How to effectively treat hypertension in adolescents

Early attention to cardiovascular risk factors in children and adolescents helps prevent and delay the onset of hypertension-related cardiovascular complications. Pediatric and adolescent hypertension differs from adult hypertension primarily in its diagnostic criteria and the fact that a substantial proportion of cases are secondary in origin.

Clinical evaluation is the first step in managing hypertension in children and adolescents:

1. Identification of potential secondary causes of hypertension.

2. Classification (staging) of hypertension.

3. Assessment of coexisting diseases and risk factors, such as obesity, dyslipidemia, abnormal glucose metabolism, and sleep-disordered breathing.

4. Evaluation for target-organ damage. Because left ventricular hypertrophy is common in pediatric and adolescent hypertension, echocardiography should be included as part of the clinical assessment.

5. Ambulatory blood pressure monitoring is recommended if “white-coat hypertension” is suspected.

Nonpharmacologic interventions include:

Even children and adolescents with blood pressure within the normal range should be encouraged to engage in regular physical activity, consume a healthy diet, and ensure adequate sleep duration.

For overweight children and adolescents—or those with blood pressure at the high-normal range—weight control and dietary modification should be prioritized as first-line therapy.

Pharmacologic antihypertensive treatment should be considered on an individualized basis for patients with evidence of renal disease, diabetes mellitus, left ventricular hypertrophy, or those whose blood pressure falls within the high-normal or prehypertensive range.