Pediatric HTN

Question 1

HTN goal

Answer 1

DBP to <90th percentile and <130/80 mm Hg in adolescents ≥ 13 years old

Question 2

Dietary eduation

Answer 2

• Reduce sodium
• DASH: high in fruits, vegetables >3 servings, low-fat milk products >2 servings, whole grains, fish, poultry, nuts, and lean red meats; limited intake of sugar and sweets

Question 3

Physical activity recommendation

Answer 3

40 minutes of moderate to vigorous, aerobic physical activity < 3-5 days per week (30-60 min duration) improved SB

Question 4

Stress reduction

Answer 4

Identify source of stress & offer advice

Question 5

Pharmacological treatment

Answer 5

or any stage of HTN associated with CKD or diabetes mellitus therapy should be initiated with a single medication at the low end of the dosing range (s

Question 6

ACE inhibitors - common and severe HTN med SE

Answer 6

Common: cough, HA, dizziness, weakness

Severe SE: hyperkalemia, AKI, angioedema, fetal toxicity

Contraindications: pregnancy, angioedema

• *may need higher doses for AA
• **recommended for DM pts

Question 7

ACE inhibitor medications

Answer 7

BENAZEPRIL – ≥6 yo
initial dose: 0.2 mg/kg per d (up to 10 mg per d)
max dose: 0.6 mg/kg per d (up to 40 mg per d)
dosing interval: daily
Formulation: Tablet: 5, 10, 20, 40 mg (generic)

CAPTOPRIL

Infants – initial dose: 0.05 mg/kg per dose
max dose: 6 mg/kg per d
dosing interval: Daily to 4 times a day
Formulation: Tablet: 12.5, 25, 50, 100 mg (generic)

Children – initial dose: 0.5 mg/kg per dose
max dose: 6 mg/kg per d
dosing interval: Three times a day

ENALAPRIL – ≥1 mo
initial dose: 0.08 mg/kg per d (up to 5 mg per d)
max dose: 0.6 mg/kg per d (up to 40 mg per d)
dosing interval: Daily to twice a day
Formulation: Tablet: 2.5, 5, 10, 20 mg (generic)

FOSINOPRIL – ≥6 y
initial dose: 0.1 mg/kg per d (up to 5 mg per d)
max dose: 40 mg per d
dosing interval: Daily
Formulation: Tablet: 10, 20, 40 mg (generic)
≥50 kg initial dose 5 mg per d, max dose 40 mg per d

LISINOPRIL – ≥6 ya
initial dose: 0.07 mg/kg per d (up to 5 mg per d)
max dose: 0.6 mg/kg per d (up to 40 mg per d)
dosing interval: Daily
Formulation: Tablet: 2.5, 5, 10, 20, 30, 40 mg (generic)

Question 8

ARBs common and severe SE

Answer 8

Common: HA, dizziness

Severe SE: hyperkalemia, AKI, fetal toxicity

Contraindications: pregnancy

**recommended for DM pts

Question 9

Angiotensin II Receptor Blocker medications

Answer 9

CANDESARTAN --	1–5 yo
initial dose: 0.2 mg/kg per d (up to 4 mg per d)
max dose: 0.4 mg/kg per d (up to 16 mg per d)
dosing interval: Daily to twice a day
formulation: Tablet: 4, 8, 16, 32 mg
≥6 yo
<50 kg	4 mg per d	16 mg per d
≥50 kg	8 mg per d	32 mg per d	

IRBESARTAN --	6–12 yo
initial dose: 75 mg per d
max dose: 150 mg per d
dosing interval: Daily
formulation: Tablet: 75, 150, 300 mg (generic)
≥13	150 mg per d	300 mg per d

LOSARTAN --	≥6 yo
initial dose: 0.7 mg/kg (up to 50 mg)
max dose: 1.4 mg/kg (up to 100 mg)
dosing interval: Daily
formulation: Tablet: 25, 50,  100 (generic)

OLMESARTAN --	≥6 yo
dosing interval: Daily
Tablet: 5, 20, 40 mg
<35 kg	10 mg	20 mg
≥35 kg	20 mg	40 mg	

VALSARTAN --	≥6 yo
initial dose: 1.3 mg/kg (up to 40 mg)
max dose: 2.7 mg/kg (up to 160 mg)
dosing interval: Daily
formulation: Tablet: 40, 80, 160, 320 mg (generic)

Question 10

CCB common and severe SE:

Answer 10

Common: flushing, peripheral edema, dizziness

Severe SE: angioedema

Contraindications: hypersensitivity to CCB

Question 11

CCB medications

Answer 11

AMLODIPINE --	1–5 y
initial dose: 0.1 mg/kg
max dose: 0.6 mg/kg (up to 5 mg per d)
dosing interval: Daily
formulations: Tablet: 2.5, 5,10 mg
≥6 ya	2.5 mg	10 mg	

FELODIPINE --	≥6 y
initial dose: 2.5 mg
max dose: 10 mg
dosing interval: Daily
formulation: Tablet (ER): 2.5,5,10 mg (generic)

ISRADIPINE -- child
initial dose: 0.05–0.1 mg/kg
max dose: 0.6 mg/kg (up to 10 mg per d)
dosing interval: Capsule: BID to TID; ER: daily
formulation: Capsule: 2.5, 5 mg
Extended-release tablet: 5, 10 mg

NIFEDIPINE ER -- child
initial dose: 0.2–0.5 mg/kg per d
max dose: 3 mg/kg/d (up to 120 mg per d)
dosing interval: Daily to twice a day
formulation: Tablet (ER): 30, 60, 90 mg (generic)

Question 12

When to follow up post intevention

Answer 12

Lifestyle changes: 3-6 mo

Pharmacological changes: frequent (every 4–6 weeks) for dose adjustments and/or addition of a second or third agent until goal BP has been achieved.

Once BP achieved, visits every 3 to 4 months.

Question 13

HTN comorbidities

Answer 13

DM, OSA, cognitive impairment