AAP Hypertension Guidelines 2017 Update
After more than 10 years since the 4th Report, an updated comprehensive blood pressure guideline for pediatric specialists has recently been published by the American Academy of Pediatrics. The Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents, the unofficial 5th Report, provides 30 graded Key Action Statements that include the level of evidence and strength of the recommendation. With a focus on improving the recognition and diagnosis of hypertension in children, there are several features of the AAP clinical practice guideline that deserve highlighting. The AAP subcommittee developed a simplified table for screening blood pressure values based on the 90th percentile blood pressure at the 5th height percentile for each gender and age. The simple table may be used by the health care provider doing the initial blood pressure measurement to determine if the treating physician needs to review and/or repeat the measurement. In addition, the classification of hypertension in adolescents (≥ 13 years of age) has been simplified to threshold values that are consistent with the upcoming ACC/ AHA adult blood pressure guidelines. In children (<13 years), where blood pressure percentiles continue to define hypertension, the normative data has been improved with removal of data from children who were overweight or obese to be more representative of a healthy population. Investigation of confirmed hypertension has been clarified and simplified given the high rates of primary hypertension in the US population. This comprehensive guideline was developed by the AAP in partnership with several associations including the Canadian Association of Paediatric Nephrologists. The guidelines are available through Open Access following the link below:
Hypertension Canada has a long history of developing and disseminating evidence-based guidelines for primary care practitioners on blood pressure management and is likely part of the reason Canadian adults have one of the best rates of treated hypertension worldwide. Responding to requests for guidance on management of childhood blood pressure, Hypertension Canada formed a pediatric subgroup of content experts to systematically review the literature and develop guidelines for children and adolescents. The recently published guidelines provide graded recommendations for measurement and diagnosis of hypertension, as well as appropriate investigation and treatment of confirmed hypertension. There is a strong emphasis on health behavior management including achieving a healthy body weight along with dietary management and increased physical activity. Indications for pharmacologic therapy are provided as well as initial therapy options for children 12 years of age or older with primary hypertension. Embedded within all guidance descriptions are indications for referral to pediatric hypertension experts so that children with secondary forms of hypertension are identified and managed appropriately by specialists and/or any child where primary care practitioners are not comfortable with pediatric management. The guideline should empower primary care physicians to appropriately identify blood pressure abnormalities in children and investigate and manage or refer those with concerns of hypertension. Several members of CAPN were members of the Hypertension Canada pediatric subcommittee who developed these guidelines and all recommendations were vetted through the strict Hypertension Canada guideline process. The guidelines are available free as Open Access by following the link below:
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