7th Brazilian Guideline of Arterial Hypertension: Chapter 10 - Hypertension in Children and Adolescents

Epidemiological context and importance of hypertension in pediatrics Arterial hypertension was identified as the major source of combined mortality and morbidity, representing 7% of global disability-adjusted life years. 1 The adoption of the BP definitions and normalization of the " National High Blood Pressure Education Program " (NHBPEP) 2004 2 has standardized the BP classification in the pediatric population. The percentage of children and adolescents diagnosed with AH is estimated to have doubled in the past two decades. The current prevalence of AH in the pediatric population is around 3% to 5%, and such values are mainly attributed to the large increase in childhood obesity. 8 The etiology of pediatric AH can be either secondary, most often associated with nephropathies, or primary, attributed to genetic causes with environmental influence, predominating in adolescents. Pediatric AH is usually asymptomatic, but as many as 40% of hypertensive children have LVH at the initial diagnosis of AH. Although oligosymptomatic in childhood, LVH is a precursor of arrhythmias and HF in adults. 9 In addition, pediatric AH is associated with the development of other changes in target organs, such as increased carotid IMT, arterial compliance reduction, and retinal arteriolar narrowing. Early diagnosis and treatment of childhood AH are associated with a lower risk for AH and for increased carotid atheromatosis in adult life. 10 Therefore, periodical BP measurements in children and adolescents are recommended, even contradicting the U.S. Preventive Services Task Force's suggestion, which considers the evidence of benefits of primary AH screening in asymptomatic children and adolescents insufficient to prevent CVD in childhood or adulthood. Definition and etiology Children and adolescents are considered hypertensive when SBP and/or DBP are greater than or equal to the 95 th percentile for age, sex and height percentile, on at least three different occasions. 2 Prehypertension in children is defined as SBP/DBP ≥ the 90 th percentile < the 95 th percentile, and in adolescents as BP levels ≥ 120/80 mm Hg and < the 95 th percentile. Stage 1 AH is considered for readings between the 95 th percentile and the 99 th percentile plus 5 mm Hg, while stage 2 AH, for readings > stage 1. The height percentiles can be obtained by using Centers for Disease Control and Prevention's (CDC) growth charts. 12 In addition, normal and high BP levels for children and adolescents are available in mobile apps, such as PA Kids and Ped(z). …