A Call for Australian Clinical Practice Guidelines for Paediatric Hypertension

At present there are no national guidelines for the detection and management of hypertension in children and adolescents in Australia. This is a significant gap given that there is substantial and growing evidence linking high blood pressure (BP) in childhood and adolescence with end organ damage, cardiovascular risk factors in adulthood, and overt cardiovascular disease in mid-adulthood. Hypertensive children and adolescents often have evidence of end organ damage, including left ventricular hypertrophy and subclinical cardiac dysfunction, increased arterial stiffness and carotid intima-media thickness , and retinal microvascular rarefaction. Furthermore, childhood BP levels track into adulthood, and higher childhood BP is predictive of hypertension and ongoing signs of end organ damage in young- to mid-adulthood, including reduced cognitive function. Last year, data from the International Childhood Cardiovascular Cohort (i3c) consortium published in the New England Journal of Medicine revealed direct associations between elevated blood pressure in childhood and fatal and non-fatal events in mid-adulthood. In absolute terms it was reported that 8%–10% of children in the 1970s to 1990s with elevated or hypertensive BP experienced an event in adulthood, compared with 3% for those with low or normal BP .

Given these data, the 75% increase in global prevalence of high BP in children and adolescents from 2000 to 2015 is concerning. Whilst the rise in obesity explains much of this trend (with hypertension occurring in 15% of obese children), it remains that hypertensive BP is found in approximately 1 in 50 normal weight children. In addition, certain groups are known to have higher risk of elevated BP, and therefore should be more closely monitored, including those with chronic kidney disease, diabetes mellitus, sleep disordered breathing or a history of aortic coarctation or prematurity...