Title
Subscribe to the Magazine for free
Subscribe for free to keep reading! If you are already subscribed, enter your email address to log back in.
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.

How to Diagnose and Treat Pediatric Hypertension

Why This Was Updated?

Our specialists regularly review advancements in health and wellness, ensuring our articles are updated with the newest information as it becomes accessible.
Medically Reviewed by

Pediatric hypertension is a rising concern globally, bearing significant long-term health implications. Left unaddressed, it can lead to cardiovascular complications and other health issues in children. This guide aims to equip healthcare professionals and caregivers with comprehensive insights into diagnosing and treating pediatric hypertension effectively and collaboratively. By highlighting the importance of early detection and management, we aim to reduce the risks associated with hypertension in children.

[signup]

Understanding Pediatric Hypertension

Pediatric hypertension refers to elevated blood pressure in children and adolescents. The definition of pediatric hypertension consists of systolic and/or diastolic blood pressure levels that exceed the 95th percentile for age, sex, and height. Stage I hypertension is diagnosed if a child’s BP is greater than the 95th percentile but less than or equal to the 99th percentile plus 5 mm Hg. Stage II hypertension is diagnosed if a child’s BP is greater than the 99th percentile plus 5 mm Hg. There are two types of pediatric hypertension:

Understanding Primary Hypertension and Secondary Hypertension.
  • Primary hypertension refers to elevated blood pressure without an identifiable cause. It often occurs in children who are obese, older, have a family history of hypertension, and have elevated systolic blood pressure.Β Β 
  • Secondary hypertension refers to hypertension in children with an identifiable cause. It often occurs in younger children, and those with medical conditions like renal disease, an endocrine disorder, sleep apnea, and elevated diastolic blood pressure.Β 

The prevalence of pediatric hypertension has increased over recent decades, paralleling the rise in childhood obesity and increasingly sedentary lifestyles. It affects approximately 2-4% of children and adolescents, with higher rates observed in certain subpopulations such as those with obesity or a family history of hypertension. Risk factors include obesity, a family history of hypertension, a sedentary lifestyle, a high sodium diet, and certain medical conditions like diabetes and kidney disease.

Understanding pediatric hypertension involves recognizing its multifactorial etiology, assessing risk factors, and implementing appropriate management strategies tailored to individual patients. Early detection and intervention are vital to reduce the likelihood of long-term cardiovascular risks.

Risk Factors for Pediatric HypertensionΒ 

Genetic risk factors play a significant role in the development of hypertension in children, with a family history of hypertension being a strong predictor of future risk. Children born to parents with hypertension are more likely to inherit genetic predispositions that contribute to elevated blood pressure levels. Additional risk factors include certain genetic syndromes and mutations (e.g., Liddle syndrome, neurofibromatosis) and congenital heart disease.

Environmental factors also contribute to pediatric hypertension. Obesity, due to sedentary lifestyles and poor dietary habits, is a major environmental risk factor. High sodium intake, low potassium intake, and consumption of processed foods further increase the risk. Environmental exposures to metals such as lead, cadmium, mercury, and phthalates may also contribute to pediatric hypertension.

Early identification of at-risk children is paramount for effective prevention and intervention strategies. Regular blood pressure screenings should be performed during pediatric check-ups starting at 3 years of age, especially in children with known risk factors such as obesity or family history of hypertension and other risk factors as described above.Β Β 

Preventive measures, including lifestyle modifications and dietary interventions, can help mitigate the progression of hypertension in at-risk children. Encouraging regular exercise and activity, and promoting a balanced diet high in whole grains, legumes, fruits, and vegetables, and low in sodium are components of preventive strategies. Early intervention in children with elevated blood pressure levels can prevent the development of cardiovascular complications later in life.Β 

Signs and Symptoms of Hypertension in ChildrenΒ 

While some children may experience symptoms such as headaches, dizziness, or fatigue, most children with pediatric hypertension are asymptomatic, resulting in underdiagnosis. As a result, routine blood pressure screenings during pediatric check-ups are key for identifying hypertension in children, especially those at higher risk due to family history or obesity.

In some cases, symptoms like nosebleeds, seizures, blurry vision, or chest pain may raise the suspicion of hypertension, but these symptoms are not specific to the condition and can overlap with other health issues. Therefore, healthcare providers must maintain a high index of suspicion and include hypertension in the differential diagnosis for children presenting with relevant symptoms or risk factors.

Asymptomatic hypertension underscores the importance of proactive screening efforts, as it can otherwise go unnoticed until complications arise. Timely identification through regular blood pressure monitoring enables prompt intervention and management to prevent adverse cardiovascular outcomes in children.

