Hypertension in children

• Most childhood and adolescent hypertension in the US is due to primary hypertension.

• Diagnosis and treatment of hypertension in children is important for reducing the risk of:

  • Hypertension and cardiovascular disease in adulthood

  • End organ damage (e.g., left ventricular hypertrophy, CKD)

• Initiate lifestyle changes for managing hypertension.

• Manage the underlying cause of secondary hypertension and treat associated comorbidities (if present).

• Aim for target blood pressure of < 90th percentile or < 130/80 mm Hg for children ≥ 13 years of age.

• Assess for indications for pharmacotherapy and start if present.

• HTN not improving with lifestyle changes

• Symptomatic HTN (e.g., headaches, altered mental status) [49]

• HTN in children with CKD or diabetes

• LVH on echocardiography

• ACE inhibitors (e.g., benazepril, captopril)

• ARBs (e.g., candesartan, losartan)

• Thiazide diuretics (e.g., chlorothiazide, hydrochlorothiazide)

• Long-acting calcium channel blocker (e.g., amlodipine)

ACE inhibitors or ARBs are generally preferred for hypertensive children with diabetes, CKD, and/or proteinuria.

Bbeta blockers are not recommended for the initial treatment of hypertension in children because of their potential adverse effects (metabolic effects such as impaired glucose tolerance and potential exacerbation of asthma) and lack of improved efficacy compared to other medications.

• Lifestyle changes for managing hypertension will also help prevent hypertension.

• Weight management, a healthy diet, and increasing activity levels should be routinely discussed as part of preventive care.