Peer Responses:
- Length: A minimum of 180 words per post, not including references
- Citations: At least two high-level scholarly reference in APA per post from within the last 5 years
- For peer posts and subsequent posts under the initial discussion board thread add in second and third line treatments and additional considerations (250 word maximum for responses). Example requirement, only evidence-based sources, such as AAFP, CDC, IDSA, ADA, JNC 8 etc. (textbook resources and internet sites affiliated with medical associations are considered credible sources to obtain the information on the most up to date guidelines). Add in the link to the guideline(s) within the discussion board for further reading by your peers.
Pediatric hypertension is defined as three elevated systolic or diastolic blood pressure readings for the pediatric patient’s age, height and sex (Thomas, Stonebrooke, & Kallash, 2022). These three blood pressure readings must be done on three separate doctor visits. The American Academy of Pediatrics has defined hypertension as SBP or DBP greater than or equal to 90th percentile and less than the 95thpercentile based on age, sex, and height tables. When measuring blood pressure in a pediatric patient it is important to be using the correct cuff size in order to get an accurate reading. Essential hypertension is the most common type of hypertension in children and the number of pediatric patients diagnosed has increased due to the obesity epidemic (Thomas, Stonebrooke, & Kallash, 2022). Secondary HTN has multiple possible etiologies and around 50-60% of cases are related to renal disease or renal artery stenosis with cardiac diseases being the next most common etiology (Thomas, Stonebrooke, & Kallash, 2022). For pediatric patients around 3.4% are diagnosed as prehypertensive and 3.6% are diagnosed with hypertension (Mosees, 2024). The pathophysiology of hypertension in pediatrics can include various different factors. One of the reasons includes retention of sodium which results in increased extracellular volume causing an increase in blood pressure (Rodriguez-Cruz, 2023). In a child who is obese, hyperinsulinemia may elevate BP by increasing sodium reabsorption (Rodriguez-Cruz, 2023). Clincial manifestations aren’t always present but in severe cases, like a hypertensive crisis, headache and seizures can be present. Lab work that can be done for a pediatric patient when it comes to hypertension includes a cbc, cmp, UA, endocrine tests, and a lipid profile (Moses, 2024). Additionally, an EKG and echocardiogram can be done. If a child under six years old is diagnosed with hypertension it is recommended to do a renal ultrasound (Moses, 2024). Non-pharmacologic lifestyle changes must include the family and the child so that progress can be made with the help of support from family. It is recommended that pediatric patients with hypertension eat five fruits and vegetables per day, one hour or more of physical activity and avoid sugary drinks (Moses, 2024). The American Academy of Pediatrics created clinical practice guidelines for screening and management of high blood pressure in children and adolescents, last updated in 2017. According the academy after lifestyle change recommendations the blood pressure measurement should be repeated in 6 months (Flynn, Kaelber, Baker-Smith, et. Al, 2017). Pediatric patients who remain hypertensive despite lifestyle modifications should be started on pharmacologic treatment to control their BP. Pediatric patients are able to take ACE inhibitors, ARBS, thiazide diuretics, and calcium channel blockers (Flynn, Kaelber, Baker-Smith, et. Al, 2017). For the most part the dose is calculated mg/kg but the American Academy of Pediatrics has detailed guidelines of medication prescription by age and medications. Blood pressure medications for pediatric patients can be increased every 2 to 4 weeks until BP is controlled, maximal dose is reached, or adverse effects occur (Flynn, Kaelber, Baker-Smith, et. Al, 2017). The patient should follow-up with their provider every 4 to 6 weeks to monitor blood pressure and treatment.
I have added a link for the guidelines set by the American Academy of Pediatrics for hypertension in pediatric patients: https://publications.aap.org/pediatrics/article/140/3/e20171904/38358/Clinical-Practice-Guideline-for-Screening-and?autologincheck=redirected
Resources
Moses, S. (2024, March). Hypertension in children. Family Practice Notebook.
https://fpnotebook.com/CV/Peds/HyprtnsnInChldrn.htm
Flynn, J. T., Kaelber, D. C., Baker-Smith, C. M., Carroll, A. E., Dionne, J. M., Gidding, S. S.,
Leu, M. G., Powers, M. E., & Samuels, J. (2017, September 1). Clinical practice guideline
for screening and management of high blood pressure in children and adolescents.
American Academy of Pediatrics.
https://publications.aap.org/pediatrics/article/140/3/e20171904/38358/Clinical-Practice-
Guideline-for-Screening-and?autologincheck=redirected
Rodriguez-Cruz, E. (2023, July 11). Pediatric hypertension. Background, Pathophysiology,
Etiology. https://emedicine.medscape.com/article/889877-over…
Thomas, J., Stonebrook, E., & Kallash, M. (2022, March). Pediatric hypertension: Review of the
definition, diagnosis, and initial management. International journal of pediatrics &
adolescent medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC90722…
