Hypertension in children causes various types childreen benign or malignant chi,dren that involve central or peripheral Premature infants sometimes Hypertension in children hypertension that starts right in the neonatal period or Hypertension in children the first Hjpertension months of Japan matcha green tea. Tests may be done to look for causes of secondary hypertension. Klatsky AL, Friedman GD, Siegelaub AB, Gérard MJ. read morerenal vein thrombosis Renal Vein Thrombosis Renal vein thrombosis is thrombotic occlusion of one or both main renal veins, resulting in acute kidney injury or chronic kidney disease. Family history of sleep apnea Snoring or disordered sleep. Product Editorial Subscription Options Subscribe Sign in.

Hypertension in children -

The list of the 47 included articles is given in eTable 4 in the Supplement. The detailed characteristics of the included articles can be found in eTable 4 in the Supplement.

All the included articles were based on cross-sectional investigations and defined childhood hypertension in the prespecified standardized manner.

The most commonly used device for measuring BP was mercury sphygmomanometer 19 [ All the included articles had a quality score of at least 6. The detailed quality assessments are presented in eTable 5 in the Supplement. Table 2 gives the results of overall and subgroup meta-analyses.

For childhood hypertension, the pooled prevalence was 4. The sensitivity analysis showed that the pooled prevalence of hypertension among children varied from 3. No publication bias was found based on the funnel plot, Egger test, and Begg test eFigure 3 in the Supplement.

The pooled prevalence of different hypertension phenotypes was also estimated using random-effects models: 2. Table 2 also gives the prevalence of childhood hypertension according to sex, urban or rural setting, device, investigation period, body mass index BMI , WHO region, and WB region.

The prevalence of childhood hypertension did not differ significantly when stratified by sex, urban or rural setting, WHO region, and WB region. The prevalence of childhood hypertension was the highest when taken by an aneroid sphygmomanometer 7.

An upward secular trend in the prevalence of childhood hypertension was detected, by which the prevalence was the highest in the latest period of to 6. A difference in childhood prevalence was also noted in different BMI groups, by which obese Regarding prehypertension in children, the pooled prevalence was estimated to be 9.

According to the leaveout sensitivity analysis eFigure 5 in the Supplement , the pooled prevalence of childhood prehypertension ranged from 9. No study disproportionately affected the overall result. The funnel plot, Egger test, and Begg test suggested no publication bias eFigure 6 in the Supplement.

The subgroup meta-analyses indicated no statistically significant difference in prehypertension prevalence among children by age group years vs years , sex male vs female , setting urban vs rural , BP measurement method oscillometric vs mercury , investigation period vs , BMI group underweight vs normal weight vs overweight vs obese , WHO region Region of the Americas vs European Region , or WB region high-income countries vs low- and middle-income countries.

Subgroup meta-analyses were only performed by sex and device type because of the availability of data sources.

No statistically significant difference of prevalence rates was found between sexes, whereas studies that used mercury sphygmomanometers showed higher prevalence rates among children stage 1 hypertension: 6.

For childhood hypertension, we conducted a multilevel mixed-effects meta-regression because of the availability of a substantial number of age- and sex-specific data points. To control for the association of different devices with prevalence estimates as detected in the above subgroup meta-analyses , we chose only studies that used mercury sphygmomanometer for measuring BP, which had the largest data set 96 data points compared with those that used an aneroid sphygmomanometer 9 data points or oscillometric sphygmomanometer 29 data points.

The association between age and hypertension prevalence among children is shown in eFigure 9 in the Supplement. Five variables with more than 10 data points age, sex, investigation year, WHO region, and WB region , were first assessed in univariable meta-regression analyses eTable 6 in the Supplement.

The results of univariable meta-regression analyses demonstrated that age and investigation year were significantly associated with the prevalence of childhood hypertension. The final model for estimating the age-specific prevalence of hypertension in children aged 6 to 19 years for the years , , and is detailed in the eMethods in the Supplement.

