Stephen R. Daniels, M.D., Ph.D. (Cincinnati Children’s Hospital Medical. Center, Cincinnati, OH); Joseph T. Flynn,. M.D., M.S. (Montefiore Medical Center,.
Missing: professore professoressa
440 KB – 60 Pages
PAGE – 3 ============
THE FOURTH REPORT ON THE Diagnosis, Evaluation, andTreatment of High Blood Pressurein Children and AdolescentsU.S.DEPARTMENTOFHEALTHANDHUMANSERVICES National Institutes of Health National Heart, Lung, and Blood InstituteNIHPublication No.05-5267 Originally printed September 1996 (96-3790) Revised May 2005
PAGE – 5 ============
THE FOURTH REPORT ON THE DIAGNOSIS, EVALUATION, AND TREATMENT OF HIGH BLOOD PRESSURE IN CHILDREN AND ADOLESCENTSCHAIRBonita Falkner, M.D.(Thomas Jefferson University, Philadelphia, PA) MEMBERSStephen R.Daniels, M.D., Ph.D. (Cincinnati ChildrenÕs Hospital Medical Center, Cincinnati, OH); Joseph T.Flynn, M.D., M.S.(Montefiore Medical Center, Bronx, NY); Samuel Gidding, M.D. (DuPont Hospital for Children, Wilmington, DE); Lee A.Green, M.D., M.P.H.(University of Michigan, Ann Arbor, MI); Julie R.Ingelfinger, M.D. (MassGeneral Hospital for Children, Boston, MA); Ronald M.Lauer, M.D. (University of Iowa, Iowa City, IA); Bruce Z.Morgenstern, M.D.(Mayo Clinic, Rochester, MN); Ronald J. Portman, M.D.(The University of Texas Health Science Center at Houston, Houston, TX); Ronald J.Prineas, M.D., Ph.D.(Wake Forest University School of Medicine, Winston-Salem, NC); Albert P.Rocchini, M.D.(University of Michigan, C.S.Mott ChildrenÕs Hospital, Ann Arbor, MI); Bernard Rosner, Ph.D.(Harvard School of Public Health, Boston, MA); Alan Robert Sinaiko, M.D.(University of Minnesota Medical School, Minneapolis, MN); Nicolas Stettler, M.D., M.S.C.E. (The ChildrenÕs Hospital of Philadelphia, Philadelphia, PA); Elaine Urbina, M.D. (Cincinnati ChildrenÕs Hospital Medical Center, Cincinnati, OH) NATIONAL INSTITUTES OF HEALTH STAFF Edward J.Roccella, Ph.D., M.P.H. (National Heart, Lung, and Blood Institute, Bethesda, MD); Tracey Hoke, M.D., M.Sc.(National Heart, Lung, and Blood Institute, Bethesda, MD); Carl E. Hunt, M.D.(National Center on Sleep Disorders Research, National Heart, Lung, and Blood Institute, Bethesda, MD); Gail Pearson, M.D., Sc.D. (National Heart, Lung, and Blood Institute, Bethesda, MD)STAFF Joanne Karimbakas, M.S., R.D., and Ann Horton, M.S.(American Institutes for Research Health Program, Silver Spring, MD)FINANCIAL DISCLOSURESDr.Flynn has served as a consultant/ advisor for Pfizer Inc., AstraZeneca LP, ESP-Pharma, and Novartis Pharmaceuticals; he received funding/grant support for research projects from Pfizer, AstraZeneca, and Novartis.ACKNOWLEDGMENTSWe would like to thank the AmericanAcademy of Pediatrics for its help in dis- seminating this report.We appreciate the assistance by: Carol Creech, M.I.L.S., Heather Banks, M.A., and Angela Jehle (American Institutes for Research Health Program, Silver Spring, MD).iiiAcknowledgmentsAcknowledgments
PAGE – 6 ============
THE NATIONAL HIGH BLOOD PRESSURE EDUCATION PROGRAM COORDINATING COMMITTEE MEMBER ORGANIZATIONS American Academy of Family PhysiciansAmerican Academy of Insurance Medicine American Academy of Neurology American Academy of Ophthalmology American Academy of Physician Assistants American Association of Occupational Health NursesAmerican College of Cardiology American College of Chest Physicians American College of Occupational and Environmental MedicineAmerican College of PhysiciansÐAmerican Society of Internal MedicineAmerican College of Preventive Medicine American Dental Association American Diabetes Association American Dietetic Association American Heart Association American Hospital Association American Medical Association American Nurses Association American Optometric Association American Osteopathic Association American Pharmaceutical Association American Podiatric Medical Association American Public Health Association American Red CrossAmerican Society of Health-SystemPharmacistsAmerican Society of