Diagnosis, evaluation, and management of high blood pressure in children and adolescents

Carissa M. Baker-Smith, Susan K. Flinn, Joseph T. Flynn, David C. Kaelber, Douglas Blowey, Aaron Carroll, Stephen R. Daniels, Sarah D. De Ferranti, Janis M. Dionne, Bonita Falkner, Samuel S. Gidding, Celeste Goodwin, Michael G. Leu, Makia E. Powers, Corinna Rea, Joshua Samuels, Madeline Simasek, Vidhu V. Thaker, Elaine M. Urbina

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Systemic hypertension is a major cause of morbidity and mortality in adulthood. High blood pressure (HBP) and repeated measures of HBP, hypertension (HTN), begin in youth. Knowledge of how best to diagnose, manage, and treat systemic HTN in children and adolescents is important for primary and subspecialty care providers. OBJECTIVES: To provide a technical summary of the methodology used to generate the 2017 "Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents, " an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." DATA SOURCES: Medline, Cochrane Central Register of Controlled Trials, and Excerpta Medica Database references published between January 2003 and July 2015 followed by an additional search between August 2015 and July 2016. STUDY SELECTION: English-language observational studies and randomized trials. METHODS: Key action statements (KASs) and additional recommendations regarding the diagnosis, management, and treatment of HBP in youth were the product of a detailed systematic review of the literature. A content outline establishing the breadth and depth was followed by the generation of 4 patient, intervention, comparison, outcome, time questions. Key questions addressed: (1) diagnosis of systemic HTN, (2) recommended work-up of systemic HTN, (3) optimal blood pressure (BP) goals, and (4) impact of high BP on indirect markers of cardiovascular disease in youth. Once selected, references were subjected to a 2-person review of the abstract and title followed by a separate 2-person full-Text review. Full citation information, population data, findings, benefits and harms of the findings, as well as other key reference information were arcHIVed. Selected primary references were then used for KAS generation. Level of evidence (LOE) scoring was assigned for each reference and then in aggregate. Appropriate language was used to generate each KAS based on the LOE and the balance of benefit versus harm of the findings. Topics that could not be researched via the stated approach were (1) definition of HTN in youth, and (2) definition of left ventricular hypertrophy. KASs related to these stated topics were generated via expert opinion. RESULTS: Nearly 15 000 references were identified during an initial literature search. After a deduplication process, 14 382 references were available for title and abstract review, and 1379 underwent full text review. One hundred twenty-four experimental and observational studies published between 2003 and 2016 were selected as primary references for KAS generation, followed by an additional 269 primary references selected between August 2015 and July 2016. The LOE for the majority of references was C. In total, 30 KASs and 27 additional recommendations were generated; 12 were related to the diagnosis of HTN, 13 were related to management and additional diagnostic testing, 3 to treatment goals, and 2 to treatment options. Finally, special additions to the clinical practice guideline included creation of new BP tables based on BP values obtained solely from children with normal weight, creation of a simplified table to enhance screening and recognition of abnormal BP, and a revision of the criteria for diagnosing left ventricular hypertrophy. CONCLUSIONS: An extensive and detailed systematic approach was used to generate evidence-based guidelines for the diagnosis, management, and treatment of youth with systemic HTN.

Original languageEnglish (US)
Article numbere20182096
JournalPediatrics
Volume142
Issue number3
DOIs
StatePublished - Sep 1 2018

Fingerprint

Hypertension
Blood Pressure
Left Ventricular Hypertrophy
Practice Guidelines
Observational Studies
Language
Therapeutics
Practice Management
Expert Testimony
Primary Health Care
Cardiovascular Diseases
Databases
Guidelines
Morbidity
Weights and Measures
Mortality

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Baker-Smith, C. M., Flinn, S. K., Flynn, J. T., Kaelber, D. C., Blowey, D., Carroll, A., ... Urbina, E. M. (2018). Diagnosis, evaluation, and management of high blood pressure in children and adolescents. Pediatrics, 142(3), [e20182096]. https://doi.org/10.1542/peds.2018-2096

