How do pediatric and adult hypertension guidelines compare?

  • Gidding SS & al.
  • Hypertension
  • 01/04/2019

  • Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • For hypertension, in the transition from childhood to adulthood, a patient will have the same treatment target and hypertension stage and similar medication choices.
  • Long-term risk stratification to age 40 years for pediatric patients remains a gap.

Why this matters

  • These authors say that the guidelines should remain separate for the populations while emphasizing awareness of the transition stage.

Key results

  • The guidelines are similar in the kind of information they provide, including BP measurement technique and health disparities.
  • In both cases, multiple measurements are recommended, emphasizing ambulatory or home monitoring.
  • Both guidelines emphasize lifestyle management for stage I hypertension. 
  • They differ in special populations they emphasize because of intrinsic differences for some conditions by age.
  • Recommendations for diagnostic evaluation are similar, with lipid profile, blood chemistry, urinalysis, and evaluating for secondary hypertension.
  • Specific to pediatric is renal ultrasound in young patients, HbA1c and liver function evaluation, and suspicion for secondary causes in children without overweight/obesity.
  • Specific to adult guidelines are complete blood count, thyroid evaluation, and ECG.
  • After age 13 years, categories of diagnosis are the same.
  • Pediatric-adult care transition remains unsatisfactory for treatment adherence.
  • Trials in children and young adults ages 20-40 years are lacking, leaving gaps.