Peds Assessment: High Blood Pressure

Front 1

What are the 2 purposes of the report on high BP in children and adolescents?

Back 1

-To update clinicians on the latest scientific evidence regarding blood pressure in children
-to provide recommendations for diagnosis, evaluation, and treatment of HTN

Front 2

The updated BP tables now include the 50th, ___, 95th, and 99th percentiles by __, __. and ___.

Back 2

90th; sex; age; height

Front 3

What is the definition of HTN in children and adolescents?

Back 3

Systolic BP AND/OR diastolic BP that is, on repeated measurements, at or above the 95th percentile.

Front 4

BP between the __ and __ percentile is now termed prehypertensive.

Back 4

90th and 95th

Front 5

What portion of the heart and other organ must be assessed in children with hypertension>?

Back 5

check for left ventricular wall hypertrophy and the eyes for AV knicking

Front 6

What disorder is often associated with HTN in children?

Back 6

sleep apnea

Front 7

What is the definition of hypertension in the slides?

Back 7

average SBP and/or DBP that is greater than or equal to the 95th percentile for sex, age, and height on 3 or more occasions

Front 8

Define prehypertension.

Back 8

Average SBP or DBP levels that are greater than or equal to the 90th percentile but less than the 95th percentile

Front 9

What is a new cut off for adolescents to be considered prehypertensive?

Back 9

120/80

Front 10

What is white coat hypertension?

Back 10

A patient with BP levels above the 95th percentile in a physician's office or clinic who is normotensive outside a clinic setting

Front 11

What is the proper method in diagnosing white coat hypertension?

Back 11

Ambulatory BP monitoring for 24 hours

Front 12

What are the proper directions to give a pt before checking BP?

Back 12

Have the patient sit up with their feet on the floor for 5 minutes.

Front 13

At what age should children have their BP checked?

Back 13

> 3 years old

Front 14

What is the preferred method of BP measurement?

Back 14

auscultation

Front 15

Getting the correct measurement for BP requires a ___ that is appropriate ___ of the child's upper arm

Back 15

cuff; size

Front 16

How should elevated BP be confirmed?

Back 16

Through repeated events

Front 17

BP > 90th percentile obtained by oscillometric devices should be repeated by ____/

Back 17

auscultation

Front 18

What aspects of the neonate would warrant a child under 3 having a BP check.

Back 18

Hx of prematurity, very low birthweight or other neonatal complications requiring intesive care.

Front 19

True or false: a child that is under 3 with repaired congenital heart disease does not require blood pressure checks.

Back 19

FALSE: they do

Front 20

LIst the renal issues that would warrant a child under age 3 having BP checks?

Back 20

=Recurrent UTIs, hematuria, proteinuria
=known renal disease or urologic malformation
=family history of congenital renal disease

Front 21

A child with a history of ICP will have HTN with a widened ___ ___.

Back 21

pulse pressure

Front 22

Should children under 3 who have solid organ transplants have BP checks?

Back 22

Yes

Front 23

T/F: malignancy and BMT are conditions in which children under age 3 would require BP checks?

Back 23

True

Front 24

True or false: a cuff that is too small for the patient will cause a decreased BP from the patients normal?

Back 24

FALSE: causes increased BP and thus false HTN

Front 25

Ambulatory BP monitoring if useful in the evaluation of...

Back 25

-white coat HTN
-Target organ injury risk
-Apparent drug resistance
-Drug-induced hypotension

Front 26

Ambulatory BP monitoring provides additional BP information in which disorders?

Back 26

-Chronic kidney disease
-Diabetes
-Autonomic dysfunction

Front 27

What are BP tables based on?

Back 27

sex, age, and height

Front 28

List the proper way to use a BP table.

Back 28

-use the standar height charts to determine the height percentile
- measure and record the child' SBP and DBP
-use the correct gender table for the SBP and DBP
-find the child's age on the left side of the table. Follow the age row horizontally across the table to the intersectino of the line for the height percentile
-For SBP percentile sin the left columns and for DBP percentiles in the right columns

Front 29

What percentile for BP is considered normal?

Back 29

<90th

Front 30

What is stage 1 HTN?

Back 30

the 95th percentile to the 99th percetnil plus 5mmHg

Front 31

Describe stage 2 HTN in terms of percentile.

Back 31

> 99th percentile plus 5mmHg

Front 32

What is the preferred follow-up for children with normal BP?

Back 32

Recheck at neck schedule physical examination

Front 33

If a child is recommended to have a BP check 6 months after an appointment, what might their BP have been?

Back 33

Prehypertensive

Front 34

If a child is found to have stage I HTN, what is the preferred recommendation for frequency of BP measurement?

Back 34

Recheck 1-2 weeks or sooner if the patient is symptomatic; if BP is persistently elevated on two additional occasions, evaluate or refer to source of care within one month

Front 35

If a child is evaluated or refered to source of care within 1 week or immediately for symptoms, what type of HTN might the child have?

