New US guidelines seek to combat hypertension in children

53770bdb-415f-4c7c-bd71-fcafe9657f32articleimage.jpg

25 Aug 2017 --- The first new national guidelines since 2004 on identifying and treating high blood pressure in children and adolescents (aged 3 to 18 years old) in the US have been published by the American Academy of Pediatrics (AAP), which convened a panel of experts to produce the new recommendations.

The AAP report, “Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents,” offers a series of evidence-based recommendations for pediatricians taken from a comprehensive review of nearly 15,000 medical studies published since 2004.

The first-line treatment remains lifestyle changes, the Case Western Reserve University School of Medicine press release points out, as there is a high correlation between hypertension and obesity. When untreated, long-standing hypertension can damage the heart, kidneys and brain.

Among the new recommendations is a call to only conducting routine blood pressure measurements at annual preventive care (“wellness”) visits, as opposed to the 2004 guidelines that urged blood pressure testing anytime a child was in a health care setting, such as for emergency room treatment or during a dental visit.

“That volume of testing outside of preventive care or wellness visits produced some false positives,” says David Kaelber MD, Ph.D., MPH professor in the Case Western Reserve University School of Medicine, Department of Medicine, and chief medical informatics officer of The MetroHealth System, who co-chaired a task force that developed the report.

Differences introduced
“Sometimes kids are in pain or have other issues that cause their blood pressure to be high in the short-term, but [do] not actually have hypertension, leading to unnecessary worry about elevated blood pressure on the part of parents and the kids themselves,” Kaelber adds. “This new guideline should also result in health care savings by reducing unnecessary BP monitoring.”

A second major difference is that the new report removed overweight and obese patients when calculating standards for normal blood pressure in young people – while retaining the benchmark of labeling high blood pressure as beginning at the 95th percentile and categorized by age, sex and height. 

“Since we know that those who are obese and overweight are more likely to have high blood pressure, removing them from our ‘normal’ calculation pool means that we will pick up more average-weight kids with higher blood pressure than under the old model, potentially preventing serious health problems in later life through earlier diagnosis,” says Kaelber of the adjustment.

A third difference is a recommendation for diagnosing high blood pressure by using an ambulatory blood pressure monitor that is attached to the body and worn in real-life settings. This replaces the old guideline which resulted in a hypertensive diagnosis after three successive elevated blood pressure readings in a physician's office. In making this recommendation, the report cites significant evidence of "white coat hypertension" – elevated blood pressure readings at the doctor's office but lower ones at home – linked to fear and anxiety in a clinical setting.

A fourth difference is a recommendation for ordering an echocardiogram for hypertensive young people only if the patient is to be started on medication to treat his or her blood pressure. Under the old guidelines, echocardiograms were routine in cases of abnormal blood pressure whether the patient was on medication or not. Evidence typically shows no health benefits of echocardiograms in young patients whose blood pressure is under control through lifestyle changes in diet and exercise.

A final major difference is that the new recommendations were developed through harmonization with new adult guidelines. The Case Western Reserve University School of Medicine press release gives an example that, under the new guidelines, patients 13 years of age or older have the same definitions of abnormal blood pressures as adult hypertension guidelines from the American Heart Association and the American College of Cardiology. Under the old guidelines, which were developed outside of adult criteria, 17-year-olds might be labeled hypertensive because their blood pressure was greater than 120/80, but when they turned 18, these same readings might only be considered elevated or pre-hypertensive and not leading to a diagnosis of hypertension.

According to the new report, an estimated 3.5 percent of all children and adolescents in the US have hypertension – 1.5 million to 2 million young people. But it also states that elevated blood pressure readings often go undetected and untreated. “These new guidelines will give us better tools for identifying and managing elevated blood pressure in young people,” says Kaelber.

To contact our editorial team please email us at editorial@cnsmedia.com

Related Articles

Health & Nutrition News

Student lunch picks: Milk and fruit losing out to fruit juice, study finds

16 Nov 2018 --- High school students participating in school meal programs are less likely to select milk, whole fruit and water when fruit juice is available, which on balance may decrease the nutritional quality of their lunches, according to a new study by the Rudd Center for Food Policy and Obesity at the University of Connecticut.

Health & Nutrition News

Navigating the digestive health space: Probiotic strain specificity and microbiome key to future NPD

16 Nov 2018 --- Emerging science linking a healthy microbiome to nearly every facet of health, as well as the ongoing media reporting on probiotics, have helped drive consumer interest in gut health. This growing area offers a wealth of opportunities to formulators, but due to regulatory demands and increasing consumer scrutiny, a clear view of how to navigate this space is vital.

Health & Nutrition News

Cranberries found to reduce negative effects of animal-based diet on gut health

15 Nov 2018 --- A Cranberry Institute and USDA-funded study into the potential protective effects of cranberries on the gut microbiome has found that adding cranberries to a meat-based diet can reduce the rise in secondary gut bile acids that have been associated with colon and GI cancer. The feeding trial – published in The Journal of Nutritional Biochemistry – found that the addition of whole cranberry powder to this common diet lessened potentially carcinogenic secondary bile acids and blunted the decline in beneficial short-chain fatty acids (SCFA) in the gastrointestinal (GI) tract.

Health & Nutrition News

Family awareness highlighted during World Diabetes Day

14 Nov 2018 --- Four in five parents have trouble recognizing the warning signs of diabetes, according to research by the International Diabetes Federation (IDF). To mark this year’s World Diabetes Day, IDF is seeking to raise awareness of the effect diabetes has on the family, with a particular focus on prevention and management of the disease. 

Health & Nutrition News

Supplement use in China could ease the double burden of malnutrition, researchers note

14 Nov 2018 --- Despite the Chinese population displaying deficiencies in some key nutrients, such as vitamin B2 and calcium, research has shown that the use of nutritional supplements is relatively low. The involved researchers suggest that adequate supplementation could help to ease the double burden of malnutrition facing the country. 

More Articles
URL : http://www.nutritioninsight.com:80/news/new-us-guidelines-seek-to-combat-hypertension-in-children.html