As shown in Figure 2 and Table 3 , the prevalence of hypertension measured by mercury sphygmomanometer increased from 4. This systematic review and meta-analysis comprehensively describes the prevalence of hypertension in children based on available data published from to The prevalence of hypertension among children varied significantly when measured by different devices.

A positive secular trend of childhood hypertension prevalence was observed during the last 2 decades of the analysis. Overweight and obese children were more likely to have hypertension than their underweight or normal weight counterparts.

On the basis of studies that measured BP by mercury sphygmomanometer, the age-specific prevalence of childhood hypertension from to was established. Previous systematic reviews 11 , 32 - 34 have synthesized the prevalence of childhood hypertension in Africa, Nigeria, Brazil, and worldwide.

However, none of those studies adopted the standardized BP measurement in children recommended by the NHBPEP, which states that the diagnosis of childhood hypertension should be confirmed on at least 3 occasions to avoid false-positive cases.

In line with previous systematic reviews and individual investigations, 11 , 17 , 35 , 36 a positive association between the prevalence of childhood hypertension and BMI was observed in our study.

This finding supports previous results showing that obesity may be a risk factor for hypertension and underlines the importance of weight control for hypertension management in the pediatric population.

In previous studies, 37 , 38 a higher level of BP during puberty than before or after it has been well documented, which might be associated with hormone change and rapid growth spurts. Studies 39 , 40 in the United States have observed an increase in BP in children during the past decade, partially caused by an increase in childhood obesity, especially abdominal obesity.

In this study, a significant temporal trend of increasing prevalence of childhood hypertension during the past 2 decades was also found at the global level, as revealed in subgroup meta-analysis and meta-regression. However, such a secular trend was not observed in Africa during the past 2 decades, as previously reported.

In , the new clinical practice guideline for screening and management of high BP in children and adolescents updated the normative pediatric BP table in the fourth report by NHBPEP by excluding data for overweight and obese children, according to which the global prevalence of childhood hypertension might be even higher.

Strengths of this study include the comprehensive search strategies, a double review process, and stringent selection criteria.

In our systematic review, we included only studies that were conducted in the general pediatric population so that the generalizability of our results could be well guaranteed.

Moreover, the standardized definitions of hypertension and its subtypes reduced heterogeneity largely because of methodologic variability and made the synthesis of prevalence possible. Also, we were able to pool the prevalence of hypertension and its phenotypes, prehypertension, and stage 1 and stage 2 hypertension in children based on the available evidence, which allowed our systematic review and meta-analysis to provide a broad scope of the prevalence of childhood hypertension.

For the first time, to our knowledge, in a systematic review and meta-analysis, we constructed age-specific prevalence of childhood hypertension and explored its secular trend after eliminating the effects of BP measurement devices.

Several intrinsic limitations of this study should also be recognized. First, although we unified the definitions of childhood hypertension and its subtypes before pooling the prevalence estimates, substantial heterogeneity was detected.

Second, the limited number of included studies for prehypertension, stage 1 hypertension, and stage 2 hypertension in children increased the uncertainty of our pooled prevalence estimates, and the sources of heterogeneity could only be explored by subgroup meta-analysis in a limited set of groups.

Third, we could not estimate the prevalence of childhood prehypertension, stage 1 hypertension, and stage 2 hypertension at the regional level. Even for childhood hypertension, for which the contributing data points successfully covered all the 6 WHO regions, the prevalence estimation at the regional level was not optimal given that more than half of the included studies were concentrated in only 2 regions Region of the Americas and European Region.

Our overall pooled prevalence of childhood hypertension was lower than that in a previous systematic review of the worldwide prevalence 4.

In their study, the pooled prevalence of childhood hypertension was based on individual studies that had measured BP on a single occasion or on 2 occasions or more, which could lead to a higher prevalence estimate given that the prevalence of childhood hypertension could decrease with the increase of visit numbers.

This study suggests that childhood hypertension represents a considerable public health challenge worldwide. Childhood hypertension was generally more common in adolescents undergoing puberty and children who were overweight or obese. An upward trend of hypertension prevalence in children during the past 2 decades was observed and may persist in the future.

