Management of Pediatric Hypertension

Diagnosis and Classification

Blood pressure should be measured at each routine visit using an appropriate-sized cuff with the child seated and relaxed 1
Hypertension must be confirmed on at least three separate days before initiating treatment 1, 3
Elevated blood pressure in children is defined as systolic or diastolic BP ≥90th percentile for age, sex, and height 1, 4
Hypertension in children is defined as systolic or diastolic BP ≥95th percentile for age, sex, and height 1, 2, 4

Lifestyle modifications should be the first-line approach for all pediatric patients with elevated blood pressure 1, 2
Key lifestyle interventions include dietary modification with sodium restriction 5, increased physical activity 1, and weight management for overweight/obese children 5, 6

ACE inhibitors or ARBs are recommended as first-line pharmacological agents for pediatric hypertension 1, 2, 6
Treatment should be initiated with an ACE inhibitor, but an ARB can be used if the ACE inhibitor is not tolerated 2, 6
Reproductive counseling is essential due to the potential teratogenic effects of both drug classes 1, 2

The goal of treatment is to achieve blood pressure consistently <90th percentile for age, sex, and height, or <120/80 mmHg in children ≥13 years 1, 2
Regular monitoring is essential to assess treatment efficacy and adjust therapy as needed 6, 3

Children with diabetes and hypertension should be treated more aggressively due to increased risk of accelerated vascular disease 5, 6
Pharmacological management should be done in collaboration with a physician experienced in pediatric hypertension, particularly for complex cases 5, 6