![]() In patients without LV target organ injury at initial echocardiographic assessment, repeat echocardiography at yearly intervals may be considered in those with stage 2 HTN, secondary HTN, or chronic stage 1 HTN incompletely treated (noncompliance or drug resistance) to assess for the development of worsening LV target organ injury.ġ6. Indications to repeat echocardiography include persistent HTN despite treatment, concentric LV hypertrophy, or reduced LV ejection fraction.ġ5-4. ![]() Repeat echocardiography may be performed to monitor improvement or progression of target organ damage at 6- to 12-mo intervals. Diagnosis is based on the presence of mean SBP and DBP 51 g/m 2.7 (boys and girls) for children and adolescents older than age 8 y and defined by LV mass >115 g/BSA for boys and LV mass >95 g/BSA for girls.ġ5-3. ![]() Children and adolescents with suspected WCH should undergo ABPM. ABPM should be performed by using a standardized approach (see Table 13) with monitors that have been validated in a pediatric population, and studies should be interpreted by using pediatric normative data.ĩ. Routine performance of ABPM should be strongly considered in children and adolescents with high-risk conditions (see Table 12) to assess HTN severity and determine if abnormal circadian BP patterns are present, which may indicate increased risk for target organ damage.Ĩ. ABPM should be performed for confirmation of HTN in children and adolescents with office BP measurements in the elevated BP category for 1 year or more or with stage 1 HTN over 3 clinic visits.ħ. If elevated BP is suspected on the basis of oscillometric readings, confirmatory measurements should be obtained by auscultation.Ħ. When doing so, providers should use a device that has been validated in the pediatric age group. Oscillometric devices may be used for BP screening in children and adolescents. Organizations with EHRs used in an office setting should consider including flags for abnormal BP values, both when the values are being entered and when they are being viewed.ĥ. Trained health care professionals in the office setting should make a diagnosis of HTN if a child or adolescent has auscultatory-confirmed BP readings ≥95th percentile at 3 different visits.Ĥ. BP should be checked in all children and adolescents ≥3 y of age at every health care encounter if they have obesity, are taking medications known to increase BP, have renal disease, a history of aortic arch obstruction or coarctation, or diabetes.ģ. BP should be measured annually in children and adolescents ≥3 y of age.Ģ. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.Įvidence Quality, Strength of Recommendationġ. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. President John F.These pediatric hypertension guidelines are an update to the 2004 “Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.” Significant changes in these guidelines include (1) the replacement of the term “prehypertension” with the term “elevated blood pressure,” (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy.Appearing before an Oireachtas committee.
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