pediatric hypertension guidelines

In reflecting on my time at the 2017 AHA Scientific Sessions, I can summarize my thought process about the new AHA Hypertension Guidelines as a complete 180.  When I first heard about the guidelines, my inner monologue went something like this:

“I don’t need to pay attention to these guidelines – they don’t affect me or my patients.  We already have separate pediatric guidelines.  Wasn’t there a new set of guidelines this year?  Maybe I should look at them a little closer…”

After reviewing the 2017 pediatric hypertension guidelines, I was pleasantly surprised how well they align with the AHA adult guidelines.  Of course, the pediatric guidelines are a little more complicated, since all of our patients have different cutoffs based on age, gender, and height.  And the cutoffs are now lower, due to the exclusion of overweight/obese children in the normative data.  But once our patients become adolescents, the cutoffs are the same as the new AHA adult guidelines.
After hearing that now nearly half of all U.S. adults will meet the diagnostic criteria for hypertension under the new guidelines, I realized: “OMG! Almost all of my patients are going to turn 13 and be hypertensive!”

Of course, as pediatric cardiologists, our patients are at especially high risk of cardiac events in adulthood, and the adult congenital heart disease population continues to grow every day, so we should be even more aware of hypertension as a significant risk factor for these children.  As Bradley Marino, MD (Chair of the Council on Cardiovascular Disease in the Young) stated during the CVDY Council Dinner, in light of current changes in the hypertension guidelines and national trends in increasing rates of obesity and heart disease-related morbidity, our role as pediatricians and cardiologists in prevention is becoming more and more important.

By the end of Scientific Sessions and in the weeks thereafter, I have become more cognizant and appreciative of my role in preventing my own patients from becoming hypertensive.  Of course, my ability to encourage lifestyle changes and long-term nutritional improvements is quite limited in the CVICU, but I am much more appreciative of my colleagues in the outpatient world and those who specialize in preventative pediatric cardiology.  I have also made a few lifestyle changes myself, since I am now uncomfortably close to meeting hypertension criteria.

David K. Werho, MD is an Assistant Clinical Professor at the University of California San Diego and a Pediatric Cardiac Intensivist at Rady Children’s Hospital – San Diego.  His research focuses on pediatric cardiac ICU outcomes as well as interventions and curriculum development in medical education.  He tweets @DWerho and contributes to the Pediatric Cardiac Intensive Care Society Newsletter as editor and contributor.