Diagnosis, evaluation, and management of high blood pressure in children and adolescents. / Baker-Smith, Carissa M.; Flinn, Susan K.; Flynn, Joseph T.; Kaelber, David C.; Blowey, Douglas; Carroll, Aaron; Daniels, Stephen R.; De Ferranti, Sarah D.; Dionne, Janis M.; Falkner, Bonita; Gidding, Samuel S.; Goodwin, Celeste; Leu, Michael G.; Powers, Makia E.; Rea, Corinna; Samuels, Joshua; Simasek, Madeline; Thaker, Vidhu V.; Urbina, Elaine M.

In: Pediatrics, Vol. 142, No. 3, e20182096, 01.09.2018.

Research output: Contribution to journalArticle

Baker-Smith, CM, Flinn, SK, Flynn, JT, Kaelber, DC, Blowey, D, Carroll, A, Daniels, SR, De Ferranti, SD, Dionne, JM, Falkner, B, Gidding, SS, Goodwin, C, Leu, MG, Powers, ME, Rea, C, Samuels, J, Simasek, M, Thaker, VV & Urbina, EM 2018, 'Diagnosis, evaluation, and management of high blood pressure in children and adolescents', Pediatrics, vol. 142, no. 3, e20182096. https://doi.org/10.1542/peds.2018-2096
Baker-Smith CM, Flinn SK, Flynn JT, Kaelber DC, Blowey D, Carroll A et al. Diagnosis, evaluation, and management of high blood pressure in children and adolescents. Pediatrics. 2018 Sep 1;142(3). e20182096. https://doi.org/10.1542/peds.2018-2096
Baker-Smith, Carissa M. ; Flinn, Susan K. ; Flynn, Joseph T. ; Kaelber, David C. ; Blowey, Douglas ; Carroll, Aaron ; Daniels, Stephen R. ; De Ferranti, Sarah D. ; Dionne, Janis M. ; Falkner, Bonita ; Gidding, Samuel S. ; Goodwin, Celeste ; Leu, Michael G. ; Powers, Makia E. ; Rea, Corinna ; Samuels, Joshua ; Simasek, Madeline ; Thaker, Vidhu V. ; Urbina, Elaine M. / Diagnosis, evaluation, and management of high blood pressure in children and adolescents. In: Pediatrics. 2018 ; Vol. 142, No. 3.
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abstract = "Systemic hypertension is a major cause of morbidity and mortality in adulthood. High blood pressure (HBP) and repeated measures of HBP, hypertension (HTN), begin in youth. Knowledge of how best to diagnose, manage, and treat systemic HTN in children and adolescents is important for primary and subspecialty care providers. OBJECTIVES: To provide a technical summary of the methodology used to generate the 2017 {"}Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents, {"} an update to the 2004 {"}Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.{"} DATA SOURCES: Medline, Cochrane Central Register of Controlled Trials, and Excerpta Medica Database references published between January 2003 and July 2015 followed by an additional search between August 2015 and July 2016. STUDY SELECTION: English-language observational studies and randomized trials. METHODS: Key action statements (KASs) and additional recommendations regarding the diagnosis, management, and treatment of HBP in youth were the product of a detailed systematic review of the literature. A content outline establishing the breadth and depth was followed by the generation of 4 patient, intervention, comparison, outcome, time questions. Key questions addressed: (1) diagnosis of systemic HTN, (2) recommended work-up of systemic HTN, (3) optimal blood pressure (BP) goals, and (4) impact of high BP on indirect markers of cardiovascular disease in youth. Once selected, references were subjected to a 2-person review of the abstract and title followed by a separate 2-person full-Text review. Full citation information, population data, findings, benefits and harms of the findings, as well as other key reference information were arcHIVed. Selected primary references were then used for KAS generation. Level of evidence (LOE) scoring was assigned for each reference and then in aggregate. Appropriate language was used to generate each KAS based on the LOE and the balance of benefit versus harm of the findings. Topics that could not be researched via the stated approach were (1) definition of HTN in youth, and (2) definition of left ventricular hypertrophy. KASs related to these stated topics were generated via expert opinion. RESULTS: Nearly 15 000 references were identified during an initial literature search. After a deduplication process, 14 382 references were available for title and abstract review, and 1379 underwent full text review. One hundred twenty-four experimental and observational studies published between 2003 and 2016 were selected as primary references for KAS generation, followed by an additional 269 primary references selected between August 2015 and July 2016. The LOE for the majority of references was C. In total, 30 KASs and 27 additional recommendations were generated; 12 were related to the diagnosis of HTN, 13 were related to management and additional diagnostic testing, 3 to treatment goals, and 2 to treatment options. Finally, special additions to the clinical practice guideline included creation of new BP tables based on BP values obtained solely from children with normal weight, creation of a simplified table to enhance screening and recognition of abnormal BP, and a revision of the criteria for diagnosing left ventricular hypertrophy. CONCLUSIONS: An extensive and detailed systematic approach was used to generate evidence-based guidelines for the diagnosis, management, and treatment of youth with systemic HTN.",
author = "Baker-Smith, {Carissa M.} and Flinn, {Susan K.} and Flynn, {Joseph T.} and Kaelber, {David C.} and Douglas Blowey and Aaron Carroll and Daniels, {Stephen R.} and {De Ferranti}, {Sarah D.} and Dionne, {Janis M.} and Bonita Falkner and Gidding, {Samuel S.} and Celeste Goodwin and Leu, {Michael G.} and Powers, {Makia E.} and Corinna Rea and Joshua Samuels and Madeline Simasek and Thaker, {Vidhu V.} and Urbina, {Elaine M.}",
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TY - JOUR