Diagnosing Pediatric HypertensionΒ 

Diagnostic criteria for pediatric hypertension begin with obtaining an accurate history and clinical examination. The history should include information about any pre-natal and gestational events, social and lifestyle factors (e.g., activity, diet, screen time, sleeping habits), medical conditions, past or current medication use, and family history. The physical exam should consist of height and weight measurements and blood pressure measurements. Blood pressure should be measured using appropriate-sized cuffs and standardized procedures, with the child seated quietly for at least five minutes before measurement. Elevated readings should be confirmed during multiple clinic visits before diagnosing hypertension.

In addition to blood pressure measurements, further diagnostic evaluation may be necessary to evaluate any underlying cause of hypertension and assessment for organ damage.Β 

  • Blood work: Blood chemistry studies, such as a basic metabolic panel, include renal function tests. An elevated serum creatinine level may indicate renal disease. Low potassium (hypokalemia) may be indicative of an endocrine disorder like hyperaldosteronism. Additionally, more specific blood work may provide further insight and clues to diagnosis. For example, hormonal testing may reveal high plasma renin activity which indicates renal vascular hypertension and possibly coarctation of the aorta. Elevated levels of catecholamines are often diagnostic of pheochromocytoma or neuroblastoma, both of which may be correlated with secondary pediatric hypertension. Fasting lipid profiles or glucose tolerance tests may provide insight into metabolic syndrome in children.Β Β 
  • Urine testing: Urinalysis may help identify the renal etiology of hypertension such as chronic kidney disease. Urinalysis positive for blood or protein often indicates renal disease. The presence of catecholamines or its metabolites in urine may be diagnostic of pheochromocytoma or neuroblastoma. Urine sodium levels may be used as a marker for dietary intake.Β Β Β 
  • Imaging: Echocardiography is useful for evaluating cardiac structure and function, particularly in children with severe or refractory hypertension. Left ventricular hypertrophy reflects chronic hypertension and is an indication for starting or increasing pharmacologic treatment. Abdominal ultrasound helps to assess the renal vasculature, kidney anatomy, and any regional tumor contributing to hypertension.Β 
  • Additional diagnostic tests: A 24-hour ambulatory blood pressure monitoring. This shows blood pressure changes related to physical activity, while awake, and during sleep.Β Β 

Accurate diagnosis and comprehensive evaluation of pediatric hypertension are essential for guiding appropriate management strategies and minimizing long-term cardiovascular risks in affected children.

[signup]

Treatment Strategies for Pediatric Hypertension

Treating pediatric hypertension requires a comprehensive approach encompassing both non-pharmacological and pharmacological interventions, often within a multidisciplinary care framework.

Non-pharmacological treatment options serve as the foundation of pediatric hypertension management. Lifestyle modifications play a key role in reducing blood pressure levels and improving overall cardiovascular health. Some pediatricians and dieticians advocate the DASH (Dietary Approaches to Stop Hypertension) diet. The DASH diet emphasizes a diet low in saturated fats, sodium, and simple sugars, and high in fiber. It advocates dietary changes, such as reducing sodium intake and increasing consumption of fruits, vegetables, and whole grains, to help optimize blood pressure control. Encouraging regular physical activity and weight management are also key components, aiming to reduce obesity and enhance cardiovascular health in children with hypertension.

Pharmacological treatment may be necessary for children with persistent or severe hypertension despite lifestyle modifications. Antihypertensive medications commonly used in pediatric practice include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, and diuretics. The selection of medication depends on factors such as age, underlying medical conditions, and medication tolerability. Regular monitoring by clinicians for side effects, including electrolyte abnormalities and renal function, is imperative to ensure the safety and efficacy of pharmacotherapy in children.

Multidisciplinary care is essential for managing pediatric hypertension effectively. This approach involves collaboration among pediatricians, cardiologists, nephrologists, dietitians, and other healthcare professionals to provide comprehensive care tailored to the individual needs of each child. Multidisciplinary teams can offer expertise in various aspects of hypertension management, coordinate treatment plans, and address psychosocial factors impacting patient adherence and outcomes.

Furthermore, patient and family education are important components of pediatric hypertension management. Providing families with information about the importance of adherence to treatment regimens, lifestyle modifications, and regular follow-up appointments empowers them to actively participate in their child's care and promotes long-term success in blood pressure control.Β Β 

Treating pediatric hypertension requires a holistic approach encompassing non-pharmacological and pharmacological interventions, supported by multidisciplinary care and patient education. By addressing lifestyle factors, selecting appropriate antihypertensive medications, and fostering collaboration among healthcare providers and families, children with hypertension can achieve better blood pressure control and reduce cardiovascular risks.