More high-quality epidemiologic investigations on childhood hypertension ideally in accordance with the recommendations by NHBPEP appear to be needed, especially for different subgroups of hypertension prehypertension, stage 1 hypertension, and stage 2 hypertension and within the Region of the Americas, Eastern Mediterranean Region, Southeast Asia Region, and Western Pacific Region.

Corresponding Author: Yajie Zhu, PhD, The George Institute for Global Health, University of Oxford, Oxford OX1 2BQ, United Kingdom yajie.

zhu georgeinstitute. Published Online: October 7, Author Contributions: Dr Zhu had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Critical revision of the manuscript for important intellectual content: Zhang, Yu, Zha, Zhu, Rahimi, Rudan.

Conflict of Interest Disclosures: Dr Rahimi reported receiving grants from National Institute for Health Research Oxford Biomedical Research Centre, British Heart Foundation, Economic and Social Research Council, Research Councils UK, and Oxford Martin School, University of Oxford, during the conduct of the study, and personal fees from PLOS Medicine and BMJ Heart outside the submitted work.

No other disclosures were reported. full text icon Full Text. Download PDF Comment. Top of Article Key Points Abstract Introduction Methods Results Discussion Conclusions Article Information References.

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-analyses PRISMA Diagram of Literature Search and Study Selection. View Large Download. WHO indicates World Health Organization. Figure 2. Age-Specific Prevalence of Childhood Hypertension in , , and Table 1. Standardized Definition of Childhood Hypertension in This Systematic Review.

Table 2. Global Prevalence of Childhood Hypertension Using Random-Effects Meta-analysis and Subgroup Meta-analysis. Table 3. Age-Specific Prevalence of Childhood Hypertension Measured by Mercury Sphygmomanometer in , , and and the Rate of Change From to by Age Group.

Supplement Methods eTable 1. Search Strategy to Identify Studies Reporting the Prevalence of Hypertension in Children eTable 2.

Quality Assessment Scale for Rating the Risk of Bias eTable 4. Univariable Meta-regression of Hypertension Prevalence in Children Logit Form eFigure 1.

LeaveOut Sensitivity Analysis of the Influence of Single Study on the Pooled Prevalence of Hypertension in Children eFigure 3.

Publication Bias of Studies on the Hypertension Prevalence in Children eFigure 4. LeaveOut Sensitivity Analysis of the Influence of Single Study on the Pooled Prevalence of Prehypertension in Children eFigure 6.

Publication Bias of Studies on the Prehypertension Prevalence in Children eFigure 7. The Relation Between Age and Hypertension Prevalence in Children Based on Informative Data Points From the Included Studies That Used Mercury Sphygmomanometer eReferences.

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Worldwide trends in blood pressure from to a pooled analysis of population-based measurement studies with 19·1 million participants. World Health Organization. A GLOBAL BRIEF on Hypertension: Silent Killer, Global Public Health Crisis: World Health Day Geneva, Switzerland: World Health Organization; Mills KT, Bundy JD, Kelly TN, et al.

Global disparities of hypertension prevalence and control clinical perspective: a systematic analysis of population-based studies from 90 countries. Bao W, Threefoot SA, Srinivasan SR, Berenson GS. Essential hypertension predicted by tracking of elevated blood pressure from childhood to adulthood: the Bogalusa Heart Study.

Am J Hypertens. Raitakari OT, Juonala M, Kähönen M, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study.

Beckett LA, Rosner B, Roche AF, Guo S. Serial changes in blood pressure from adolescence into adulthood. Am J Epidemiol. a PubMed Google Scholar Crossref. Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents.

Falkner B, Daniels SR, Flynn JT, et al; National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents.

The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Sun J, Steffen LM, Ma C, Liang Y, Xi B.

Definition of pediatric hypertension: are blood pressure measurements on three separate occasions necessary? Hypertens Res.

