"The long-term health risks for hypertensive children and adolescents can be substantial. If left untreated, they pose a growing public health challenge," said Bonita Falkner, M.D., professor of Medicine and Pediatrics at Jefferson Medical College of Thomas Jefferson University in Philadelphia, who chaired the national committee to develop the guidelines. "We want to update clinicians on the latest scientific evidence."
The guidelines are the results of the National High Blood Pressure Education Program Working Group and update previous guidelines from 1996. The complete report is scheduled to be published in the July issue of Pediatrics.
In children and adolescents, the normal range of blood pressure is traditionally determined by body size and age. The guidelines offer blood pressure standards that are based on gender, age and height, which, Dr. Falkner says, provide a more precise classification according to body size and avoid misclassifying children who are very tall or very short.
The guidelines also encourage pediatricians to recommend diet, exercise and weight control counseling for children who fit into a new category known as prehypertension. "The definition of hypertension remains the same," Dr. Falkner says. "Prehypertension refers to an average systolic blood pressure or diastolic blood pressure that is greater than or equal to the 90th percentile, but less than the 95th percentile in children. By adolescence, a blood pressure reading of greater than 120/80 is considered to be prehypertension.
"We know that elevated blood pressure levels in children and adolescents can be associated with obesity and risk factors for diabetes and cholesterol disorders," she says. "These guidelines provide a kind of checklist to assist pediatricians in translating the blood pressure numbers and in helping to recognize these potential problems.
"Once hypertension is recognized, pediatricians can begin providing treatment. Currently, it is estimated that from one to three percent of children and adolescents may have hypertension."
Pediatricians often find that taking the blood pressure measurement of young children is challenging. It is important that the blood pressure cuff used in a child is the correct size in order to obtain an accurate measure, Dr. Falkner stresses. An elevated blood pressure should be confirmed on repeated visits before a physician characterizes a child as having hypertension.
Initially, the guidelines recommend therapeutic lifestyle changes such as dietary modifications, weight reduction, regular physical activity and restriction of sedentary activity to help prevent increases in blood pressure in children and adolescents over time. Dr. Falkner also recommends that physicians take a sleep history due to to association of sleep apnea with overweight and high blood pressure. If these measures don't prove to be effective, antihypertensive drug therapy may be appropriate to control the blood pressure.
The American Society of Hypertension (ASH) is the largest organization in the United States devoted exclusively to hypertension and related cardiovascular diseases. ASH is committed to alerting physicians, allied health professionals and the public about new medical options, facts, research finding and treatment choices designed to reduce the risk of cardiovascular disease.
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