Management of Adolescent Hypertension

Initial Assessment and Diagnosis

The American Diabetes Association recommends confirming hypertension diagnosis by measuring blood pressure on three separate days using an appropriate-sized cuff with the patient seated and relaxed 1, 3
Blood pressure ≥95th percentile for age, sex, and height on three separate occasions confirms hypertension, according to the American Academy of Pediatrics 1, 4
The American Diabetes Association suggests obtaining baseline laboratory evaluation including urinalysis, serum creatinine, blood urea nitrogen, and urinary albumin excretion to exclude secondary causes and assess for early renal involvement 1, 3
The American Academy of Pediatrics recommends obtaining fasting lipid profile if not already done 1, 3
Consider echocardiography to assess for left ventricular hypertrophy, particularly before initiating pharmacologic treatment, as suggested by the American Academy of Pediatrics 2, 5

The American Academy of Pediatrics recommends initiating ACE inhibitor or ARB immediately as first-line antihypertensive therapy for adolescents with hypertension and metabolic abnormalities 1, 2, 3
ACE inhibitors or ARBs are the preferred initial agents for adolescents with hypertension and metabolic abnormalities, according to the American Diabetes Association 1, 2, 3
Provide reproductive counseling before starting ACE inhibitor or ARB due to teratogenic effects, as recommended by the American Academy of Pediatrics 1, 2, 3
Start at low end of dosing range and titrate every 2-4 weeks until blood pressure normalizes, as suggested by the American Academy of Pediatrics 2
The treatment goal is blood pressure consistently <90th percentile for age, sex, and height, or <130/80 mmHg in adolescents ≥13 years old, according to the American Academy of Pediatrics 1, 5

The American Heart Association recommends implementing dietary modification, such as the DASH diet, restricting saturated fat to 7% of total calories and dietary cholesterol to 200 mg/day 1, 3
Eliminate added salt and reduce high-sodium foods, as recommended by the American Heart Association 4
Prescribe moderate to vigorous physical activity at least 3-5 days per week for 30-60 minutes per session, as suggested by the American Academy of Pediatrics 5
Counsel to lose at least 5% of body weight if overweight, as recommended by the American Academy of Family Physicians 6

See patient every 4-6 weeks until blood pressure normalizes, as recommended by the American Academy of Pediatrics 2
Measure blood pressure at each visit using proper technique, as suggested by the American Diabetes Association 1, 3
Monitor for adverse effects of ACE inhibitor/ARB including cough, hyperkalemia, and renal function changes, as recommended by the American Academy of Pediatrics 2
Repeat echocardiography at 6-12 month intervals if left ventricular hypertrophy present, or yearly if stage 2 hypertension persists, as suggested by the American Academy of Pediatrics 5