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Dr. David Kaelber Chairs National Committee on Identifying High Blood Pressure in Children

Included in a release from the American Academy Of Pediatrics

During a visit to the pediatrician, it’s common for parents to ask if their child’s height and weight is normal for their age range. However, blood pressure doesn’t come up as often.

A national committee co-chaired by Dr. David Kaelber has published new guidelines on identifying and treating high blood pressure in children and adolescents, which he hopes will start a conversation among providers and parents.

The American Academy of Pediatrics’ (AAP) Subcommittee on Screening and Management of High Blood Pressure in Children has released the report “Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.” This is the first set of guidelines for high blood pressure in children developed by the Academy. The report will be published in the September 2017 issue of Pediatrics.

An estimated 3.5 percent of all children and adolescents have high blood pressure. The prevalence of pediatric hypertension has increased since 1988, and yet the condition often goes undiagnosed and untreated, according to the report.

“We do a good job of checking blood pressure when patients come to the pediatrician’s office. We have lots of improvement -- especially nationally and even at MetroHealth -- on interpreting the numbers,” said Dr. Kaelber, a MetroHealth pediatrician.

Blood pressure is checked nearly every time a child sees a provider, especially at regular preventive or well child care visits. Although the information is usually recorded, it oftentimes isn’t reviewed as a pattern to see if there is an issue.

The Academy convened a 20-person committee to develop the new evidence-based guidelines on pediatric hypertension, which serve as an update to the most recent set of guidelines, issued in 2004 by the National Heart, Lung, and Blood Institute that was endorsed by AAP. The committee reviewed approximately 15,000 articles published since 2004 as part of its work – including a 2007 study published by Dr. Kaelber and MetroHealth researchers. “Because of our data experience, we have a national role in the way people tackle pediatric hypertension,” he said.

The new report focuses on the diagnosis, evaluation and initial management of abnormal blood pressures in children and adolescents.

The guidelines include new blood pressure tables that are based on normal-weight children. Previously, such tables included blood pressure measurements in children and adolescents who are overweight or obese – a condition that is likely to increase blood pressure. As a result, the new blood pressure values are lower than those used in prior guidelines and allow for a more precise classification of blood pressure according to body size.

“Prevention and early detection are key,” said Dr. Joseph Flynn, who co-chaired the subcommittee. “High blood pressure levels tend to carry into adulthood, raising the risks for cardiovascular disease and other problems. By catching the condition early, we are able to work with the family to manage it, whether that’s through lifestyle changes, medication, or a combination of treatments.”

The AAP guidelines recommend that pediatricians:

  • Perform routine blood pressure measurements only at annual preventive care visits.

  • Follow a simpler screening table that identifies blood pressures needing further evaluation.

  • Follow a simplified blood pressure classification for adolescents age 13 or older that aligns with forthcoming guidelines from the American Heart Association and American College of Cardiology.

  • Use 24-hour ambulatory blood pressure monitoring to more exactly diagnose hypertension.

  • Start blood pressure-lowering medications if lifestyle changes fail to reduce the blood pressure, or if the child has another condition like diabetes or kidney disease.

Left untreated, uncontrolled long-standing hypertension can have damaging ef­fects on the heart, kidneys, and brain. The first-line treatment remains lifestyle changes, as there is a high correlation between hypertension and obesity.

“If there is diagnosis of hypertension, there are many ways we can treat it. These guidelines offer a renewed opportunity for pediatricians to identify and address this important – and often unrecognized – chronic disease in our patients,” Dr. Kaelber said. “The easy part was developing the new guidelines. Now we begin the harder work of implementing them to help children and adolescents.”

Dr. Kaelber said that for colleagues and providers at MetroHealth, he hopes the new guidelines will make the collection of blood pressure readings in children less complicated. “Let’s collect less data, but more importantly, evaluate it when we do.”