Diagnosis and treatment of hypertension in children and adolescents

OBJECTIVE: To review the current recommendations regarding the diagnosis an d treatment of hypertension in children to provide education to practitione rs. DATA SOURCES AND STUDY SELECTION: Review of recent recommendations of the T ask Force on Blood Pressure Control in Children and the current literature, specifically regarding ambulatory blood pressure monitoring in children. I n general, search criteria were restricted to studies with a primary focus of blood pressure for subjects 18 years of age or less, focusing on importa nt studies of the past 20 years. DATA SYNTHESIS: Optimal determination of blood pressure in children require s use of appropriate technique, particularly the use of an appropriately si zed cuff, and then comparison with normal values based on age, sex and heig ht. Ambulatory blood pressure monitoring is a research tool that, in select ed high risk patients, may facilitate detection of occult hypertension. Car eful clinical assessment is the key tool for identifying secondary causes o r a predisposition to primary hypertension, with laboratory testing reserve d if a specific underlying cause is suspected. Management is directed at se condary causes, and general cardiovascular risk reduction is aimed at dieta ry modification, increased exercise and attainment or maintenance of ideal body weight. institution of drug therapy depends on the degree of hypertens ion and the risk of future end-organ damage or cardiovascular disease. CONCLUSIONS: Hypertension is an under-recognized clinical entity in childre n. Studies are needed to define the mechanisms and magnitude of cardiovascu lar risk, the role of ambulatory blood pressure monitoring, and the efficac y and safety of drug therapy.