T1 - Diagnosis, evaluation, and management of high blood pressure in children and adolescents

AU - Baker-Smith, Carissa M.

AU - Flinn, Susan K.

AU - Flynn, Joseph T.

AU - Kaelber, David C.

AU - Blowey, Douglas

AU - Carroll, Aaron

AU - Daniels, Stephen R.

AU - De Ferranti, Sarah D.

AU - Dionne, Janis M.

AU - Falkner, Bonita

AU - Gidding, Samuel S.

AU - Goodwin, Celeste

AU - Leu, Michael G.

AU - Powers, Makia E.

AU - Rea, Corinna

AU - Samuels, Joshua

AU - Simasek, Madeline

AU - Thaker, Vidhu V.

AU - Urbina, Elaine M.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Systemic hypertension is a major cause of morbidity and mortality in adulthood. High blood pressure (HBP) and repeated measures of HBP, hypertension (HTN), begin in youth. Knowledge of how best to diagnose, manage, and treat systemic HTN in children and adolescents is important for primary and subspecialty care providers. OBJECTIVES: To provide a technical summary of the methodology used to generate the 2017 "Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents, " an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." DATA SOURCES: Medline, Cochrane Central Register of Controlled Trials, and Excerpta Medica Database references published between January 2003 and July 2015 followed by an additional search between August 2015 and July 2016. STUDY SELECTION: English-language observational studies and randomized trials. METHODS: Key action statements (KASs) and additional recommendations regarding the diagnosis, management, and treatment of HBP in youth were the product of a detailed systematic review of the literature. A content outline establishing the breadth and depth was followed by the generation of 4 patient, intervention, comparison, outcome, time questions. Key questions addressed: (1) diagnosis of systemic HTN, (2) recommended work-up of systemic HTN, (3) optimal blood pressure (BP) goals, and (4) impact of high BP on indirect markers of cardiovascular disease in youth. Once selected, references were subjected to a 2-person review of the abstract and title followed by a separate 2-person full-Text review. Full citation information, population data, findings, benefits and harms of the findings, as well as other key reference information were arcHIVed. Selected primary references were then used for KAS generation. Level of evidence (LOE) scoring was assigned for each reference and then in aggregate. Appropriate language was used to generate each KAS based on the LOE and the balance of benefit versus harm of the findings. Topics that could not be researched via the stated approach were (1) definition of HTN in youth, and (2) definition of left ventricular hypertrophy. KASs related to these stated topics were generated via expert opinion. RESULTS: Nearly 15 000 references were identified during an initial literature search. After a deduplication process, 14 382 references were available for title and abstract review, and 1379 underwent full text review. One hundred twenty-four experimental and observational studies published between 2003 and 2016 were selected as primary references for KAS generation, followed by an additional 269 primary references selected between August 2015 and July 2016. The LOE for the majority of references was C. In total, 30 KASs and 27 additional recommendations were generated; 12 were related to the diagnosis of HTN, 13 were related to management and additional diagnostic testing, 3 to treatment goals, and 2 to treatment options. Finally, special additions to the clinical practice guideline included creation of new BP tables based on BP values obtained solely from children with normal weight, creation of a simplified table to enhance screening and recognition of abnormal BP, and a revision of the criteria for diagnosing left ventricular hypertrophy. CONCLUSIONS: An extensive and detailed systematic approach was used to generate evidence-based guidelines for the diagnosis, management, and treatment of youth with systemic HTN.

