevated blood pressure”;
new normative blood pressure tables based on children with normal weight;
simplified screening table for identifying blood pressures needing further evaluation;
simplified blood pressure classification in adolescents 13 years of age and older
that aligns with forthcoming American Heart Association/American College of Cardiology
adult blood pressure guidelines;
a more limited recommendation to perform screening blood pressure measurement only
at preventive care visits;
streamlined recommendations on initial evaluation and management of abnormal blood
expanded role for ambulatory blood pressure monitoring in both diagnosis and ongoing
management of pediatric hypertension;
more limited recommendation on when to perform an echocardiogram in the evaluation
of newly diagnosed hypertensive pediatric patients (generally only before medication
revised definition of left ventricular hypertrophy;
revised treatment goals based on published evidence; and
30 evidence-based key action statements and an additional 27 clinical recommendations
based on expert opinion.
Dr. Flynn and Dr. Kaelber are among the co-authors of the clinical practice guideline
and served as co-chairs of the subcommittee.