Treat with confidence. Trusted answers from the American Academy of Pediatrics.

Simplified Blood PressureTable

 Full BPtables arecomplicated
o Leads to under-recognition
of childhood HTN
 Simplified BPtable created
for use in initial screeningof
BPvalues
o Based on 90th percentile
BPvalues for children at 5th
height percentile
Flynn JT, Kaelber DC, Baker-Smith CM, et al., and AAP Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical practice guideline for
screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904
 TTrreeatatwwithhccoonfnfidedencncee..TTrususteeddansanswweerssfroommttheheAAmmeericcananAAccadeademmyyoofPPeedidiatatrriiccss..

Simplified BP Table
 Full BPtables arecomplicated
o Leads to under-recognition
of childhood HTN
 Simplified BPtable created
for use in initial screeningof
BPvalues
o Based on 90th percentile
BPvalues for children at 5th
height percentile
Flynn JT, Kaelber DC, Baker-Smith CM, et al., and Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical practice guideline for screening
and management of high blood pressure in children and adolescents. Pediatrics.2017;140(3):e20171904
 Treat with confidence. Trusted answers from the American Academy of Pediatrics.

Blood Pressure MeasurementFrequency

 Unclear what age is optimal to begin routine BP
measurement.
 Data suggest that prevention and intervention efforts
should begin early.
 New guideline does not change recommendation to
begin BPmeasurement at age3.
o Now, only annual measurement is recommended
unless risk factors are present.
 Treat with confidence. Trusted answers from the American Academy of Pediatrics.

KAS 1: Blood Pressure MeasurementFrequency

Flynn JT, Kaelber DC, Baker-Smith CM, et al., and AAP Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical practice guideline for screening and
management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904
 Treat with confidence. Trusted answers from the American Academy of Pediatrics.

KAS 2: Blood Pressure MeasurementFrequency

 BPshould be checked in all children andadolescents
≥3 years of age at every health care encounter if they
have obesity, are taking medications known to
increase BP,have renal disease, a history of aortic
arch obstruction or coarctation, or diabetes.

Flynn JT, Kaelber DC, Baker-Smith CM, et al., and AAP Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical practice guideline for
screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904
 Treat with confidence. Trusted answers from the American Academy of Pediatrics.

Repeat High Blood PressureMeasurements

 BPin childhood may vary considerably between visits
and even during the same visit
o Many potential etiologies for isolated elevatedBPin
children and adolescents
 Therefore, the clinician should:
o Repeat high BPreadings at avisit
o Obtain multiple measurements over timebefore
diagnosing HTN
 Treat with confidence. Trusted answers from the American Academy of Pediatrics.

KAS 3: Diagnosis ofHypertension

 Trained health care professionals in the office setting
should make a diagnosis of HTN if a child or
adolescent has auscultatory confirmed BPreadings
≥95th percentile* at 3 different visits.

*≥130/80 in adolescents ≥13 years of age

Flynn JT, Kaelber DC, Baker-Smith CM, et al., and AAP Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical practice guideline for
screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904
 TTrreeatatwwithhccoonfnfidedencncee..TTrususteeddansanswweerssfroommttheheAAmmeericcananAAccadeademmyyoof
PPeedidiatatrriiccss..

BP Measurement & Classification

Flynn JT, Kaelber DC, Baker-Smith CM, et al., and AAP Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical practice guideline for
screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904
Treat with confidence. Trusted answers from the American Academy of Pediatrics.
 Treat with confidence. Trusted answers from the American Academy of Pediatrics.

Management on Basis of Office Blood Pressure: Normal Blood

Pressure
 If BPis normal or normalizes after repeat readings
(i.e. <90th percentile), then no additional action is
needed.
o Give standard lifestyle recommendations (nutrition,
sleep, physical activity, etc.).
o Recheck BPat next routine well-care visit.
 Treat with confidence. Trusted answers from the American Academy of Pediatrics.

Management on Basis of Office Blood Pressure: Elevated Blood

Pressure
1. If BPiselevated 3. If BPis still elevated after12
o Lifestyle recommendations months (i.e. 3 time points)
at each visit o ABPM (prior to diagnostic
o Recheck BPin 6 months evaluation)
(auscultation) o Diagnostic evaluation
2. If BPis still elevated after6 o Consider subspecialty
referral
months
o Check upper and lower 4. If BPnormalizes at any point,
extremity BP return to annualscreening
o Recheck BPin 6 months
(auscultation)
 Treat with confidence. Trusted answers from the American Academy of Pediatrics.

Management on Basis of Office Blood Pressure: Stage 1

Hypertension
1. If BPis Stage 1 HTN and patient 3. If BPis still Stage 1 HTN after
is asymptomatic 3 visits
o Lifestyle recommendations o ABPM (prior to diagnostic
at each visit evaluation)
o Recheck BPin 1–2 weeks o Diagnostic evaluation
(auscultation) o Consider subspecialty
2. If BPis still Stage 1 HTN after referral
1–2 weeks o Initiate treatment (primary
o Check upper and lower care provider or
extremity BP subspecialist)
o Recheck BPin 3 months
(auscultation)
 Treat with confidence. Trusted answers from the American Academy of Pediatrics.

Management on Basis of Office Blood Pressure: Stage 2

Hypertension
1. If BPis Stage 2 HTN and patient 2. If BPis still Stage 2 HTN after
is asymptomatic 1 week
o Lifestyle recommendations o ABPM (prior to diagnostic
at each visit, if appropriate evaluation)
o Check upper and lower o Diagnostic evaluation
extremity BP o Consider subspecialty
o Recheck BPor refer to referral within 1week
subspecialty care within o Initiate treatment
1 week (primary care physician,
subspecialist)

If patient is symptomatic or BP is >30 mm Hg above the 95th percentile (or >180/120

in an adolescent), refer for emergencycare.
 Treat with confidence. Trusted answers from the American Academy of Pediatrics.

Oscillometric vs Auscultatory BloodPressure

 Pediatric normative BPvalues are based on
auscultation.
 Despite this, oscillometric devices are commonly
used in many healthcare settings.
o Several perceived benefits
o Known inaccuracies