Monitoring and Follow-UpΒ 

Regular monitoring of blood pressure and assessment of treatment efficacy are important components of managing pediatric hypertension effectively. Most pediatricians begin to monitor children’s blood pressure as early as 3 years of age during annual checkups. Regular monitoring enables early detection of elevated blood pressure and early intervention if needed.

Children diagnosed with hypertension require frequent blood pressure measurements to monitor treatment progress and control. Monitoring allows healthcare providers to track changes in blood pressure levels over time, assess response to treatment, adjust therapy strategy or dosage of medication, and identify any adverse effects of therapy. Routine monitoring also facilitates ongoing communication between healthcare providers, patients, and families to address any concerns or challenges related to hypertension management.Β  Remote blood pressure monitoring has been successfully used in the pediatric population.

Long-term follow-up strategies are essential to prevent complications and optimize outcomes in children with hypertension. These strategies encompass regular clinic visits, comprehensive cardiovascular assessments, and ongoing education and support for patients and families. Long-term follow-up aims to reduce the risk of cardiovascular events, monitor for the development of secondary hypertension or associated comorbidities, and promote compliance with lifestyle modifications and medication regimens.

Incorporating a multidisciplinary approach to long-term follow-up ensures comprehensive care and coordination among healthcare providers involved in the management of pediatric hypertension. Collaboration between pediatricians, cardiologists, nephrologists, dietitians, and other specialists facilitates comprehensive assessments, individualized treatment plans, and proactive interventions to address evolving needs and optimize long-term outcomes.

Preventing Pediatric HypertensionΒ 

Pediatric hypertension management encompasses a holistic approach that emphasizes preventive measures, public health initiatives, and early screening programs to promote cardiovascular health from an early age. Healthcare providers and caregivers play a pivotal role in implementing these strategies to mitigate the risk of hypertension and its associated complications in children.

Preventive measures focus on cultivating healthy lifestyle habits from infancy, including promoting breastfeeding, encouraging physical activity, and dietary habits rich in fruits, vegetables, legumes, and whole grains. Limiting sodium intake and minimizing exposure to processed foods and sugars also contribute to lowering the risk of hypertension in children.

Public health initiatives help raise awareness about pediatric hypertension and its modifiable risk factors within communities and schools. Some schools partner with their local health departments to provide educational campaigns, workshops, and community events to disseminate information about the importance of maintaining a healthy lifestyle and monitoring blood pressure regularly. Online initiatives such as Take2Heart also help raise awareness and educate families. Early screening programs are essential for detecting hypertension in children before complications arise. Healthcare providers advocate for routine blood pressure measurements during pediatric check-ups and school health screenings.

[signup]

Key Takeaways

The rising prevalence of pediatric hypertension is a significant contributor to morbidity. Early detection, accurate blood pressure measurements, and considering age, sex, and height percentiles, are crucial for diagnosis. Early interventions and lifestyle adjustments, particularly in primary hypertension, such as healthy eating and physical activity, are pivotal for managing hypertension and preventing long-term cardiovascular complications. Identifying the etiology of secondary hypertension promptly is vital to minimize its impact on a child’s health and prevent organ damage. Healthcare providers and caregivers play pivotal roles in promoting cardiovascular health from an early age, fostering a culture of prevention and proactive management. Through advocating for preventive measures and supporting early screening programs, they empower children and families to adopt lifelong habits conducive to good cardiovascular health.

Pediatric hypertension is a rising concern globally, bearing significant long-term health implications. If not addressed, it may contribute to cardiovascular complications and other health issues in children. This guide aims to equip healthcare professionals and caregivers with comprehensive insights into identifying and managing pediatric hypertension effectively and collaboratively. By highlighting the importance of early detection and management, we aim to reduce the risks associated with hypertension in children.

[signup]

Understanding Pediatric Hypertension

Pediatric hypertension refers to elevated blood pressure in children and adolescents. The definition of pediatric hypertension consists of systolic and/or diastolic blood pressure levels that exceed the 95th percentile for age, sex, and height. Stage I hypertension is identified if a child’s BP is greater than the 95th percentile but less than or equal to the 99th percentile plus 5 mm Hg. Stage II hypertension is identified if a child’s BP is greater than the 99th percentile plus 5 mm Hg. There are two types of pediatric hypertension:

Understanding Primary Hypertension and Secondary Hypertension.
  • Primary hypertension refers to elevated blood pressure without an identifiable cause. It often occurs in children who are obese, older, have a family history of hypertension, and have elevated systolic blood pressure.Β Β 
  • Secondary hypertension refers to hypertension in children with an identifiable cause. It often occurs in younger children, and those with medical conditions like renal disease, an endocrine disorder, sleep apnea, and elevated diastolic blood pressure.Β 

The prevalence of pediatric hypertension has increased over recent decades, paralleling the rise in childhood obesity and increasingly sedentary lifestyles. It affects approximately 2-4% of children and adolescents, with higher rates observed in certain subpopulations such as those with obesity or a family history of hypertension. Risk factors include obesity, a family history of hypertension, a sedentary lifestyle, a high sodium diet, and certain medical conditions like diabetes and kidney disease.

