Diagnosis and treatment of hypertension in children and adolescents.

OBJECTIVE

To review the current recommendations regarding the diagnosis and treatment of hypertension in children to provide education to practitioners.

DATA SOURCES AND STUDY SELECTION

Review of recent recommendations of the Task Force on Blood Pressure Control in Children and the current literature, specifically regarding ambulatory blood pressure monitoring in children. In general, search criteria were restricted to studies with a primary focus of blood pressure for subjects 18 years of age or less, focusing on important studies of the past 20 years.

DATA SYNTHESIS

Optimal determination of blood pressure in children requires use of appropriate technique, particularly the use of an appropriately sized cuff, and then comparison with normal values based on age, sex and height. Ambulatory blood pressure monitoring is a research tool that, in selected high risk patients, may facilitate detection of occult hypertension. Careful clinical assessment is the key tool for identifying secondary causes or a predisposition to primary hypertension, with laboratory testing reserved if a specific underlying cause is suspected. Management is directed at secondary causes, and general cardiovascular risk reduction is aimed at dietary modification, increased exercise and attainment or maintenance of ideal body weight. Institution of drug therapy depends on the degree of hypertension and the risk of future end-organ damage or cardiovascular disease.

CONCLUSIONS

Hypertension is an under-recognized clinical entity in children. Studies are needed to define the mechanisms and magnitude of cardiovascular risk, the role of ambulatory blood pressure monitoring, and the efficacy and safety of drug therapy.