Hypertension American Society of Nephrology Association of Black Cardiologists Citizens for Public Action on High Blood Pressure and Cholesterol, Inc.Hypertension Education Foundation, Inc. International Society on Hypertension in BlacksNational Black Nurses Association, Inc. National Heart, Lung, and Blood InstituteAd Hoc Committee on Minority PopulationsNational Hypertension Association, Inc. National Kidney Foundation, Inc. National Medical Association National Optometric Association National Stroke Association Society for Nutrition Education The Society of Geriatric CardiologyFederal Agencies:Agency for Healthcare Research and Quality Centers for Medicare and Medicaid Services Department of Veterans Affairs Health Resources and Services Administration National Center for Health Statistics National Heart, Lung, and Blood Institute National Institute of Diabetes and Digestive and Kidney DiseasesivThe Fourth Report on the Diagnosis,Evaluation,and Treatment of High Blood Pressure in Children and Adolescents
PAGE – 8 ============
viThe Fourth Report on the Diagnosis,Evaluation,and Treatment of High Blood Pressure in Children and Adolescents List of Tables TABLE 1.Conditions Under Which Children <3 Years Old Should Have . . . . . . . . . . . . . . .5Blood Pressure Measured . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TABLE 2.Recommended Dimensions for Blood Pressure Cuff Bladders . . . . . . . . . . . . . . . .6TABLE 3.Blood Pressure Levels for Boys by Age and Height Percentile . . . . . . . . . . .10TABLE 4.Blood Pressure Levels for Girls by Age and Height Percentile . . . . . . . . . . .12TABLE 5.Classification of Hypertension in Children and Adolescents, . . . . . . . . . . . .14With Measurement Frequency and Therapy Recommendations . . . . . . .TABLE 6.Indications for Antihypertensive Drug Therapy in Children . . . . . . . . . . . . .14TABLE 7.Clinical Evaluation of Confirmed Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . .15TABLE 8.Examples of Physical Examination Findings Suggestive . . . . . . . . . . . . . . . . .20of Definable Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TABLE 9.Antihypertensive Drugs for Outpatient Management . . . . . . . . . . . . . . . . . . . . .28of Hypertension in Children 1Ð17 Years Old . . . . . . . . . . . . . . . . . . . . .TABLE 10.Antihypertensive Drugs for Management of Severe Hypertension . . . . . . .33in Children 1Ð17 Years Old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TABLE AÐ1.Demographic Data on Height/Blood Pressure Distribution Curves . . . . . .35by Study Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TABLE BÐ1.Regression Coefficients From Blood Pressure Regression Models . . . . . . .38List of FiguresFIGURE 1.Management Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
PAGE - 9 ============
This is the fourth report from the NationalHigh Blood Pressure Education Program (NHBPEP) Working Group on Children and Adolescents; it updates the previous pub- lication, Update on the Task Force Report (1987) on High Blood Pressure in Children and Adolescents (Pediatrics.1996;98:649Ð58).The purpose of this report is to update clini- cians on the latest recommendations concerning the diagnosis, evaluation, and treatment of hypertension in children; recom- mendations are based on English-language, peer-reviewed, scientific evidence (from 1997 to 2004) and the consensus expert opinion of the NHBPEP Working Group. This report includes new data from the1999Ð2000 National Health and Nutrition Examination Survey (NHANES), as well as revised blood pressure (BP) tables that include the 50th, 90th, 95th, and 99th percentiles by sex, age, and height.Hypertension in children and adolescents continues to be defined as systolic BP (SBP) and/or diastolic BP (DBP) that is, on repeated measurement, at or above the 95th percentile for sex, age, and height. BP between the 90th and 95th percentile in childhood is now termed ÒprehypertensionÓ and is an