Understanding pediatric hypertension involves recognizing its multifactorial etiology, assessing risk factors, and implementing appropriate management strategies tailored to individual patients. Early detection and intervention are vital to reduce the likelihood of long-term cardiovascular risks.

Risk Factors for Pediatric HypertensionΒ 

Genetic risk factors play a significant role in the development of hypertension in children, with a family history of hypertension being a strong predictor of future risk. Children born to parents with hypertension are more likely to inherit genetic predispositions that contribute to elevated blood pressure levels. Additional risk factors include certain genetic syndromes and mutations (e.g., Liddle syndrome, neurofibromatosis) and congenital heart disease.

Environmental factors also contribute to pediatric hypertension. Obesity, due to sedentary lifestyles and poor dietary habits, is a major environmental risk factor. High sodium intake, low potassium intake, and consumption of processed foods further increase the risk. Environmental exposures to metals such as lead, cadmium, mercury, and phthalates may also contribute to pediatric hypertension.

Early identification of at-risk children is important for effective prevention and intervention strategies. Regular blood pressure screenings should be performed during pediatric check-ups starting at 3 years of age, especially in children with known risk factors such as obesity or family history of hypertension and other risk factors as described above.Β Β 

Preventive measures, including lifestyle modifications and dietary interventions, can help manage the progression of hypertension in at-risk children. Encouraging regular exercise and activity, and promoting a balanced diet high in whole grains, legumes, fruits, and vegetables, and low in sodium are components of preventive strategies. Early intervention in children with elevated blood pressure levels can help manage the risk of cardiovascular complications later in life.Β 

Signs and Symptoms of Hypertension in ChildrenΒ 

While some children may experience symptoms such as headaches, dizziness, or fatigue, most children with pediatric hypertension are asymptomatic, resulting in underdiagnosis. As a result, routine blood pressure screenings during pediatric check-ups are key for identifying hypertension in children, especially those at higher risk due to family history or obesity.

In some cases, symptoms like nosebleeds, seizures, blurry vision, or chest pain may raise the suspicion of hypertension, but these symptoms are not specific to the condition and can overlap with other health issues. Therefore, healthcare providers must maintain a high index of suspicion and include hypertension in the differential diagnosis for children presenting with relevant symptoms or risk factors.

Asymptomatic hypertension underscores the importance of proactive screening efforts, as it can otherwise go unnoticed until complications arise. Timely identification through regular blood pressure monitoring enables prompt intervention and management to support cardiovascular health in children.

Diagnosing Pediatric HypertensionΒ 

Diagnostic criteria for pediatric hypertension begin with obtaining an accurate history and clinical examination. The history should include information about any pre-natal and gestational events, social and lifestyle factors (e.g., activity, diet, screen time, sleeping habits), medical conditions, past or current medication use, and family history. The physical exam should consist of height and weight measurements and blood pressure measurements. Blood pressure should be measured using appropriate-sized cuffs and standardized procedures, with the child seated quietly for at least five minutes before measurement. Elevated readings should be confirmed during multiple clinic visits before diagnosing hypertension.

In addition to blood pressure measurements, further diagnostic evaluation may be necessary to evaluate any underlying cause of hypertension and assessment for organ function.Β 

  • Blood work: Blood chemistry studies, such as a basic metabolic panel, include renal function tests. An elevated serum creatinine level may indicate renal disease. Low potassium (hypokalemia) may be indicative of an endocrine disorder like hyperaldosteronism. Additionally, more specific blood work may provide further insight and clues to diagnosis. For example, hormonal testing may reveal high plasma renin activity which indicates renal vascular hypertension and possibly coarctation of the aorta. Elevated levels of catecholamines are often diagnostic of pheochromocytoma or neuroblastoma, both of which may be correlated with secondary pediatric hypertension. Fasting lipid profiles or glucose tolerance tests may provide insight into metabolic syndrome in children.Β Β 
  • Urine testing: Urinalysis may help identify the renal etiology of hypertension such as chronic kidney disease. Urinalysis positive for blood or protein often indicates renal disease. The presence of catecholamines or its metabolites in urine may be diagnostic of pheochromocytoma or neuroblastoma. Urine sodium levels may be used as a marker for dietary intake.Β Β Β 
  • Imaging: Echocardiography is useful for evaluating cardiac structure and function, particularly in children with severe or refractory hypertension. Left ventricular hypertrophy reflects chronic hypertension and is an indication for starting or increasing pharmacologic treatment. Abdominal ultrasound helps to assess the renal vasculature, kidney anatomy, and any regional tumor contributing to hypertension.Β 
  • Additional diagnostic tests: A 24-hour ambulatory blood pressure monitoring. This shows blood pressure changes related to physical activity, while awake, and during sleep.Β Β 