Back 35

Type 2

Front 36

List the recommended therapeutic lifestyle changes for children with normal BP.

Back 36

-Encourage healthy diet
-sleep
-physical activity

Front 37

What are the patient recommendations for therapeutic lifestyle recommendations for children with pre/type 1 and type 2 HTN?

Back 37

Recommend weight management counseling if overweight, introduce physical activity and diet management

Front 38

What is the name of the Diet that is recommended for HTN patients?

Back 38

DASH diet with low salt and high fruits and veggies

Front 39

At what stage of HTN should the HCP not initiate pharmacologic therapy unless compelling indications are present?

Back 39

prehypertension

Front 40

What are some compelling indications that could cause pharmacologic therapy to be used for prehypertensive patients?

Back 40

Chronic Kidney disease
Diabetes mellitus
heart failure
left ventricular hypertrophy

Front 41

True or false: you should NOT initiate pharmacologic therapy with stage 1 HTN unless there are compelling indications.

Back 41

FALSE: you should initiate therapy based on indications for antiphyertensive medications

Front 42

The recommended pharmacologic therapy for stage 2 HTN in children is to ___ ___.

Back 42

initiate therapy

Front 43

List the indications for antihypertensive drug therapy in children.

Back 43

-symptomatic hypertension
-secondary HTN
-Heypertensive target-organ damage
-Diabetes
-persistent hypertension despite non-pharmacologic measures

Front 44

What exams should be done if a child with persistent BP > 95th percentile has a risk of renal disease and chronic pyelonepritis?

Back 44

BUN, creatinine, electrolytes, urinalysis, urine culture

Front 45

A CBC is done to check children with HTN who have a risk for which disorders?

Back 45

anemia, consistent with chronic renal disease

Front 46

Patients who have renal disease have a (low/high) erythropoetin level?

Back 46

LOW: leads to anemia

Front 47

What purpose would a renal ultrasound have for patients with persistent hypertension?

Back 47

Check for renal scarring congenital anomaly or disparate renal size

Front 48

What is the normal age range for children to have a fasting lipid panel, and a fasting glucose?

Back 48

9-11 years old

Front 49

What stages of HTN are indicated to have a fasting lipid panel and fasting glucose?

Back 49

Overweight patients with BP at 90th-94th percentiles; all patients with BP > 95th percentile;
Family history of HTN, cardiovascular disease or chronic renal disease

Front 50

Why should a drug screen be conducted for patients with HTN?

Back 50

To identify substances that might cause hypertension

Front 51

What is the name of the procedure used to identify sleep disorder in association with hypertension?

Back 51

polysomnography

Front 52

What is the target population for polysomnography?

Back 52

Any child with a history of loud, frequent snoring

Front 53

What exam would be done to identify cardiac involvement and the presence of left ventricular enlargement?

Back 53

Echocardiogram

Front 54

What is the target population for an echocardiogram with HTN?

Back 54

Patients with comorbid risk factors and BP at the 90th-94th, and all patients above the 95th percentile

Front 55

Why must patients with HTN seek medical attention from an ophthalmologist?

Back 55

To check for retinal vascular changes associated with HTN

Front 56

What does a plasma renin determination find?

Back 56

Identifies low renin, suggesting mineralcorticoid-related disease

Front 57

Which children should have a plasma renin determination done?

Back 57

Young children with stage 1 HTN and any child or adolescent with stage 2 and positive family history for severe HTN

Front 58

What tests are done to identify steroid-mediated hypertension?

Back 58

Plasma and urine steroid levels

Front 59

Plasma and urine catecholamines are used to identify what form of HTN?

Back 59

catecholamine-mediated HTN

Front 60

True or false: the younger the child is when HTN is diagnosed, the more likely you are to find a cause?

Back 60

TRUE: will find a coarctation of the aorta, renal or adrenal disorder

Front 61

Why are hypertension and prehypertension such significant health issues in children?

Back 61

The growing rate of obesity in children

Front 62

True or False: Secondary HTN is more common in children than in adults.

Back 62

TRUE

Front 63

Where should BP be measured when HTN is confirmed?

Back 63

In both arms and a leg

Front 64

children with what predisposing factors should be evaluated more closely for renovascular disease?

Back 64

-Umbilical artery catheter placements
-neurofibromatosis
-Look for cafe au lait spots

Front 65

What is the primary therapy for obesity-related hypertension?

Back 65

weight reduction

Front 66

What is the recommended amount of exercise that should happen daily?

Back 66

1 hour

Front 67

What type of intervention greatly improves success rates of therapy for obesity-related HTN?

Back 67

Family-based interventions

Front 68

What are the target organs for damage related to HTN?

Back 68

kidneys, eyes and heart