indication for lifestyle modifications. New guidelines are provided for the staging of hypertension in children and adolescents, as well as updated recommendations for diag- nostic evaluation of hypertensive children. In addition, the report evaluates the evidence of early target-organ damage in children andadolescents with hypertension; provides the rationale for early identification and treat- ment;and provides revised recommendations,based on recent studies, for the use of antihy- pertensive drug therapy.Treatment recom- mendations also include updated evaluation of nonpharmacologic therapies to reduce additional cardiovascular risk factors.The report describes how to identify hypertensive children who need additional evaluation for sleep disorders that may be associated with BP elevation.Dr.Bonita Falkner has our deep appreciation for leading the members of the NHBPEP Working Group in developing this new report. Dr.Falkner and the Working Group per- formed diligently and brilliantly to assemble this document in a timely manner.Applying these recommendations to clinical practice will address the important public health issue of improving inadequate BP control.Barbara M.Alving, M.D. Acting DirectorNational Heart, Lung, and Blood Institute and Chair National High Blood Pressure Education Program Coordinating CommitteeviiForewordForeword
PAGE - 11 ============
1IntroductionIntroductionConsiderable advances have been made indetection, evaluation, and management of high blood pressure, or hypertension, in chil- dren and adolescents.Because of the development of a large national database on normative blood pressure (BP) levels throughout childhood, the ability to identify children who have abnormally elevated BP has improved.On the basis of developing evidence, it is now apparent that primary hypertension is detectable in the young and occurs commonly.The long-term health risks for hypertensive children and adolescents can be substantial; therefore, it is important that clinical measures be taken to reduce these risks and optimize health outcomes.The purpose of this report is to update clini-cians on the latest scientific evidence regarding BP in children and to provide rec- ommendations for diagnosis, evaluation, and treatment of hypertension based on available evidence and consensus expert opinion of the Working Group when evidence was lacking.This publication is the fourth report from the National High Blood Pressure Education Program (NHBPEP) Working Group on Children and Adolescents and updates the previous 1996 publication, Update on theTask Force Report (1987) on High BloodPressure in Children and Adolescents.1This report includes the following information:New data, from the 1999Ð2000 National Health and Nutrition Examination Survey (NHANES), have been added to the child-hood BP database, and the BP data havebeen reexamined.The revised BP tables now include the 50th, 90th, 95th, and 99thpercentiles by sex, age, and height. Hypertension in children and adolescents continues to be defined as systolic BP (SBP) and/or diastolic BP (DBP) that is, on repeated measurement, at or above the 95th percentile.BP between the 90th and 95th percentile in childhood had been designated Òhigh normal.Ó To be consistent with the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), this level of BP will now be termed ÒprehypertensiveÓ and is an indi- cation for lifestyle modifications.2The evidence of early target-organ damage in children and adolescents with hyperten- sion is evaluated, and the rationale for early identification and treatment is provided.Based on recent studies, revised recommen- dations for use of antihypertensive drug therapy are provided.Treatment recommendations includeupdated evaluation of nonpharmacologic therapies to reduce additional cardiovas- cular risk factors.Information is included on the identification of hypertensive children who need addi- tional evaluation for sleep disorders.
440 KB – 60 Pages