2: Ped HTN Management

Question 1

What is management for normal BP <90th percentile?

Answer 1

• Primary prevention
• Screen for comorbidities
• Recheck in one year (or sooner)
• Encourage:
  
  • Healthy diet
  • Regular exercise
  • Sufficient sleep

Question 2

What is management for pre-HTN BP 90th-95th percentile (or 120/80)?

Answer 2

• Recheck in 6 months
• Weight-management counseling if overweight
• Introduce physical activity and diet management
• No pharmacotherapy unless compelling indications such as CKD, diabetes mellitus, heart failure, or LVH exist

Question 3

What is management for Stage 1 HTN BP 95th-99th percentile?

Answer 3

• Recheck in 1-2 weeks, sooner if symptomatic
• Evaluate
• Refer within one month
• Weight-management counseling if overweight
• Introduce physical activity and diet management
• Pharmacotherapeutics if:
  
  • Symptomatic HTN
  • Secondary HTN
  • Hypertensive organ damage
  • DM T1 or T2
  • Persistent HTN despite lifestyle measures

Question 4

What is management for Stage 2 HTN BP >99th percentile?

Answer 4

• Evaluate
• Refer within one week or immediately if symptomatic
• Weight-management counseling if overweight
• Introduce physical activity and diet management
• Initiate pharmacotherapeutics

Question 5

What are the components of HTN evaluation?

Answer 5

• Comprehensive H and P
• UA and culture
• BUN, creatinine, electrolytes
• CBC
• Glucose
• Lipid panel
• Renal US
• Echocardiogram
• Illicit Drug screen
• Polysomnogram
• Ambulatory (home) BP monitoring
• Plasma renin
• Renovascular imaging
• Plasma and urine catecholamine levels
• Plasma and urine steroid levels

Question 6

What are lifestyle recommendations for HTN?

Answer 6

• Weight reduction OR maintenance
• Decrease screen time to less than or = to 2 hrs
• Increase physical activity – something child enjoys
• Healthy diet, encourage breakfast, DASH diet (low sodium)

Question 7

Name the classes of meds used for HTN.

Answer 7

• ACE Inhibitors
• Beta Blockers
• ARBs
• CCBs
• Alpha and Beta Blockers
• Central Alpha Agonist
• Diuretics
• Peripheral Alpha Antagonists
• Vasodilators

Question 8

Which med is a last resort?

Answer 8

Vasodilator Minoxidil