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Please respond to discussion below using APA 7th edition, 3 references dated less than 4 years, and 1 interactive question.
Hypertension in Children and Adolescents
Hypertension is a common diagnosis in adults but relatively uncommon in people under 18. Confirmed hypertension is diagnosed only in about 2-4% of the pediatric population (Bell et al., 2018; Song et al., 2019). However, elevated blood pressure is 16.3% (Bell et al., 2018). Hypertension can be categorized as either primary or secondary. Primary hypertension has no identifiable cause (Maaks et al., 2019). Secondary hypertension can be attributed to an underlying issue in another system, such as the kidneys (Maaks et al., 2019). Normal blood pressure is defined as systolic blood pressure (SBP) and diastolic blood pressure (DBP), both under the 90th percentile according to the patients age, sex, and height (Mattoo, 2022a). Elevated blood pressure is defined at SBP and/or DBP as being greater than or equal to the 90th percentile but still below the 95th percentile (Mattoo, 2022a). Stage I hypertension is when either or both SBP and DBP are above the 95th percentile with 12mmHg added or above 130/80mmHg (Mattoo, 2022a). Lastly, stage II hypertension is either or both SBP and DBP above the 95th percentile plus 12mmHg, or above 140/90mmHg (Mattoo, 2022a). Children above the age of 13 will follow adult hypertension guidelines. To diagnose a child with elevated blood pressure or hypertension, there needs to be documentation of elevation on three separate visits (Mattoo, 2022b).
Physical exam findings will be present if the patient is experiencing a hypertensive emergency or if there is end organ damage. Some signs and symptoms of a hypertensive emergency include headache, vomiting, visual changes, seizures, chest pain, palpitations, cough, and shortness of breath (Flynn et al., 2017). Some examples of physical exam findings when a patient has end organ damage would be retinal vascular changes, cardiac heave, and laterally displaced PMI (Mattoo, 2022b). When evaluating a child with hypertension, the provider should consider the underlying causes of the elevation in blood pressure. Some examples include coarctation of the aorta, hyperthyroidism, renal failure, pheochromocytoma, medications, and obstructive sleep apnea (Goknar & Caliskan, 2020).
Management of hypertension in pediatrics differs based on the level of elevated blood pressure. Possible labs the provider could order for a patient with hypertension include kidney function tests, urinalysis, lipid profile, Ha1c, and serum alanine transaminase (Khuory et al., 2018; Mattoo, 2022c). For children with elevated blood pressure, lifestyle changes are indicated with a follow-up on blood pressure in six months (Flynn et al., 2017). After six months, if the blood pressure remains elevated, it is recommended to re-check the blood pressure on both upper extremities and one lower extremity and re-check in six months. After a year, the provider could order ambulatory blood pressure monitoring and refer the patient to either nephrology or cardiology (Flynn et al., 2017). Stage I hypertension has a closer follow-up, with the next appointment being scheduled one to two weeks away from the initial appointment (Flynn et al., 2017). If still elevated, the provider should schedule the next visit for three months in the future (Flynn et al., 2017). Lastly, the provider will refer the patient if they are still hypertensive after the three-month visit (Flynn et al., 2017). When managing a child with stage II hypertension, the management will differ on whether they are symptomatic. If the child is symptomatic, the provider should send an immediate stat referral directly to the emergency department for evaluation (Flynn et al., 2017). However, if the patient is not symptomatic, the provider will re-check the blood pressure in one week and send a referral for further evaluation (Flynn et al., 2017). If a medication is indicated, the provider should start with ACE inhibitors.
References
Bell, C.S., Samuel, J.P., & Samuels, J.A. (2018). Prevalence of hypertension in children. American Heart Association, 73. https://doi.org/10.1161/HYPERTENSIONAHA.118.11673
Flynn, J.T., Kaelber, D.C., Baker-SMith, C.M., Blowey, D., Carroll, A.E., Daniels, S.R., Ferranti, S., Dionne, J.M., Falkner, B., Finn, S.K., Gidding, S.G., Goodwin, C., Leu, M.G., Powers, M.E., Rea, C., Smauels, J., Simasek, M., Thaker, V.V., Urbina, E.M. (2017). Clinical practice guidelines for screening and management of high blood pressure in children and adolescents. American Academy of Pediatrics, 140(3).
Goknar, N., & Caliskan, S. (2020). New guidelines for the diagnosis, evaluation, and treatment of pediatric hypertension. Turkish Pediatric Archives, 55(1), 11-12. https://doi.org/10.14744/turkpediatriars.2020.92679
Khoury, M., Khuory, P.R., Dolan, L.M., Kimball, T.R., & Urbina, E.M. (2018). Clinical implications of the revision of the AAP pediatric hypertension guidelines. Pediatrics, 142(2). https://doi.org/10.1542/peds.2018-0245
Maaks, D.L.G., Starr, N.B., Brady, M.A., Gaylord, N.M. Driessnack, M., & Duderstadt, K.G. (2020). Burns’ pediatric primary care (7th ed.). Elsevier.
Mattoo, T.K. (2022a). Definition and diagnosis of hypertension in children and adolescents. UptoDate. https://www.uptodate.com/contents/definition-and-diagnosis-of-hypertension-in-children-and-adolescents/print?search=hypertension
Mattoo, T.K. (2022b). Evaluation of hypertension in children and adolescents. UptoDate.https://www.uptodate.com/contents/evaluation-of-hypertension-in-children-and-adolescents/print?search=hypertension
Mattoo, T.K. (2022c). Non-emergent treatment of hypertension in children and adolescents. UptoDate. https://www.uptodate.com/contents/nonemergent-treatment-of-hypertension-in-children-and-adolescents/print?search=hypertension
Song, P., Zhang, Y., & Yu, J. (2019). Global prevalence of hypertension in children: A systematic review and meta-analysis. JAMA Pediatrics, 173(12). https://doi.org/10.1001/jamapediatrics.2019.3310
