TABLE 7.

Clinical Evaluation of Confirmed Hypertension

Study or ProcedurePurposeTarget Population
Evaluation for identifiable causes
    History, including sleep history, family history, risk factors, diet, and habits such as smoking and drinking alcohol; physical examinationHistory and physical examination help focus subsequent evaluationAll children with persistent BP ≥95th percentile
    BUN, creatinine, electrolytes, urinalysis, and urine cultureR/O renal disease and chronic pyelonephritisAll children with persistent BP ≥95th percentile
    CBCR/O anemia, consistent with chronic renal diseaseAll children with persistent BP ≥95th percentile
    Renal U/SR/O renal scar, congenital anomaly, or disparate renal sizeAll children with persistent BP ≥95th percentile
Evaluation for comorbidity
    Fasting lipid panel, fasting glucoseIdentify hyperlipidemia, identify metabolic abnormalitiesOverweight patients with BP at 90th–94th percentile; all patients with BP ≥95th percentile; family history of hypertension or CVD; child with chronic renal disease
    Drug screenIdentify substances that might cause hypertensionHistory suggestive of possible contribution by substances or drugs.
    PolysomnographyIdentify sleep disorder in association with hypertensionHistory of loud, frequent snoring
Evaluation for target-organ damage
    EchocardiogramIdentify LVH and other indications of cardiac involvementPatients with comorbid risk factors* and BP 90th–94th percentile; all patients with BP ≥95th percentile
    Retinal examIdentify retinal vascular changesPatients with comorbid risk factors and BP 90th–94th percentile; all patients with BP ≥95th percentile
Additional evaluation as indicated
    ABPMIdentify white-coat hypertension, abnormal diurnal BP pattern, BP loadPatients in whom white-coat hypertension is suspected, and when other information on BP pattern is needed
    Plasma renin determinationIdentify low renin, suggesting mineralocorticoid-related diseaseYoung children with stage 1 hypertension and any child or adolescent with stage 2 hypertension
Positive family history of severe hypertension
Renovascular imagingIdentify renovascular diseaseYoung children with stage 1 hypertension and any child or adolescent with stage 2 hypertension
    Isotopic scintigraphy (renal scan)
    MRA
    Duplex Doppler flow studies
    3-Dimensional CT
    Arteriography: DSA or classic
    Plasma and urine steroid levelsIdentify steroid-mediated hypertensionYoung children with stage 1 hypertension and any child or adolescent with stage 2 hypertension
    Plasma and urine catecholaminesIdentify catecholamine-mediated hypertensionYoung children with stage 1 hypertension and any child or adolescent with stage 2 hypertension
  • BUN, blood urea nitrogen; CBC, complete blood count; R/O, rule out; U/S, ultrasound.

  • * Comorbid risk factors also include diabetes mellitus and kidney disease.