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- Donald J. Weaver Jr, MD, PhD*
- *Division of Nephrology and Hypertension, Department of Pediatrics, Levine Children’s Hospital at Carolinas Medical Center, Charlotte, NC
AUTHOR DISCLOSURE
Dr Weaver has disclosed that he is a member of the speakers’ bureau for Alexion Pharmaceuticals. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
- ABPM:
- ambulatory blood pressure monitoring
- BMI:
- body mass index
- BP:
- blood pressure
- DASH:
- Dietary Approach to Stop Hypertension
Introduction
After the publication of my review on pediatric hypertension, the American Academy of Pediatrics' Subcommittee on Screening and Management of High Blood Pressure in Children issued new Clinical Practice Guidelines for Screening and Management of High Blood Pressure in Children and Adolescents. (1)(2) These guidelines represent an update to the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents that was published in 2004. (3) For the new guidelines, the subcommittee consisted of 17 members and was co-chaired by a pediatric nephrologist and a general pediatrician. To develop these recommendations, an extensive literature review addressing the diagnosis, management, and treatment of pediatric hypertension was conducted. Articles were then reviewed by 2 subcommittee members. Selected articles were then evaluated for quality of evidence based on an AAP grading matrix. From this, 30 key action statements were developed. In addition, 27 additional recommendations based on consensus expert opinion were also provided. Herein I highlight 7 significant changes in the initial screening and management of pediatric patients with hypertension that are important to primary care pediatricians.
New Definitions of Pediatric Hypertension
Recently, the American Heart Association and the American College of Cardiology updated the definition of adult hypertension based on large observational studies that established a graded association between increased blood pressure (BP) and risk of cardiovascular disease, end-stage renal disease, and mortality. (4) Specifically, a meta-analysis of 61 prospective studies determined that the risk of cardiovascular disease increased beginning at systolic BP levels greater than 115 mm Hg and diastolic BP levels greater than 75 mm Hg. The risk of death from ischemic heart disease …
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