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Evaluation and Management of Stage 2 Hypertension in Pediatric Patients

  • Pediatric Hypertension (B Falkner, Section Editor)
  • Published:
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Abstract

Purpose of Review

To update the definition and clinical practice of stage 2 hypertension (HTN) in pediatrics.

Recent Findings

The 2017 American Academy of Pediatrics Clinical Practice Guideline (AAP CPG) for Screening and Management of High Blood Pressure in Children and Adolescent includes new normative blood pressure tables for children and adolescents ages 1 to 17 years and new definitions for stage 2 HTN. This review will highlight these aspects as well as new recommendations in the guideline specific to stage 2 HTN. It will outline how the new guideline differs from the previous 2004 guideline, the implications of these differences, and suggested changes in evaluation and management of stage 2 HTN. Lastly, the review will address topics relevant to daily clinical practice including competitive athletic participation, investigation for secondary HTN and HTN comorbidities, and blood pressure-lowering therapy.

Summary

With the publication of the new AAP CPG introducing revised normative tables, the prevalence of stage 2 HTN in pediatrics is expected to rise. Based on the new guidelines, there is less emphasis on investigation for secondary HTN and more attention to lifestyle modifications for primary HTN. Future research should address whether there is BP level within the stage 2 HTN range above which the approach to evaluation and management should be altered in this heterogeneous patient population.

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Acknowledgements

We thank Ethan Lennox, MA, for his proofreading and language editing.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Nephrology, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA

    Yosuke Miyashita

  2. Department of Pediatrics, Division of Pediatric Nephrology, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Coral Hanevold

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Correspondence to Yosuke Miyashita.

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This article is part of the Topical Collection on Pediatric Hypertension

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Miyashita, Y., Hanevold, C. Evaluation and Management of Stage 2 Hypertension in Pediatric Patients. Curr Hypertens Rep 20, 73 (2018). https://doi.org/10.1007/s11906-018-0873-z

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