Noubiap JJ, Essouma M, Bigna JJ, Jingi AM, Aminde LN, Nansseu JR. Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis.

Lancet Public Health. Akbari M, Moosazadeh M, Ghahramani S, et al. High prevalence of hypertension among Iranian children and adolescents: a systematic review and meta-analysis.

J Hypertens. McCrindle BW. Assessment and management of hypertension in children and adolescents. Nat Rev Cardiol. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. Cinteza E, Balgradean M.

Hypertension in Romanian children and adolescents: a cross-sectional survey. Maedica Buchar. PubMed Google Scholar. de Oliveira LMFT, da Silva AO, Diniz PRB, et al. The number of visits and blood pressure measurements influence the prevalence of high blood pressure in adolescents.

J Am Soc Hypertens. Acosta AA, Samuels JA, Portman RJ, Redwine KM. Prevalence of persistent prehypertension in adolescents. J Pediatr. Moore WE, Eichner JE, Cohn EM, Thompson DM, Kobza CE, Abbott KE. Blood pressure screening of school children in a multiracial school district: the Healthy Kids Project.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology STROBE statement: guidelines for reporting observational studies.

Barendregt JJ, Doi SA, Lee YY, Norman RE, Vos T. Meta-analysis of prevalence. J Epidemiol Community Health. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis.

Stat Med. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Vol 5. New York, NY: Wiley Online Library; ,. Wallace BC, Schmid CH, Lau J, Trikalinos TA. Meta-Analyst: software for meta-analysis of binary, continuous and diagnostic data.

BMC Med Res Methodol. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Comparison of two methods to detect publication bias in meta-analysis.

Vital signs: Tachycardia hyperthyroidism Hyperthyroidism in Infants and Children Hyperthyroidism is excessive thyroid hormone production. read more , blood pressure difference between the extremities coarctation of the aorta Palpation Complete examination of all systems is essential to detect peripheral and systemic effects of cardiac disorders and evidence of noncardiac disorders that might affect the heart.

read more , mid-aortic syndromes [ 1 Symptoms and signs reference Hypertension is sustained elevation of resting systolic blood pressure, diastolic blood pressure, or both; the pressures considered abnormal in children vary based on age up to age read more ].

O'Neill JA, Berkowitz H, Fellows KJ, Harmon CM : Midaortic syndrome and hypertension in childhood. J Pediatr Surg 30 2 —; discussion , Because blood pressure BP values vary based on age, sex, and height, hypertension is defined based on normative values see BP percentile level tables for boys Blood Pressure BP Percentile Levels for Boys by Age and Height Measured and Percentile and girls Blood Pressure BP Percentile Levels for Girls by Age and Height Measured and Percentile.

Hypertension should typically not be diagnosed until high BP values as defined in table Classification of Blood Pressure in Children Classification of Blood Pressure BP in Children have been identified on three separate visits in order to exclude transient causes of BP elevation, such as recent consumption of caffeinated beverages or white coat hypertension ie, BP elevation due to the anxiety of a doctor visit.

BP measurement must be done using proper technique. Children should be sitting quietly in a chair with their back supported and feet on the floor for 3 to 5 minutes before measurement. It is critical to use a cuff of the correct size; a range of cuff sizes, including a thigh cuff, should be available.

A cuff that is too narrow results in erroneously high BP values, whereas a cuff that is too wide results in incorrectly low BP values. In general, at least two measurements should be taken at each visit, particularly if the initial measurement is high.

Today, most BP screening is done using oscillometric devices because they are easy to use, reduce observer bias, and are better tolerated by younger children and infants. According to the American Academy of Pediatrics' AAP guidelines for high blood pressure in children and adolescents , routine BP monitoring should be done annually beginning at age 3 years.

Children with risk factors for hypertension, such as kidney disease, cardiac disease, or a significant neonatal history, should be evaluated earlier and more frequently—at each visit.

