Pediatric Hypertension

Question 1

At what age should you start measuring BP in kids?

Answer 1

Children at 3 year old and older OR less than 3 yo if they have one of the following : prematurity, CHD, UTI, Renal Disease, Family h/o congenital renal disease, Illness or Medication associated with HTN, Elevated ICP

Question 2

How should pediatric BP be measured?

Answer 2

Avoid stimulant
Seated for 5 minutes with back supported feet on floor, R arm preferred, Appropriate cuff size with bladder width 40% of arm length from shoulder to elbow and bladder length should cover 80-100% of arm cricumference

Question 3

What is the definition of HTN in pediatrics?

Answer 3

Average systolic BP and or Diastolic BP > or = to 95thile for Age Gender and HEIGHT on at least 3 occasions.
Great app for figuring this out is Pedia BP

Question 4

What is definition of pre HTN in pediatrics

Answer 4

3 BP > 90thile < 95%ile

OR adolescent with BP > 120/80 (just like adults)

Question 5

When is ambulatory BP monitoring indicated in children?

Answer 5

To confirm diagnosis of HTN

Evaluate presence of masked HTN

Question 6

What are the definitions of Stage 1 and Stage 2 HTN in children

Answer 6

Stage 1 = >95%ile < 99%ile + 5 mm Hg on 3 occasions

Stage 2 = > 99thile + 5mmg Hg on 3 occasions

Question 7

How should you manage pre HTN initially in children?

Answer 7

Recommend weight managemnt if appropriate
Repeat BP in 6 months
No pharmacolgic therapy unless CKD, eart failure or LVH

Question 8

If pre HTN persists at 6 month recheck in children what should you do next?

Answer 8

Labs: lipid, CMP, CBC, UA
ECHOcardiogram
Nutrition Consult
If negative w/u f/u in 6 months

Question 9

How should you maage pediatric patient with Stage 1 HTN

Answer 9

All get:
Labs: CBC, CMP, lipids, UA
Renal ultrasound
ECHOcardiogram
Weight loss if appropriate
If no LVH monitor in 3-6 months and anti HTN medication if no improvement. 
If LVH start antiHTN medication
May participate in sports unless has LVH

Question 10

What are the medication options for children with HTN?

Answer 10

ACE/ARB - consider in patient who needs renal protection, very careful in girls of reproductive age, better first choice for males
BB - consider in patients with migraine avoid in asthma or heart failure
CCB - avoid in children < 1, otherwise first choice for girls
Diuretic - typically second line because requires electrolyte monitoring

Question 11

How should you manage stage 2 HTN in children?

Answer 11

Same as work up for stage 1 but add:
Labs: renin and aldosterone and lipid and A1C if BMI > 85%
Diet Consult re sodium intake
Restrict sports participation until HTN controlled
Begin meds immediately and refer to pediatric HTN expert (peds cardiology in Asheville)
Sleep study referral if history of snoring

Question 12

When should sports participation be limited related to HTN in children?

Answer 12

Pre HTN and Stage 1 HTN no restriction unless patient with stage 1 has LVH on echo then should limit until BP controlled
Stage 2 HTNrestricted until BP controlled.