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Treatment of hypertension in children and adolescents

INTRODUCTION

It has become clear that hypertension (HTN) begins in childhood and adolescence and that it contributes to the early development of cardiovascular disease (CVD). In hypertensive adults, multiple randomized trials have shown that reduction of BP by antihypertensive therapy reduces cardiovascular morbidity and mortality. (See "Hypertension: Who should be treated?".) Based upon these observations, identifying children with HTN and successfully treating their HTN should have an important impact on long-term outcomes of CVD.

Issues related to the treatment of HTN in children and adolescents will be reviewed here. The epidemiology, etiology, diagnosis, and evaluation of HTN are discussed separately. (See "Epidemiology, risk factors, and etiology of hypertension in children and adolescents" and "Definition and diagnosis of hypertension in children and adolescents" and "Evaluation of hypertension in children and adolescents".)

The treatment of hypertensive emergencies and urgencies in children is also presented elsewhere. (See "Management of hypertensive emergencies and urgencies in children".)

DEFINITIONS

In children, the following definitions based upon the 2004 National High Blood Pressure Education Program Working Group (NHBPEP) are used to classify BP measurements in the United States [1]. BP percentiles are based upon gender, age, and height derived from normative data (table 1A-B and table 2A-B). The systolic and diastolic BP are of equal importance; if there is a disparity between the two, the higher value determines the BP category. The age- and height-specific blood pressure percentiles may be determined using calculators for boys (calculator 1) or for girls (calculator 2).

  • Normal BP — Both systolic and diastolic BP <90th percentile.
  • Prehypertension — Systolic and/or diastolic BP ≥90th percentile but <95th percentile or if BP exceeds 120/80 mmHg (even if <90th percentile for age, gender, and height).
  • Hypertension — HTN is defined as either systolic and/or diastolic BP ≥95th percentile measured upon three or more separate occasions. The degree of HTN is further delineated by the two following stages.
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