Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study

David C. Kaelber; Weiwei Liu; Michelle Ross; A. Russell Localio; Janeen B. Leon; Wilson D. Pace; Richard C. Wasserman; Alexander G. Fiks; for the Comparative Effectiveness Research Through Collaborative Electronic Reporting (CER2) Consortium

doi:10.1542/peds.2016-2195

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RE: Dx and Rx of Pediatric Hypertension
Dmitri De la Cruz

Published on: 14 December 2016
RE: Chinese Guideline for Hypertension in Children: Reality and Necessity
Li Yongjun

Published on: 08 December 2016

Published on: (14 December 2016)

RE: Dx and Rx of Pediatric Hypertension
Dmitri De la Cruz, Pediatrician, Community Clinic
The methods did not clarify whether electronic or manual B/P were measured. In my experience there are significant differences which are not only technical but there may also be a component of white-coat HTN when the patient is in the triage room vs. settled down in the exam room. Further, if 3 manual blood pressures (which unfortunately, are measured on a typical circular small dial rather than the standard columnar sphygmomanometer) are elevated, then the patient is referred for ambulatory blood pressure measurements at home. This selects the true elevated pressures from white-coat ones.

Competing Interests: None declared.
Published on: (8 December 2016)

RE: Chinese Guideline for Hypertension in Children: Reality and Necessity
Li Yongjun, pediatrician, Shengjing Hospital of China Medical University
Blood pressure cutoff for hypertension in children is important to pediatric clinicians to make a definite diagnosis for their patients. In china, the most widely accepted clinical criteria for the diagnosis of hypertension in children is the Fourth Report on the Evaluation of the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents published by the U.S. National High Blood Pressure Education Program(NHBPEP) [1]. I wonder whether the U.S.-based data may be accurately applied in China because different racial and ethnic groups have diffrent features of BP level and prevalence of hypertension[2,3].In recent years, Chinese scholars have attempted to develop our own BP tables for diagnosing hypertensionin children and adolescents. In 2010, Mi J et al reviewed the large Chinese epidemiological surveys involving 112227 children and developped the blood pressure reference standards for Chinese children[4]. In 2015, Bo X et al established international blood pressure references among non-overweight children and adolescents aged 6-17 years based on seven nationally representative data (China, India, Iran, Korea, Poland, Tunisia and USA)[5]. Anyhow, it is a dilemma because there is no concensus on the diagnosis criteria. The reality is the recommended standards for assessing blood pressure in Chinese children is still a major focus. And I believe, our task is not to examine the guidelines for diagnosis and initial medication management of abnormal...
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Blood pressure cutoff for hypertension in children is important to pediatric clinicians to make a definite diagnosis for their patients. In china, the most widely accepted clinical criteria for the diagnosis of hypertension in children is the Fourth Report on the Evaluation of the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents published by the U.S. National High Blood Pressure Education Program(NHBPEP) [1]. I wonder whether the U.S.-based data may be accurately applied in China because different racial and ethnic groups have diffrent features of BP level and prevalence of hypertension[2,3].In recent years, Chinese scholars have attempted to develop our own BP tables for diagnosing hypertensionin children and adolescents. In 2010, Mi J et al reviewed the large Chinese epidemiological surveys involving 112227 children and developped the blood pressure reference standards for Chinese children[4]. In 2015, Bo X et al established international blood pressure references among non-overweight children and adolescents aged 6-17 years based on seven nationally representative data (China, India, Iran, Korea, Poland, Tunisia and USA)[5]. Anyhow, it is a dilemma because there is no concensus on the diagnosis criteria. The reality is the recommended standards for assessing blood pressure in Chinese children is still a major focus. And I believe, our task is not to examine the guidelines for diagnosis and initial medication management of abnormal BP in pediatric patients are routinely followed or not, which is discussed by Kaelber DC et al[6].Instead, we shoud rethink our Chinese guidelines for diagnosis, and I believe that is a necessity.
References
[1]National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 suppl 4th report):555-576
[2]Rosner B, Cook N, Portman R, Daniels S, Falkner B: Blood pressure differences by ethnic group among United States children and adolescents. Hypertension 2009, 54(3):502-508.
[3]Suglia SF, Clark CJ, Gary-Webb TL.Adolescent Obesity, Change in Weight Status, and HypertensionNovelty and Significance Racial/Ethnic Variations.Hypertension 2013, 61(2):290-295.
[4]Mi J, Wang T, Meng L, ,et al.Development of blood pressure reference standards for Chinese children.Chin J Evid Based Pediatr 2010, 5(1):4-14.
[5]Xi B, Zong X, Kelishadi R,et al. Establishing International Blood Pressure References Among Non-Overweight Children and Adolescents Aged 6-17 Years. Circulation 2015 Dec15. Epub 2015 Dec 15.
[6]Kaelber DC, Liu W, Ross M,et al. Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study.Pediatrics Dec 2016, 138 (6) e2016219.
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Competing Interests: None declared.