For the majority of children and adolescents, lifestyle modification in terms of dietary changes and increased physical activity is used to treat hypertension. However, this does not apply to patients with established second-degree hypertension and those with established first-degree hypertension and organ damage. In both groups, pharmacological treatment should be included.
In the course of our diagnosis of hypertension in children and adolescents, it is important to remember to correctly interpret the results of blood pressure measurements. The results of subsequent measurements should always be compared with the corresponding values on centile grids. These generally available grids significantly depend on the patient's age and gender and body height.
Anormal blood pressure is one that is below the 90th percentile. In this case, the next BP measurement should be taken at the next routine medical visit.
Prehypertension is diagnosed when the centile value of systolic or diastolic blood pressure is between the 90th and 95th percentile, or when blood pressure is >120/80mmHg. In this case, subsequent BP measurements should be repeated in 6 months.
First degree hypertension is diagnosed when the centile value of systolic or diastolic blood pressure is between the 95th and 99th centile + 5mmHg. In this case, repeat measurements, are taken within one week or even earlier.
Lastly, we diagnose second-degree hypertension when the centile value is >99th percentile +5mmHg. In this case, we refer the patient to a specialist centre, either within a week or immediately if there are symptoms of elevated blood pressure.
For patients with established first-degree hypertension and organ damage and for patients with second-degree hypertension - pharmacological treatment should be initiated. Our goal is to achieve blood pressure values below the 95th percentile. However, there is a group of patients for whom the goal of treatment, should be to achieve a blood pressure value of the 90th percentile. This group includes: patients with diabetes, patients with chronic kidney disease and those at increased risk of cardiovascular disease. In the treatment of hypertension in children and adolescents, we can use drugs of the following groups: diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and calcium channel blockers.
In the diabetic group, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are recommended. In the renal disease group, those with proteinuria, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are also used to protect renal function.
When we initiate pharmacological treatment in children and adolescents, we choose one preparation from an acceptable group of drugs. Treatment is started with a low dose and gradually increased until blood pressure control is achieved. If the expected effect is not achieved, we can add a second preparation from a different drug group.
The initiation of pharmacological treatment does not exempt us from monitoring for organ damage. In addition, it obliges us to check for adverse drug reactions.
When selecting drugs for pharmacological treatment of hypertension, it should also be borne in mind that hypotensive drugs have metabolic effects. The predominant phenotype in primary hypertension is visceral obesity and the metabolic syndrome. Consequently, the drugs of first choice should be converting enzyme inhibitors, angiotensin receptor blockers or calcium channel blockers. Beta adrenolytics and diuretics are rather avoided.
