Hypertension in Children: Motivating Improvement in Clinical Practice

Hypertension in children is a common and serious problem associated with target organ damage including left ventricular hypertrophy (LVH), increased carotid intima-media thickness (CIMT), and microalbuminuria. Unfortunately, there is ample evidence that the problem goes unrecognized in clinical practice. There are multiple reasons for this including the complexity of blood pressure standards in children, a lack of knowledge among clinicians, skepticism about the importance of hypertension in children, conflicting screening recommendations, and discomfort among clinicians, patients, and families with pharmacotherapy. Strategies to improve rates of diagnosis include clinical decision support systems, educational programs, and incorporating diagnosis and management of hypertension into a broader strategy to address weight and lifestyle among overweight and obese children. Furthermore, evidence about the long-term impact of hypertension in children is emerging and should motivate improved screening, diagnosis, and management according to established guidelines.