Hypertension Diagnosis and Management in Adolescents
Diagnostic Criteria
- The American Diabetes Association recommends confirming hypertension diagnosis by measuring blood pressure on three separate days using an appropriately-sized cuff with the adolescent seated and relaxed, as a single elevated reading is insufficient for diagnosis 1, 2
- Hypertension is defined as Stage 1: Systolic BP 130-139 mmHg or diastolic BP 80-89 mmHg, and Stage 2: Systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg 1, 2, 3
Differential Diagnosis
- Renal causes, such as chronic kidney disease, should be considered, with serum creatinine and urinalysis for proteinuria 1
- Renovascular disease, such as renal artery stenosis, should be considered if abdominal bruit is present 5
- Hyperthyroidism should be considered, with thyroid function tests if clinically indicated 2, 4
- NSAIDs can induce hypertension 6
Initial Evaluation
- Accurate BP measurement with appropriate cuff size in both arms is essential 1, 2
- Cardiovascular examination for murmurs or abnormal heart sounds is recommended 5
- Abdominal examination for bruits or masses is recommended 5
- Urinalysis to detect proteinuria or hematuria suggesting renal disease is necessary 1
- Serum creatinine and estimated GFR to assess renal function are necessary 1
- Fasting lipid panel to assess cardiovascular risk is recommended 1, 2
- Fasting glucose or HbA1c to screen for diabetes is necessary 1
Initial Management
- Intensive lifestyle modifications, including DASH dietary pattern, sodium restriction, increased potassium intake, aerobic exercise, and weight loss, should be initiated for 3-6 months 1, 2, 3
- Pharmacologic treatment should be considered if target BP is not reached after 3-6 months of lifestyle intervention, or if left ventricular hypertrophy is present on echocardiography 1, 2, 7
- First-line pharmacologic agents include ACE inhibitors, angiotensin receptor blockers, long-acting calcium channel blockers, and thiazide diuretics 1, 2, 7