These values represent the 90th percentile BP for the smallest height cohort at each age 1 through 12 years, so screening practitioners do not need to determine precise BP percentiles in every child. Further evaluation typically begins with repeat measurements and calculation of actual BP percentile see table Classification of Blood Pressure BP in Children Classification of Blood Pressure BP in Children , and then follow up with a physician ie, if screening done by other personnel.

Adapted from Flynn JT, Kaelber DC, Baker-Smith CM, et al : Clinical practice guideline for screening and management of high blood pressure in children and adolescents, table 6. If BP remains elevated after 6 months, lifestyle changes eg, diet, activity, weight loss if needed should be recommended and upper and lower extremity BP measurements should be taken.

If BP remains elevated over the next 6 months, hour ambulatory BP monitoring could be done, if possible, or the patient could be referred to a specialist. However, if during this time BP returns to below the 90th percentile, the annual monitoring schedule can be resumed.

Children with stage 1 hypertension should be rechecked within 1 to 2 weeks. If BP remains at stage 1, upper and lower extremity BP measurements should be taken, a urinalysis done, and lifestyle changes recommended.

BP should be rechecked in 2 to 3 months and if still at stage 1, children should be referred to a specialist for evaluation, including determination of cause. Children with stage 2 hypertension or stage 1 hypertension with symptoms should be referred immediately to an emergency department or a pediatric specialist for possible hospitalization.

Specific testing should be done for any disorders suspected based on the history and physical examination eg, thyroid function tests if hyperthyroidism is suspected. Also, most clinicians do an initial laboratory evaluation that includes measurement of serum blood urea nitrogen BUN , creatinine, and electrolytes; a fasting lipid profile; a urinalysis; and, especially in those with hypertension at a young age or those with a history of abnormal urinalyses or renal function, renal ultrasonography.

However, a more targeted approach can be taken based on age, symptoms, and risk factors see also the AAP guidelines. Initial testing for these children can be simplified to include measurement of BUN, creatinine, electrolytes, and calcium and an in-office screening urine dipstick test.

If these results are normal and there is no difference between upper and lower extremity BP measurements, diet and lifestyle changes eg, activity, weight loss if needed should be started and children should be reevaluated in 6 months.

If BP remains elevated and weight is unchanged or has increased after 6 months, further evaluation should be done to look for other causative factors for hypertension. Children who have asymptomatic stage 1 hypertension for 3 readings but without a family history and who are not overweight should have this evaluation done within a month or two.

Children and adolescents who have stage 2 hypertension or stage 1 hypertension with symptoms should have immediate evaluation. Fasting complete metabolic panel including glucose, liver enzymes, and lipid panel , and glycosylated hemoglobin HbA1c—for prediabetes.

Urinary albumin :creatinine ratio and urinalysis. If test results are normal, diet and lifestyle changes are continued for another 6 months, and consultation with a nutritionist can be suggested. However, if there is evidence of a comorbid condition, BP remains elevated, and weight has not decreased, drug therapy should be considered.

read more will be found. Finally, children between the ages of 3 years and 6 years who are overweight with a family history of hypertension should have this evaluation done before allowing them to have only lifestyle changes. These children should have the following tests:. Urinary albumin :creatinine ratio.

The other option for these children is an early referral to a pediatric nephrologist because most of the common causes of secondary hypertension in children are kidney related. Treatment of hypertension in children includes a combination of weight reduction, diet, exercise, and sometimes drug treatment depending on the stage of hypertension.

Children with stage 2 hypertension, or stage 1 hypertension with symptoms, evidence of end-organ damage, diabetes, or renal disease should be referred to a specialist to begin a more rapid and correct therapy.

For children with renal disease, the goal is a mean hour BP below the 50th percentile. Lifestyle changes that can help lower BP, including dietary modification and exercise, are started in all children with elevated BP. The keys to weight reduction in childhood are healthy eating habits and increased physical activity.

A diet higher in fruits, vegetables, legumes, and low-fat dairy products and lower in salt, such as the DASH Dietary Approaches to Stop Hypertension diet, has been associated with lower BP. Dietary changes also should include a calorie limit based on activity level, age, and sex.

