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Mar.04.2021

Hypertension Comorbidity (Pediatric Inpatient)

Clinical Description

  • Care of the hospitalized child with a known history of hypertension.

Key Information

  • Hypertension in children is determined by age, height and sex.
  • Elevated blood pressure in children may be due to renal conditions, endocrine conditions or congenital heart disease. A growing number of children; however, are diagnosed with hypertension due to obesity, lack of exercise and unhealthy diets.
  • Children with hypertension rarely have signs or symptoms, even if blood pressure is dangerously high. For this reason, parents or children may interpret medication or risk factor modification unnecessary.
  • Use appropriate size cuff for accurate blood pressure reading. Bladder width should be approximately 40% of arm circumference. Bladder length should be 80-100% of the arm circumference.
  • If elevated blood pressure reading with oscillometric device, the reading should be repeated with auscultation. If using oscillometric devices, assure they are approved for use in the pediatric population.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Blood Pressure in Desired Range

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • Education: Comorbidity: Self-Management

Correlate Health Status

  • Correlate health status to:

    • history, comorbidity, congenital anomaly
    • age, developmental level
    • sex, gender identity
    • baseline assessment data
    • physiologic status
    • response to medication and interventions
    • psychosocial status, social determinants of health
    • barriers to accessing care and services
    • child and family/caregiver:
      • health literacy
      • cultural and spiritual preferences
    • safety risks
    • family interaction
    • plan for transition of care

Hypertension Comorbidity

Signs/Symptoms/Presentation

  • known history of hypertension
  • maintenance medication use

Problem Intervention

Maintain Blood Pressure Management

  • Evaluate adherence to home antihypertensive regimen (e.g., exercise and activity, diet modification, medication).
  • Provide scheduled antihypertensive medication; consider administration time and effects.
  • Monitor response to antihypertensive medication therapy (e.g., blood pressure, electrolyte levels, medication effects).

