Hypertension 2020

Question 1

Simplified diagnosis of hypertension in children

Answer 1

Simplified: 120/80 for children 6-11 and 130/85 for children 12-17

Question 2

Stage 1 vs Stage 2 hypertension

Answer 2

Stage 1: 95th to 95th plus 12 (repeat BP on 2 more occasions within 1 month to confirm)
Stage 2: >95th plus 12 (prompt referral for evaluation and pregnancy)

Question 3

What routine testing lab is done for all children with hypertension

Answer 3

Blood chemistry (Na, K, Cl, CO2, Cr)
Urinalysis
Renal ultrasound

Question 4

How is cardiovascular risk assessed in all children with hypertension

Answer 4

Diabetes screening

Cholesterol, HDL, LDL, non-HDL, triglycerides

Question 5

How is target organ damage assessed in all children with hypertension

Answer 5

Echocardiogram (measure LV mass index, LV function, evaluation of aortic arch)
Retinal examination
Albumin to creatinine ratio

Question 6

When is pharmacological management for hypertension initiated in children?

Answer 6

Symptomatic hypertension
Target organ damage
Stage 2 hypertension
BP >90th percentile associated with diabetes, CKD, or heart failure
Stage 1 hypertension for >6 months despite a trial of non pharm therapy

Question 7

Initial monotherapy for hypertension in children

Answer 7

ACEI, ARB, or long acting dihydropyridine (amlodipine, extended release nifedipine)
ACEI and ARBs are not first line for black patients
Beta blockers are alternate options but not ideal

Question 8

Treatment goals for hypertension

Answer 8

Office BP <95th%
ABPM: <95th%
Patients with risk factors or target organ damage: <90th%