Accurate diagnosis and comprehensive evaluation of pediatric hypertension are essential for guiding appropriate management strategies and minimizing long-term cardiovascular risks in affected children.

[signup]

Treatment Strategies for Pediatric Hypertension

Managing pediatric hypertension requires a comprehensive approach encompassing both non-pharmacological and pharmacological interventions, often within a multidisciplinary care framework.

Non-pharmacological treatment options serve as the foundation of pediatric hypertension management. Lifestyle modifications play a key role in supporting healthy blood pressure levels and improving overall cardiovascular health. Some pediatricians and dieticians advocate the DASH (Dietary Approaches to Stop Hypertension) diet. The DASH diet emphasizes a diet low in saturated fats, sodium, and simple sugars, and high in fiber. It advocates dietary changes, such as reducing sodium intake and increasing consumption of fruits, vegetables, and whole grains, to help optimize blood pressure control. Encouraging regular physical activity and weight management are also key components, aiming to reduce obesity and enhance cardiovascular health in children with hypertension.

Pharmacological treatment may be necessary for children with persistent or severe hypertension despite lifestyle modifications. Antihypertensive medications commonly used in pediatric practice include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, and diuretics. The selection of medication depends on factors such as age, underlying medical conditions, and medication tolerability. Regular monitoring by clinicians for side effects, including electrolyte abnormalities and renal function, is important to ensure the safety and efficacy of pharmacotherapy in children.

Multidisciplinary care is essential for managing pediatric hypertension effectively. This approach involves collaboration among pediatricians, cardiologists, nephrologists, dietitians, and other healthcare professionals to provide comprehensive care tailored to the individual needs of each child. Multidisciplinary teams can offer expertise in various aspects of hypertension management, coordinate treatment plans, and address psychosocial factors impacting patient adherence and outcomes.

Furthermore, patient and family education are important components of pediatric hypertension management. Providing families with information about the importance of adherence to treatment regimens, lifestyle modifications, and regular follow-up appointments empowers them to actively participate in their child's care and promotes long-term success in blood pressure control.Β Β 

Managing pediatric hypertension requires a holistic approach encompassing non-pharmacological and pharmacological interventions, supported by multidisciplinary care and patient education. By addressing lifestyle factors, selecting appropriate antihypertensive medications, and fostering collaboration among healthcare providers and families, children with hypertension can achieve better blood pressure control and support cardiovascular health.

Monitoring and Follow-UpΒ 

Regular monitoring of blood pressure and assessment of treatment efficacy are important components of managing pediatric hypertension effectively. Most pediatricians begin to monitor children’s blood pressure as early as 3 years of age during annual checkups. Regular monitoring enables early detection of elevated blood pressure and early intervention if needed.

Children diagnosed with hypertension require frequent blood pressure measurements to monitor treatment progress and control. Monitoring allows healthcare providers to track changes in blood pressure levels over time, assess response to treatment, adjust therapy strategy or dosage of medication, and identify any adverse effects of therapy. Routine monitoring also facilitates ongoing communication between healthcare providers, patients, and families to address any concerns or challenges related to hypertension management.Β  Remote blood pressure monitoring has been successfully used in the pediatric population.

Long-term follow-up strategies are essential to support cardiovascular health and optimize outcomes in children with hypertension. These strategies encompass regular clinic visits, comprehensive cardiovascular assessments, and ongoing education and support for patients and families. Long-term follow-up aims to reduce the risk of cardiovascular events, monitor for the development of secondary hypertension or associated comorbidities, and promote compliance with lifestyle modifications and medication regimens.

Incorporating a multidisciplinary approach to long-term follow-up ensures comprehensive care and coordination among healthcare providers involved in the management of pediatric hypertension. Collaboration between pediatricians, cardiologists, nephrologists, dietitians, and other specialists facilitates comprehensive assessments, individualized treatment plans, and proactive interventions to address evolving needs and optimize long-term outcomes.

