Exam 2 - HTN, HLD + Obesity Flashcards
What patients should have BP checked at every PC visit?
Obesity, renal disease, diabetes, heart disease, or meds known to elevate BP.
Conditions where children younger than 3 years should have BP checked: slide 7
Drugs in kids associated with elevated BP: slide 7
Difference between screening and diagnostic BPs for kids
Screening uses initial oscillatory technique based on age.
If over limits in screening chart (90%), then compare against age AND gender AND height chart.
age 1-13 stages of HTN slide 12!
Age over 13 - stages of HTN slide 13
Elevated BP - now what?
If initial BP is >90%, then perform 2 additional BP measurements on SAME visit and average them. If still >90%, then take 2 manual BPs and average them to define BP category. If BP is normal after repeat readings, then no additional action is needed.
Repeat BP check in _____ for elevated BP after implementing ______
6 months
Lifestyle interventions.
stage 1 HTN recheck in _____ after implementing _____. Recheck in _____ and refer to _______. If still in stage 1 after 3 visits, implement _________ and ______
1-2 weeks
Lifestyle interventions
3 months
Nutrition/ weight management
ABPM and diagnostic evaluation, treatment and consider specialty referral.
Stage 2 HTN flow of care?
Asymptomatic - upper and lower extremity check
Lifestyle counseling and recheck in 1 week. May refer to sub specialty care within 1 week.
Still elevated in stage 2 at 1 week? ABPM, diagnostic eval, treatment initiation.
Symptomatic? ER.
diagnostic eval for pediatric HTN
UA, chemistry, lipids, renal ultrasonography in those <6 years old or those with abnormal UA or renal fxn
obese (>95%): Hgb A1C, AST, ALT, fasting lipids
Fasting glucose, TSH, drug screening sleep study and CBC.
What would you see if you were concerned about Coarct of aorta as cause for HTN?
Right arm BP 20mmHG greater than lower extremity.
Secondary causes of HTN in kids
Renal and renovascular - stenosis, usually under age 6
Cardiac - Coarct of aorta, long-segment narrowing of abd aorta
Endocrine
Environmental exposures (lead, cadmium, mercury, phthalates - soaps, shampoos, tubing, plastics)
Neurofibromatosis
Medication related (OCP, CNS stimulants for ADD, NSAIDS, decongestants)
_______ renal ultrasound is the one to order to rule out renal cause of secondary HTN
DOPPLER
Goal for Tx in pediatric HTN
SBP and DBP to <90th percentile or <130/80 in teens.
Lifestyle interventions for pediatric HTN
DASH diet
Physical activity - moderate to vigorous activity at least 3-5 days/week 30-60minutes per session
Wt loss
Stress reduction.
Start pharmacological tx for peds HTN if:
Remain HTN after lifestyle modification
Symptomatic HTN
Stage 2 without clearly modifiable factor
Any stage associated with CKD or DM.
See patients on pharm tx for HTN every ____ until BP controlled.
4-6weeks.
Start _____ in female patients at risk for pregnancy
CCB - not ACE/ARB
What are some risk factors for developing pediatric HLD?
BMI >95%
HTN
HLD <40
Hx Kawasaki dz, autoimmune dz or inflammatory d/o
DM
Renal disease
Smoking
Familial hypercholesterolemia.
UNIVERSAL Screening recommendations for HLD (non-fasting, non-HDL)
Once at 9-11
Once at 17-21
Selective TARGETED screening for HLD (family hx, unknown family hx or personal risk factors)
Early fasting lipid screening.
Screening levels are the same for all children 2-18 yo - exce[t
Triglycerides - 0-9 have one level and 10-19.
Pharmacological treatement for HLD is only for age _______
8 and older.
1st line for HLD tx
Statins (rosuvastatin and pravastatin are approved for 8yo and older.
Statins are contraindicated in ______
Pregnancy.
Goal of lipid tx
LDL-C <130 but ideally under 110 OR a 50% reduction
Hypertriglyceridemia puts patient at risk for:
Pancreatitis.
Vibrates and omega 3 fatty acids can help with hypertriglyceridemai.
Obesity in children ____
Over weight = 85-95%
Obese = >95%
Review Peds specific CPG (AAP) and KAS PDFs