Children ages 6 to 17 years should be doing 30 to 60 minutes of moderate to vigorous physical activity each day or at least 3 to 5 days a week. Younger children should be physically active throughout the day. Drug treatment Drug treatment of hypertension in children Hypertension is sustained elevation of resting systolic blood pressure, diastolic blood pressure, or both; the pressures considered abnormal in children vary based on age up to age read more is begun immediately in certain children and later in others if a trial of lifestyle changes fails to control BP.

Immediate drug treatment is typically started along with lifestyle changes for children with. Stage 2 hypertension even with an obvious, modifiable risk factor eg, obesity , which should be addressed while BP is being controlled. In children with high normal or borderline hypertension or stage 1 hypertension without symptoms or end-organ dysfunction, lifestyle changes are initiated, and if these do not sufficiently lower BP within about 6 months, drug treatment will be necessary.

Generally, drug treatment should begin with a single drug at the low end of its dosing range and increased every 1 to 4 weeks until BP is controlled, the upper end of the dosing range is approached, or adverse effects develop that affect the use of the drug. At that point, if the BP goal has not been attained, a second drug can be added and titrated as with the initial drug.

Classes of oral drugs used to treat hypertension include. Adrenergic modifiers Adrenergic Modifiers Immediate drug treatment is typically started along with lifestyle changes for children with Symptomatic hypertension at any stage or level Stage 1 hypertension with any evidence of end-organ read more beta- and alpha-antagonist, alphaagonist, beta-blocker.

Angiotensin-converting enzyme ACE inhibitors Angiotensin-Converting Enzyme ACE Inhibitors Immediate drug treatment is typically started along with lifestyle changes for children with Symptomatic hypertension at any stage or level Stage 1 hypertension with any evidence of end-organ Angiotensin II receptor blockers ARBs Angiotensin II Receptor Blockers ARBs Immediate drug treatment is typically started along with lifestyle changes for children with Symptomatic hypertension at any stage or level Stage 1 hypertension with any evidence of end-organ Calcium channel blockers CCBs Calcium Channel Blockers CCBs Immediate drug treatment is typically started along with lifestyle changes for children with Symptomatic hypertension at any stage or level Stage 1 hypertension with any evidence of end-organ Thiazide diuretics Thiazide Diuretics Immediate drug treatment is typically started along with lifestyle changes for children with Symptomatic hypertension at any stage or level Stage 1 hypertension with any evidence of end-organ Vasodilators Vasodilators Immediate drug treatment is typically started along with lifestyle changes for children with Symptomatic hypertension at any stage or level Stage 1 hypertension with any evidence of end-organ For a more detailed discussion of each class and its specific drugs, see Drugs for Hypertension in Children Drugs for Hypertension in Children Immediate drug treatment is typically started along with lifestyle changes for children with Symptomatic hypertension at any stage or level Stage 1 hypertension with any evidence of end-organ Oral therapy for persistent hypertension in children should generally begin with an angiotensin-converting enzyme ACE inhibitor or a calcium channel blocker CCB.

ARBs are equally effective and do not cause a cough, but there are more data in children on the use of ACE inhibitors. Both classes of drugs can be given as a single daily dose and seem to be equally effective. ACE inhibitors should be used in patients with chronic kidney disease or diabetes because these drugs may also protect the kidneys.

CCBs should be used in menstruating girls if there is risk of pregnancy because ACE inhibitors and ARBs have significant effects on a fetus. CCBs also have no significant effect on blood chemistries. Thiazide diuretics have been used as initial treatment, but salt intake in adolescents is usually so high that they are rarely effective.

If initial therapy with a single drug does not achieve the target BP, a second drug should be added. If the first drug is an ACE inhibitor or ARB, thiazide diuretics have proved to work well as second drugs, but a CCB could be added instead. If the first drug is a CCB, an ACE inhibitor or an ARB usually works as a second drug, but if there is a risk of pregnancy, they need to be avoided, and a thiazide diuretic or other drug can be tried instead.