Preventing Pediatric HypertensionΒ 

Pediatric hypertension management encompasses a holistic approach that emphasizes preventive measures, public health initiatives, and early screening programs to promote cardiovascular health from an early age. Healthcare providers and caregivers play a pivotal role in implementing these strategies to mitigate the risk of hypertension and its associated complications in children.

Preventive measures focus on cultivating healthy lifestyle habits from infancy, including promoting breastfeeding, encouraging physical activity, and dietary habits rich in fruits, vegetables, legumes, and whole grains. Limiting sodium intake and minimizing exposure to processed foods and sugars also contribute to lowering the risk of hypertension in children.

Public health initiatives help raise awareness about pediatric hypertension and its modifiable risk factors within communities and schools. Some schools partner with their local health departments to provide educational campaigns, workshops, and community events to disseminate information about the importance of maintaining a healthy lifestyle and monitoring blood pressure regularly. Online initiatives such as Take2Heart also help raise awareness and educate families. Early screening programs are essential for detecting hypertension in children before complications arise. Healthcare providers advocate for routine blood pressure measurements during pediatric check-ups and school health screenings.

[signup]

Key Takeaways

The rising prevalence of pediatric hypertension is a significant contributor to health concerns. Early detection, accurate blood pressure measurements, and considering age, sex, and height percentiles, are crucial for identification. Early interventions and lifestyle adjustments, particularly in primary hypertension, such as healthy eating and physical activity, are pivotal for managing hypertension and supporting cardiovascular health. Identifying the etiology of secondary hypertension promptly is vital to minimize its impact on a child’s health and support organ function. Healthcare providers and caregivers play pivotal roles in promoting cardiovascular health from an early age, fostering a culture of prevention and proactive management. Through advocating for preventive measures and supporting early screening programs, they empower children and families to adopt lifelong habits conducive to good cardiovascular health.

The information provided is not intended to be a substitute for professional medical advice. Always consult with your doctor or other qualified healthcare provider before taking any dietary supplement or making any changes to your diet or exercise routine.
Learn More
No items found.

Lab Tests in This Article

1. Akgun, C., Dogan, M., Akbayram, S., Tuncer, O., Peker, E., Taskin, G., Arslan, S., & Arslan, D. (2010). The Incidence of Asymptomatic Hypertension in School Children. Journal of Nippon Medical School, 77(3), 160–165. https://doi.org/10.1272/jnms.77.160

2. American Academy of Pediatrics. (n.d.). Screening & Treating Kids for High Blood Pressure: AAP Report Explained. HealthyChildren.org. https://www.healthychildren.org/English/health-issues/conditions/heart/Pages/High-Blood-Pressure-in-Children.aspx

3. American Heart Association. (2010). Echocardiogram (Echo). Www.heart.org. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/echocardiogram-echo

4. Bell, C. S., Samuel, J. P., & Samuels, J. A. (2019). Prevalence of Hypertension in Children. Hypertension, 73(1), 148–152. https://doi.org/10.1161/hypertensionaha.118.11673

5. Blake, K. (2023, April 28). What Is a Heart Healthy Diet and Who Should Follow One? Rupa Health. https://www.rupahealth.com/post/what-is-a-heart-healthy-diet-and-who-should-follow-one

6. Christie, J. (2023, January 6). A functional medicine approach to obesity and weight management. Rupa Health. https://www.rupahealth.com/post/an-integrative-approach-to-obesity

7. Cohen, J. F. W., Lehnerd, M. E., Houser, R. F., & Rimm, E. B. (2017). Dietary Approaches to Stop Hypertension Diet, Weight Status, and Blood Pressure among Children and Adolescents: National Health and Nutrition Examination Surveys 2003-2012. Journal of the Academy of Nutrition and Dietetics, 117(9), 1437-1444.e2. https://doi.org/10.1016/j.jand.2017.03.026

8. Cleveland Clinic. (n.d.). Catecholamines Test: What It Is, Purpose & Procedure. Cleveland Clinic. https://my.clevelandclinic.org/health/diagnostics/22144-catecholamines-test

9. Cloyd, J. (2023a, April 4). Integrative Medicine Approach to Patients with Sleep Apnea. Rupa Health. https://www.rupahealth.com/post/integrative-medicine-approach-to-patients-with-sleep-apnea

10. Cloyd, J. (2023, April 10). A Functional Medicine Hypertension Protocol. Rupa Health. https://www.rupahealth.com/post/functional-medicine-hypertension-protocol

