Professional Statements and Societal Positions Guidelines
American Academy of Pediatrics-2017
The American Academy of Pediatrics published clinical guidelines for the screening and management of high blood pressure (BP) in children and adolescents. Table below lists recommendations made.
Table:
Recommendation | LOE | SOR |
'ABPM should be performed for confirmation of HTN in children and adolescents with office BP measurements in the elevated BP category for one (1) year or more or with stage one (1) HTN over three (3) clinic visits.' | C | Moderate |
'Routine performance of ABPM should be strongly considered in children and adolescents with high-risk conditions to assess HTN severity and determine if abnormal circadian BP patterns are present, which may indicate increased risk for target organ damage.' | B | Moderate |
'ABPM should be performed by using a standardized approach with monitors that have been validated in a pediatric population, and studies should be interpreted by using pediatric normative data.' | C | Moderate |
'Children and adolescents with suspected WCH should undergo ABPM.' | B | Strong |
American College of Cardiology et al-2017
The American College of Cardiology, with 10 other medical specialty societies, published guidelines on the prevention, detection, evaluation, and management of high BP in adults. Table below lists recommendations made.
Table:
Recommendations | COR | LOE |
'In adults with an untreated SBP greater than 130 mm Hg but less than 160 mm Hg or DBP greater than 80 mm Hg but less than 100 mm Hg, it is reasonable to screen for the presence of white coat hypertension by using either daytime ABPM or HBPM before diagnosis of hypertension' | IIa | B-NR |
'In adults with white coat hypertension, periodic monitoring with either ABPM or HBPM is reasonable to detect transition to sustained hypertension' | IIa | C-LD |
'In adults being treated for hypertension with office BP readings, not at goal and HBPM readings suggestive of a significant white coat effect, confirmation by ABPM can be useful' | IIa | C-LD |
'In adults with untreated office BPs that are consistently between 120 mm Hg and 129 mm Hg for SBP or between 75 mm Hg and 79 mm Hg for DBP, screening for masked hypertension with HBPM (or ABPM) is reasonable' | IIa | B-NR |
'In adults on multiple-drug therapies for hypertension and office BPs within 10 mm Hg above goal, it may be reasonable to screen for white coat effect with HBPM (or ABPM)' | IIb | C-LD |
American Heart Association 2022
In 2022, the American Heart Association updated its 2014 recommendations
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on routine ambulatory blood pressure monitoring (ABPM) in children and adolescents, which included the following:
- 'To confirm the diagnosis of hypertension in an individual with hypertension on the basis of clinic BP measurements:
- Distinguish between ambulatory hypertension and WCH [white coat hypertension].
- To better assess BP in an individual with clinic BP persistently in the elevated but not hypertensive range.
- To evaluate for possible masked hypertension when there is a clinical suspicion of hypertension, but clinic BP readings are normal or in the elevated BP range.
- To assess BP patterns in high-risk individuals:
- Assess for abnormal circadian variation in BP, such as abnormal dipping, or isolated nocturnal hypertension in individuals with diabetes, CKD [chronic kidney disease], solid-organ transplant, and severe obesity with or without sleep-disordered breathing.
- Assess the severity and persistence of BP elevation in individuals at high risk for hypertensive TOD [target organ damage].
- To optimize drug therapy for hypertension:
- Confirm BP control in treated individuals
- Evaluate for pseudo-resistant hypertension
- Determine if symptoms suggestive of hypotension can be confirmed as such.
- An ABPM device suitable for use in children should be selected:
- Only oscillometric or auscultatory ABP devices that have been validated according to American National Standards Institute (ANSI)/Association for the Advancement of Medical Instrumentation (AAMI)/International Organization for Standardization (ISO) should be used. The British Hypertension standard is acceptable for devices marketed before publication of the ANSI/AAMI/ISO standards.
- Appropriate cuff sizes as recommended in the 2017 CPG [clinical practice guideline] must be available for the device selected.'
U.S. Preventive Services Task Force (USPSTF) 2021
In 2021 the USPSTF commissioned a systematic review and reaffirmed its prior 2015 recommendations on screening for hypertension in adults. The following recommendation was given a grade A rating:
- 'The USPSTF recommends screening for high blood pressure in adults aged 18 years or older. The USPSTF recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment.'
The document further elaborated on the choice of office measurements, recommending ABPM as the reference standard for confirming the diagnosis of hypertension.
In 2021, the USPSTF issued updated recommendations for high BP screening in children and adolescents. Based on a systematic review of 42 studies, the USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for high BP in this population.