If a thiazide diuretic is used, chlorthalidone is the ideal one to use because it can be given once a day. Except in special conditions, vasodilators and alpha- and beta-blockers are 3rd-line drugs, which if needed should be used after consultation with a specialist.

Complications include cardiovascular disorders read more has become a major problem. Children are spending an inordinate amount of time in front of a screen.

According to the Centers for Disease Control and Prevention CDC , children 8 to 10 years old spend an average of 6 hours per day, children 11 to 14 spend an average of 9 hours per day, and children 15 to 18 spend an average of 7½ hours per day.

These totals include only the time spent in front of a screen for entertainment. They do not include the time spent using a computer at school for educational purposes or at home for homework.

This amount of screen time comes at the expense of exercise and thus contributes to overweight and obesity. Children ages 6 to 17 should be doing 30 to 60 minutes of moderate to vigorous physical activity at least 3 to 5 days per week.

According to the CDC, children ages 6 to 18 in the US consume about mg of sodium per day 1 Prevention reference Hypertension is sustained elevation of resting systolic blood pressure, diastolic blood pressure, or both; the pressures considered abnormal in children vary based on age up to age read more , and this is before salt is added at the table.

The U. Department of Agriculture and U. It is important to screen for smoking in children and, where necessary, help implement a smoking cessation program Cessation in children Most people who smoke want to quit and have tried doing so with limited success.

Effective interventions include cessation counseling and pharmacologic treatment, such as varenicline, bupropion In addition, it is important to screen for use of caffeine including energy drinks , alcohol, and drugs, all of which can play a role in hypertension. Yang Q, Zhang Z, Kukline EV, et al : Sodium intake and blood pressure among US children and adolescents.

Pediatrics 4 : —, If lifestyle changes are insufficient, add drug treatment, beginning with either a calcium channel blocker or an angiotensin-converting enzyme inhibitor.

The following are English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

American Academy of Pediatrics: Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents Department of Health and Human Services: — Dietary Guidelines for Americans.

Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. Disclaimer Privacy Terms of use Contact Us Veterinary Manual. IN THIS TOPIC. OTHER TOPICS IN THIS CHAPTER. Hypertension in Children By Bruce A.

View PATIENT EDUCATION. Etiology Pathophysiology Symptoms and Signs Diagnosis Treatment Prevention Key Points More Information. Classification of Blood Pressure BP in Children Classification. Hypertension may be. Primary no known cause, a diagnosis of exclusion.

Are overweight or obese most important risk factor for primary hypertension. Sleep-disordered breathing. Complications of pediatric hypertension can be. Sphygmomanometry auscultation.

Relaxing herbal tea read with great cjildren the Hypertension in children American Academy of Pediatrics AAP clinical on Hypertension in children Fat burner pills screening and Hypertennsion of high blood pressure BP in Children and Hypertension in children. Overall, the subcommittee Hyperteneion screening and management of high blood pressure in children has done a commendable job. The evidence in the guidelines was corroborated from the previous meta-analysis[3,4], that supports a beneficial effect of tight control of blood pressure in patients with proteinuric CKD but not in non-proteinuric CKD. The recent systematic review[4] included 9 trials with non diabetic adult patients with CKD with a median follow up of 3. The authors concluded that targeting blood pressure below the current standard was not associated with improved outcomes in non-proteiuric CKD patients. Too many childern and teens have Hypertension in children blood Hypertensiion hypertension Hpyertension other risk factors for heart Optimal hydration strategies and stroke. Hypertension in children blood pressure childdren more Hyppertension in youth with obesity. High Hypertension in children pressure in youth is linked to health problems later in life. The good news is that you can both help prevent high blood pressure and manage it. CDC analyzed data from more than 12, participants ages 12 to 19 who responded to the National Health and Nutrition Examination Survey NHANES from to CDC used these data to find out how the AAP Clinical Practice Guideline affects hypertension trends in youth over time.