11. Cloyd, J. (2023c, July 3). The Role of Physical Activity in Promoting Heart Health. Rupa Health. https://www.rupahealth.com/post/the-role-of-physical-activity-and-exercise-in-promoting-heart-health-including-the-use-of-alternative-exercise-modalities-such-as-tai-chi-and-qigong

12. Feld, L. G., & Corey, H. (2007). Hypertension in Childhood. Pediatrics in Review, 28(8), 283–298. https://doi.org/10.1542/pir.28-8-283

13. Flynn, J. T., Daniels, S. R., Hayman, L. L., Maahs, D. M., McCrindle, B. W., Mitsnefes, M., Zachariah, J. P., & Urbina, E. M. (2014). Update: Ambulatory Blood Pressure Monitoring in Children and Adolescents. Hypertension, 63(5), 1116–1135. https://doi.org/10.1161/hyp.0000000000000007

14. Flynn, J., Zhang, Y., Solar-Yohay, S., & Shi, V. (2012). Clinical and Demographic Characteristics of Children With Hypertension. Hypertension, 60(4), 1047–1054. https://doi.org/10.1161/hypertensionaha.112.197525

15. Hansen, M. L., Gunn, P. W., & Kaelber, D. C. (2007). Underdiagnosis of Hypertension in Children and Adolescents. JAMA, 298(8), 874–879. https://doi.org/10.1001/jama.298.8.874

16. Houle, S. K. D., Chatterley, T., & Tsuyuki, R. T. (2014). Multidisciplinary approaches to the management of high blood pressure. Current Opinion in Cardiology, 29(4), 344–353. https://doi.org/10.1097/hco.0000000000000071

17. Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., Donahue, K., Doubeni, C. A., Epling, J. W., Kubik, M., Ogedegbe, G., Pbert, L., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B. (2020). Screening for High Blood Pressure in Children and Adolescents. JAMA, 324(18), 1878. https://doi.org/10.1001/jama.2020.20122

18. Kruizinga, M. D., Heide, N. van der, Moll, A., Zhuparris, A., Yavuz, Y., Kam, M. L. de, Stuurman, F. E., Cohen, A. F., & Driessen, G. J. A. (2021). Towards remote monitoring in pediatric care and clinical trialsβ€”Tolerability, repeatability and reference values of candidate digital endpoints derived from physical activity, heart rate and sleep in healthy children. PLOS ONE, 16(1), e0244877. https://doi.org/10.1371/journal.pone.0244877

19. Mayo Clinic. (2018). High blood pressure in children - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure-in-children/symptoms-causes/syc-20373440

20. Mayo Clinic. (2018b). Left ventricular hypertrophy - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/left-ventricular-hypertrophy/symptoms-causes/syc-20374314

21. Mayo Clinic. (2018b). Neuroblastoma - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/neuroblastoma/symptoms-causes/syc-20351017

22. Mayo Clinic. (2021, January 21). Neurofibromatosis - Symptoms and Causes. Mayo Clinic; Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/neurofibromatosis/symptoms-causes/syc-20350490

23. McCrindle, B. W., Urbina, E. M., Dennison, B. A., Jacobson, M. S., Steinberger, J., Rocchini, A. P., Hayman, L. L., & Daniels, S. R. (2007). Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents. Circulation, 115(14), 1948–1967. https://doi.org/10.1161/circulationaha.107.181946

24. Miliku, K., Moraes, T. J., Becker, A. B., Mandhane, P. J., Sears, M. R., Turvey, S. E., Subbarao, P., & Azad, M. B. (2021). Breastfeeding in the First Days of Life Is Associated With Lower Blood Pressure at 3 Years of Age. Journal of the American Heart Association, 10(15). https://doi.org/10.1161/jaha.120.019067

25. Mubarik, A., Anastasopoulou, C., Riahi, S., & Aeddula, N. R. (2022). Liddle Syndrome. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK536911/

26. Roche, S. L., Timberlake, K., Manlhiot, C., Balasingam, M., Wilson, J., George, K., McCrindle, B. W., & Kantor, P. F. (2016). Angiotensin‐Converting Enzyme Inhibitor Initiation and Dose Uptitration in Children With Cardiovascular Disease: A Retrospective Review of Standard Clinical Practice and a Prospective Randomized Clinical Trial. Journal of the American Heart Association, 5(5). https://doi.org/10.1161/jaha.116.003230

27. Rupa Health. (n.d.). Basic Metabolic Panel by BostonHeart Diagnostics. Rupa Health. Retrieved March 1, 2024, from https://www.rupahealth.com/lab-tests/bostonheart-basic-metabolic-panel