Associated Documentation

  • Medication Review/Management

Education

CPG-Specific Education Topics

Comorbidity: Self-Management

  • adherence to disease management plan

  • when to seek medical attention

General Education Topics

General Education

  • admission, transition of care

  • orientation to care setting, routine

  • advance care planning

  • diagnostic tests/procedures

  • diet modification

  • opioid medication management

  • oral health

  • medication management

  • pain assessment process

  • safe medication disposal

  • tobacco use, smoke exposure

  • treatment plan

Safety Education

  • call light use

  • equipment/home supplies

  • fall prevention

  • harm prevention

  • infection prevention

  • MDRO (multidrug-resistant organism) care

  • personal health information

  • resources for support

References

  • Baker-Smith, C.; Flinn, S. K.; Glynn, J. T.; Kaelber, D. C.; Blowey, D.; Carroll, A. E.; Daniels, S. R.; de Ferranti, S. D.; Dionne, J. M.; Falkner, B.; Gidding, S. S.; Goodwin, C.; Leu, M. G.; Powers, M. E.; Rea, C.; Samuels, J.; Simasek, M.; Thaker, V. V.; Urbina, E.; subcommittee on Screening and Management of High BP in Children. Diagnosis, Evaluation, and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2018;142(3) doi:10.1542/peds.2018-2096 Source[Clinical Practice Guidelines]
  • Bernardi, L.; France, M.; Xavier, A.; Novello, D. Interdisciplinarity as a strategy for the prevention of systemic arterial hypertension in children: a systematic review. Science & Collective Health. 2017;22(12) doi:10.1590/1413-812320172212.09052016 Source[Systematic Review]
  • Bricarello, L. P.; Poltronieri, F.; Fernandes, R.; Retondario, A; de Moraes Trindade, E. B. S.; de Vasconcelos, F. D. A. G. Effects of the dietary approach to stop hypertension (DASH) diet on blood pressure, overweight and obesity in adolescents: a systematic review. Clinical Nutrition ESPEN. 2018;28, 1-11. Source[Systematic Review]
  • Burrello, J.; Erhardt, E. M.; Saint-Hilary, G.; Veglio, F.; Rabbia, F.; Mulatero, P.; Monticone, S.; D'Ascenzo, F. Pharmacological Treatment of Arterial Hypertension in Children and Adolescents a Network Meta-analysis. Hypertension. 2018;72, 306-313. doi:10.1161/HYPERTENSIONAHA.118.10862 Source[Meta-analysis]
  • Chaturvedi, S.; Lipszyc, D. H.; Licht, C.; Craig, J. C.; Parekh, R. Pharmacological interventions for hypertension in children. Evidence-Based Child Health. 2014;9(3), 498-580. doi:10.1002/ebch.1974 [Metasynthesis,Meta-analysis,Systematic Review]
  • Chaudhuri, A.; Sutherland, S. M. Evaluation and management of elevated blood pressures in hospitalized children. Pediatric Nephrology. 2018;34, 1671-1681. doi:10.1007/s00467-018-4070-8 Source[Review Articles]
  • Farhangi, M. A.; Nikniaz, L.; Khodarahmi, M. Sugar-sweetened beverages increases the risk of hypertension among children and adolescence: a systematic review and dose-response meta-analysis. Journal of Translational Medicine. 2020;18 doi:10.1186/s12967-020-02511-9 Source[Meta-analysis]
  • Flynn, J. T.; Kaelber, D. C.; Baker-Smith, C. M.; Blowey, D.; Carroll, A. E.; Daniels, S. R.; Gidding, S. S. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3), e20171904. [Quality Measures,Clinical Practice Guidelines]
  • Flynn, J. T.; Kaelber, D. C.; Baker-Smith, C. M.; Blowey, D.; Carroll, A. E.; Daniels, S. R.; Gidding, S. S. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3), e20171904. [Quality Measures,Clinical Practice Guidelines]
  • Guzman-Limon, M.; Samuels, J. Pediatric Hypertension Diagnosis, Evaluation, and Treatment. Pediatric Clinics of North America. 2019;66, 45-57. doi:10.1016/j.pcl.2018.09.001 Source[Expert/Committee Opinion]
  • Harris, K. C.; Benoit, G.; Dionne, J.; Feber, J.; Cloutier, L.; Zarnke, K. B.; Padwal, R. S.; Rabi, D. M.; Fournier, A. Hypertension Canada's 2016 Canadian hypertension education program guidelines for blood pressure measurement, diagnosis, and assessment of risk of pediatric hypertension. Canadian Journal of Cardiology. 2016;32(5), 589-597. doi:http://dx.doi.org/10.1016/j.cjca.2016.02.075 [Quality Measures,Clinical Practice Guidelines]
  • Hockenberry, M. J.; Wilson, D.; Rodgers, C. C. (2019). Wong's nursing care of infants and children. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Leyvraz, M.; Chatelan, A.; da Costa, B. R.; Taffe´, P.; Paradis, G.; Bovet, P.; Bochud, M.; Chiolero, A. Sodium intake and blood pressure in children and adolescents; a systematic review and meta-analysis of experimental and observatinal studies. International Journal of Epidemiology. 2018;June 27, 1796-1810. doi:10.1093/ije/dyy121 Source[Meta-analysis,Systematic Review]
  • Lopilato, A. C.; Muratagic, M.; Patel, S. Pediatric hypertension:  A pharmacological review. AACN: Advanced Critical Care. 2017;26(2), 81-90. doi:10.1097/NCI.0000000000000084 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Lurbe, E.; Agabiti-Rosei, E.; Cruickshank, J. K.; Dominiczak, A.; Erdine, S.; Hirth, A.; Invitti, C.; Litwin, M.; Mancia, G.; Pall, D.; Rascher, W.; Redon, J.; Schaefer, F.; Seeman, T.; Sinha, M.; Stabouli, S.; Webb, N. J.; Wühl, E.; Zanchetti, A. European society of hypertension guidelines for the management of high blood pressure in children and adolscents. Journal of Hypertension. 2016;34(10), 1887. doi:10.1097/HJH.0000000000001039 [Quality Measures,Clinical Practice Guidelines]
  • Natsis, M.; Antza, C.; Doundoulakis, I.; Stabouli, S.; Kotsis, V. Hypertension in obesity: novel insights. Current Hypertension Reviews. 2020;16, 30-36. doi:10.2174/1573402115666190415154603 [Review Articles]
  • Nerenberg, K. A.; Zarnke, K. B.; Leung, A. A.; Dasgupta, K.; Butalia, S.; McBrien, K.; Lamarre-Cliche, M. Hypertension Canada's 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Canadian Journal of Cardiology. 2018;34(5), 506-525. [Quality Measures,Clinical Practice Guidelines]
  • Paczkowska, A.; Kopciuch, D.; Nowakowska, E.; Hoffmann, K.; Bryl, W. Compliance among adolescents with arterial hypertension. Advances in Clinical and Experimental Medicine. 2016;25(3), 441-448. doi:10.17219/acem/33838 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Patel, N.; Walker, N. Clinical assessment of hypertension in children. Clinical Hypertension. 2016;22(15) doi:10.1186/s40885-016-0050-0 Source[Expert/Committee Opinion]
  • Rabi, D. M.; McBrien, K. A.; Sapir-Pichhadze, R.; Makhla, M.; Ahmed, S. B.; Dumanski, S. M.; et al.. Hypertension Canada's 2020 comprehensive guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children. Canadian Journal of Cardiology. 2020;36, 596-624. doi:10.1016/j.cjca.2020.02.086 [Clinical Practice Guidelines]
  • Seravalle, G.; Grassi, G. Obesity and hypertension. Pharmacological Research. 2017;122, 1-7. Source[Review Articles]
  • Siddiqi, N.; Shataqt, I. F. Antihypertensive agents: a long way to safe drug prescribing in children. Pediatric Nephrology. 2020;35, 2049-2065. doi:10.1007/s00467-019-04314-7 Source[Review Articles]
  • Strilchuk, L.; Cincione, R. I.; Fogacci, F.; Cicero A. F. G. Dietary interventions in blood pressure lowering: current evidence in 2020. Kardiologia Polska. 2020;78(7-8), 659-666. doi:10.33963/KP.15468 [Review Articles]

Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.

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