Hypertension in Pediatrics (S2:E36)

Pediatric hypertension occurs in 2% to 5% of all pediatric patients. It is one of the top five chronic diseases in children and adolescents. Pediatric hypertension affects approximately 65 children per million. In cases where the cause is unknown, it can be as rare as one in a million.

In a busy practice, a general pediatrician could see a patient with hypertension in their office every one to two days. Yet, according to the National Heart, Lung and Blood Institute, doctors miss the diagnosis in up to 75% of pediatric patients. Thus, appropriate medication initiation occurs far less frequently than current guidelines suggest. These statistics emphasize the importance of education and awareness in primary care.

Listen to pediatric medical experts discuss pediatric hypertension

In today’s episode we talk with Steve Daniels, MD, about pediatric hypertension. Dr. Daniels helped develop a pediatric hypertension clinical practice guideline in 2018. All pediatricians can benefit from a review of these important guidelines.

We'll explain how primary care providers (PCPs) can incorporate blood pressure screening at well-child visits. We’ll also explore the practical benefits of changes in nomenclature. For example, replacing the term “prehypertension” with “elevated blood pressure” can be helpful. Changes in language are particularly comforting when sharing treatment recommendations with families.

Dr. Daniels is a pediatric cardiologist, Pediatrician in chief and L. Joseph Butterfield Chair of Pediatrics at Children's Hospital Colorado, professor of pediatrics at the University of Colorado School of Medicine and professor of epidemiology at the University of Colorado School of Public Health. Dr. Daniels is a sought-out expert in the field of pediatric hypertension and pediatric nutrition.

In this episode, our expert discusses:

• The increasing prevalence of hypertension in children
• How it has become more common to see hypertension across a variety of ethnicities, socioeconomic groups and weight ranges
• What role genetics and obesity might play in pediatric hypertension cases
• Best practices for approaching a patient with high blood pressure and the criteria for making a diagnosis
• Why it’s so important to measure height in addition to blood pressure
• How guideline tables for hypertension are now incorporated into electronic medical records
• The importance of understanding the patient’s family history of high blood pressure
• Why it's important to consider the child’s weight
• When it's time to look into possible secondary causes
• Doing a lipid profile to determine the risk factors for cardiovascular disease
• How to communicate the diagnosis with parents
• How to help parents understand the implications of their child's condition
• What left ventricular hypertrophy indicates about the effects on the cardiovascular system
• How lifestyle changes can have a dramatic impact on children
• The role of physical activity in improving blood pressure
• Why we don't always need to see a BMI reduction to know treatment is helping
• The DASH diet and other measures that can be taken before prescribing medication
• Consequences of hypertension in children, including its effect on neurocognitive functioning

Pediatric hypertension treatment at Children’s Colorado

Experts in our Pediatric Pulmonary Hypertension Program treat children and adolescents who have pediatric hypertension. Today, Children's Colorado is involved in almost every clinical trial of new medications for children with pediatric hypertension. We see more, treat more and heal more children than any hospital in our seven-state region. Refer a patient to Children’s Colorado.