28. Rupa Health. (n.d.-b). Creatinine by Access Med Labs. Rupa Health. Retrieved March 1, 2024, from https://www.rupahealth.com/lab-tests/access-medical-labs-creatinine

29. Samuels, J., & Bell, C. (2018). Recognizing elevated blood pressure in pediatrics: the value of repeated measures. The Journal of Clinical Hypertension, 20(1), 183–185. https://doi.org/10.1111/jch.13163

30. Stotter, B. R., & Ferguson, M. A. (2018). Should ACE inhibitors and ARBs be used in combination in children? Pediatric Nephrology, 34(9), 1521–1532. https://doi.org/10.1007/s00467-018-4046-8

31. Thomas, J., Stonebrook, E., & Kallash, M. (2020). Pediatric hypertension: Review of the definition, diagnosis, and initial management. International Journal of Pediatrics and Adolescent Medicine. https://doi.org/10.1016/j.ijpam.2020.09.005

32. Weaver, D. J. (2019). Pediatric Hypertension: Review of Updated Guidelines. Pediatrics in Review, 40(7), 354–358. https://doi.org/10.1542/pir.2018-0014

33. Weinberg, J. (2023, July 12). Integrative Medicine Approach to Hyperaldosteronism: Blending Conventional and Complementary Therapies. Rupa Health. https://www.rupahealth.com/post/integrative-medicine-approach-to-hyperaldosteronism-blending-conventional-and-complementary-therapies

34. Weinberg, J. (2024, January 25). A Functional Medicine Approach to Pheochromocytoma. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-approach-to-pheochromocytoma

Subscribe to the Magazine for free to keep reading!
Subscribe for free to keep reading, If you are already subscribed, enter your email address to log back in.
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
See All Magazine Articles
Trusted Source
The Journal of Pediatrics
Peer Reviewed Journal
Visit Source
CDC
Government Authority
Visit Source
Office of Dietary Supplements
Government Authority
Visit Source
National Heart Lung and Blood Institute
Government Authority
Visit Source
National Institutes of Health
Government Authority
Visit Source
Clinical Infectious Diseases
Peer Reviewed Journal
Visit Source
Brain
Peer Reviewed Journal
Visit Source
The Journal of Rheumatology
Peer Reviewed Journal
Visit Source
Journal of the National Cancer Institute (JNCI)
Peer Reviewed Journal
Visit Source
Journal of Cardiovascular Magnetic Resonance
Peer Reviewed Journal
Visit Source
Hepatology
Peer Reviewed Journal
Visit Source
The American Journal of Clinical Nutrition
Peer Reviewed Journal
Visit Source
The Journal of Bone and Joint Surgery
Peer Reviewed Journal
Visit Source
Kidney International
Peer Reviewed Journal
Visit Source
The Journal of Allergy and Clinical Immunology
Peer Reviewed Journal
Visit Source
Annals of Surgery
Peer Reviewed Journal
Visit Source
The Journal of Neurology, Neurosurgery & Psychiatry
Peer Reviewed Journal
Visit Source
Chest
Peer Reviewed Journal
Visit Source
Blood
Peer Reviewed Journal
Visit Source
Gastroenterology
Peer Reviewed Journal
Visit Source
The American Journal of Respiratory and Critical Care Medicine
Peer Reviewed Journal
Visit Source
The American Journal of Psychiatry
Peer Reviewed Journal
Visit Source
Diabetes Care
Peer Reviewed Journal
Visit Source
The Journal of the American College of Cardiology (JACC)
Peer Reviewed Journal
Visit Source
The Journal of Clinical Oncology (JCO)
Peer Reviewed Journal
Visit Source
Journal of Clinical Investigation (JCI)
Peer Reviewed Journal
Visit Source
Circulation
Peer Reviewed Journal
Visit Source
JAMA Internal Medicine
Peer Reviewed Journal
Visit Source
PLOS Medicine
Peer Reviewed Journal
Visit Source
Annals of Internal Medicine
Peer Reviewed Journal
Visit Source
Nature Medicine
Peer Reviewed Journal
Visit Source
The BMJ (British Medical Journal)
Peer Reviewed Journal
Visit Source
The Lancet
Peer Reviewed Journal
Visit Source
Journal of the American Medical Association (JAMA)
Peer Reviewed Journal
Visit Source
Pubmed
Comprehensive biomedical database
Visit Source
Harvard
Educational/Medical Institution
Visit Source
Cleveland Clinic
Educational/Medical Institution
Visit Source
Mayo Clinic
Educational/Medical Institution
Visit Source
The New England Journal of Medicine (NEJM)
Peer Reviewed Journal
Visit Source
Johns Hopkins
Educational/Medical Institution
Visit Source