Canadian Journal of Cardiology

Hypertension Canada's 2017 Guidelines for the Diagnosis, Assessment, Prevention, and Treatment of Pediatric Hypertension

Published:March 16, 2017DOI:https://doi.org/10.1016/j.cjca.2017.03.007

      Abstract

      After the 2016 guidelines for blood pressure measurement, diagnosis, and investigation of pediatric hypertension, we now present evidence-based guidelines for the prevention and treatment of hypertension in children. These guidelines were developed by Hypertension Canada's Guideline Committee pediatric subgroup after thorough evaluation of the available literature. Included are 10 guidelines specifically addressing health behaviour management, indications for drug therapy in children with hypertension, choice of therapy for children with primary hypertension, and goals of therapy for children with hypertension. Although the pediatric literature is inherently limited by small numbers of participants, fewer trials, and a prolonged latency to the development of vascular outcomes, this report reflects the current and highest level of evidence and provides guidance for primary care practitioners on the management of pediatric hypertension. Studies of therapeutic lifestyle modifications in children are available to guide current management and more antihypertensive drugs have been studied in children since the Food and Drug Administration Modernization Act. Consistent with Hypertension Canada's guideline policy, diagnostic and therapeutic algorithm tools will be developed and the guidelines will be reviewed annually and updated according to new evidence.

      Résumé

      Après la publication, en 2016, des lignes directrices concernant la mesure, le diagnostic et l’évaluation de l’hypertension chez l’enfant, nous vous présentons maintenant les lignes directrices fondées sur des données probantes portant sur la prévention et le traitement de l’hypertension chez l’enfant. Ces lignes directrices ont été élaborées par le sous-groupe de médecine pédiatrique du comité des lignes directrices d’Hypertension Canada après une revue détaillée de la littérature médicale publiée à ce sujet. On retrouve 10 lignes directrices traitant des saines habitudes de vie, des indications de pharmacothérapie chez l’enfant atteint d’hypertension, du choix du traitement chez l’enfant atteint d’hypertension primaire et des objectifs thérapeutiques pour ce groupe de patients. Bien que la littérature médicale concernant les enfants comporte des limites inhérentes au faible nombre d’études disponibles, au peu de participants prenant part aux études et à l’importante période de latence entre le diagnostic et l’apparition de problèmes vasculaires, notre rapport s’appuie sur les plus récentes et les meilleures données probantes actuellement disponibles pour offrir aux intervenants de première ligne des indications sur la prise en charge de l’hypertension chez l’enfant. Diverses études sur la modification du mode de vie à des fins thérapeutiques chez l’enfant permettent désormais de guider les intervenants à ce chapitre et nous disposons également d’information sur un plus grand nombre d’antihypertenseurs ayant été étudiés chez l’enfant à la suite de l’adoption de la Food and Drug Administration Modernization Act aux États-Unis. Conformément à la politique sur les lignes directrices d’Hypertension Canada, nous élaborerons des algorithmes de diagnostic et de traitement de l’hypertension chez l’enfant et nous reverrons annuellement les lignes directrices en fonction des données probantes émergentes.
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