AB - Systemic hypertension is a major cause of morbidity and mortality in adulthood. High blood pressure (HBP) and repeated measures of HBP, hypertension (HTN), begin in youth. Knowledge of how best to diagnose, manage, and treat systemic HTN in children and adolescents is important for primary and subspecialty care providers. OBJECTIVES: To provide a technical summary of the methodology used to generate the 2017 "Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents, " an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." DATA SOURCES: Medline, Cochrane Central Register of Controlled Trials, and Excerpta Medica Database references published between January 2003 and July 2015 followed by an additional search between August 2015 and July 2016. STUDY SELECTION: English-language observational studies and randomized trials. METHODS: Key action statements (KASs) and additional recommendations regarding the diagnosis, management, and treatment of HBP in youth were the product of a detailed systematic review of the literature. A content outline establishing the breadth and depth was followed by the generation of 4 patient, intervention, comparison, outcome, time questions. Key questions addressed: (1) diagnosis of systemic HTN, (2) recommended work-up of systemic HTN, (3) optimal blood pressure (BP) goals, and (4) impact of high BP on indirect markers of cardiovascular disease in youth. Once selected, references were subjected to a 2-person review of the abstract and title followed by a separate 2-person full-Text review. Full citation information, population data, findings, benefits and harms of the findings, as well as other key reference information were arcHIVed. Selected primary references were then used for KAS generation. Level of evidence (LOE) scoring was assigned for each reference and then in aggregate. Appropriate language was used to generate each KAS based on the LOE and the balance of benefit versus harm of the findings. Topics that could not be researched via the stated approach were (1) definition of HTN in youth, and (2) definition of left ventricular hypertrophy. KASs related to these stated topics were generated via expert opinion. RESULTS: Nearly 15 000 references were identified during an initial literature search. After a deduplication process, 14 382 references were available for title and abstract review, and 1379 underwent full text review. One hundred twenty-four experimental and observational studies published between 2003 and 2016 were selected as primary references for KAS generation, followed by an additional 269 primary references selected between August 2015 and July 2016. The LOE for the majority of references was C. In total, 30 KASs and 27 additional recommendations were generated; 12 were related to the diagnosis of HTN, 13 were related to management and additional diagnostic testing, 3 to treatment goals, and 2 to treatment options. Finally, special additions to the clinical practice guideline included creation of new BP tables based on BP values obtained solely from children with normal weight, creation of a simplified table to enhance screening and recognition of abnormal BP, and a revision of the criteria for diagnosing left ventricular hypertrophy. CONCLUSIONS: An extensive and detailed systematic approach was used to generate evidence-based guidelines for the diagnosis, management, and treatment of youth with systemic HTN.

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