As a clinical pharmacist, you will hear buzz about how to treat hypertension in children and adolescents, due to Hypertension guidelines. About 2% to 4% of children in have hypertension. Kids are considered hypertensive if their BP is at the 95th percentile or higher for their age, sex, and height, measured on at least 3 separate occasions.
Emphasize lifestyle changes first, and encourage the whole family to get on board. For example, suggest the 5-2-1-0 approach: 5 or more fruits and veggies, 2 hours max recreational screen time, 1 hour or more physical activity, 0 sugary drinks, and drinking more water every day. Suggest reasonable goals for overweight or obese kids, such as 5% to 10% weight loss in a year, or not gaining weight as they grow. Recommend drug therapy in kids 12 years or older if BP remains elevated for 6 months, or sooner in kids with diabetes, kidney disease, etc. Explain that kids under 12 should see a specialist first to check for underlying causes of their high blood pressure. Advise starting with an ACEI (lisinopril, etc), ARB (valsartan, etc), or long-acting dihydropyridine CCB (amlodipine, etc) for most kids. Lean toward a CCB for teenage girls, since ACEIs and ARBs are linked to severe fetal toxicity if used during pregnancy.
But stick with an ACEI or ARB for kids with diabetes or kidney disease with proteinuria to help slow nephropathy. In this case, educate teen girls about contraception. Advise saving beta-blockers as an alternative. Also caution about using them in kids with asthma or type 1 or 2 diabetes, and in athletes. Don't jump to thiazide diuretics as monotherapy, but they might be added to other antihypertensives if needed.
References
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Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM; 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 Sep;140(3):e20171904. Available at: https://publications.aap.org/pediatrics/article/140/3/e20171904/38358/Clinical-Practice-Guideline-for-Screening-and?autologincheck=redirected
Ferguson MA, Flynn JT. Rational use of antihypertensive medications in children. Pediatr Nephrol. 2014 Jun;29(6):979-88. Available at: https://link.springer.com/article/10.1007/s00467-013-2510-z
Goldberg EM, Levy PD. New Approaches to Evaluating and Monitoring Blood Pressure. Curr Hypertens Rep. 2016 Jun;18(6):49. Available at: https://link.springer.com/article/10.1007/s11906-016-0650-9
Dionne JM, Harris KC, Benoit G, Feber J, Poirier L, Cloutier L, Nakhla M, Rabi DM, Daskalopoulou SS, Fournier A; Hypertension Canada Guideline Committee. Hypertension Canada's 2017 Guidelines for the Diagnosis, Assessment, Prevention, and Treatment of Pediatric Hypertension. Can J Cardiol. 2017 May;33(5):577-585. Available at: https://www.onlinecjc.ca/article/S0828-282X(17)30112-5/fulltext
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