eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Hypertension: Follow-up

Author: Edwin Rodriguez-Cruz, MD, Assistant Professor, Department of Pediatrics, San Juan Bautista Medical School and Medical Center; Consulting Interventional/Clinical Pediatric Cardiologist, Department of Pediatrics, Hospital El Maestro and San Juan Bautista Medical Center; Consulting Interventional/Clinical Pediatric Cardiologist, Department of Cardiology, Cardiovascular Center of Puerto Rico and the Caribbean and Veterans Affairs Hospital and Medical Center of Puerto Rico
Coauthor(s): Leigh M Ettinger, MD, MS, Clinical Assistant Professor, Division of Pediatric Nephrology, The Joseph M Sanzari Children's Hospital, Hackensack University Medical Center; Adrian Spitzer, MD, Professor, Department of Pediatrics, Albert Einstein College of Medicine; Director of NIH Training Program, Children's Hospital at Montefiore Medical Center
Contributor Information and Disclosures

Updated: Nov 16, 2009

Follow-up

Further Outpatient Care

  • Closely monitor patients with hypertension, particularly during the initial phase of therapy. A chemistry panel should be checked after therapy with an ACE inhibitor or an angiotensin II receptor blockers (ARBs) is started or increased.
  • The frequency of visits is dictated by various factors, including the following:
    • Degree of control
    • Extent of understanding of the disease and its treatment by both the parents and/or caregivers and the patient
    • Adherence to nonpharmacologic and pharmacologic treatments
    • Ability to properly monitor blood pressure (BP) at home
    • Likelihood of drug adverse effects
    • Need to monitor for complications of hypertension
    • Need to monitor for weight loss
  • After surgical or catheter treatment of coarctation of the aorta, patients must be monitored yearly with accurate measurement of systolic and diastolic pressures in the right arm. For these measurements, the patient should be properly positioned. Systolic pressures in both the right arm and leg should be obtained with the patient supine. Remember that systolic pressure in the lower leg should exceed that in the arm.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize remediable causes of hypertension, especially coarctation of the aorta in a symptomatic infant
  • Failure to properly advise the parents and/or caregivers and child about restriction of exercise, when appropriate
  • Failure to inform parents and/or caregivers and child about the potential adverse effects of medication
  • Failure to inform parents and/or caregivers and child about the potential complications of persistent hypertension
 


More on Hypertension

Overview: Hypertension
Differential Diagnoses & Workup: Hypertension
Treatment & Medication: Hypertension
Follow-up: Hypertension
Multimedia: Hypertension
References
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References

  1. [Guideline] Task Force. Report of the Second Task Force on Blood Pressure Control in Children--1987. Task Force on Blood Pressure Control in Children. National Heart, Lung, and Blood Institute, Bethesda, Maryland. Pediatrics. Jan 1987;79(1):1-25. [Medline].

  2. [Guideline] Task Force. Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. National High Blood Pressure Education Program Working Group on Hypertension Control. Pediatrics. Oct 1996;98(4 Pt 1):649-58. [Medline].

  3. [Guideline] NHLBI. 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. Aug 2004;114(2 Suppl 4th Report):555-76. [Medline]. [Full Text].

  4. Gruskin AB. Factors affecting blood pressure. In: Drukker A, Gruskin AB, eds. Pediatric Nephrology: Pediatric and Adolescent Medicine. 3rd ed. Basel, Switzerland: Karger; 1995:1097.

  5. Hanevold C, Waller J, Daniels S, Portman R, Sorof J. The effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics. Feb 2004;113(2):328-33. [Medline].

  6. [Guideline] University of Michigan Health System. Essential hypertension. Ann Arbor (MI): University of Michigan Health System; 2009 Feb. [Full Text].

  7. Bartosh SM, Aronson AJ. Childhood hypertension. An update on etiology, diagnosis, and treatment. Pediatr Clin North Am. Apr 1999;46(2):235-52. [Medline].

  8. Falkner B, Gidding SS, Portman R, Rosner B. Blood pressure variability and classification of prehypertension and hypertension in adolescence. Pediatrics. Aug 2008;122(2):238-42. [Medline].

  9. Gerber LM, Stern PM. Relationship of body size and body mass to blood pressure: sex-specific and developmental influences. Hum Biol. Aug 1999;71(4):505-28. [Medline].

  10. Hindmarsh PC, Brook CG. Evidence for an association between birth weight and blood pressure. Acta Paediatr Suppl. Feb 1999;88(428):66-9. [Medline].

  11. Lauer RM, Connor WE, Leaverton PE, Reiter MA, Clarke WR. Coronary heart disease risk factors in school children: the Muscatine study. J Pediatr. May 1975;86(5):697-706. [Medline].

  12. Moore VM, Cockington RA, Ryan P, Robinson JS. The relationship between birth weight and blood pressure amplifies from childhood to adulthood. J Hypertens. Jul 1999;17(7):883-8. [Medline].

  13. Simsolo RB, Romo MM, Rabinovich L, et al. Family history of essential hypertension versus obesity as risk factors for hypertension in adolescents. Am J Hypertens. Mar 1999;12(3):260-3. [Medline].

  14. Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics. Mar 2004;113(3 Pt 1):475-82. [Medline].

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Further Reading

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Keywords

hypertension, pediatric hypertension, infantile hypertension, adolescent hypertension, prehypertension, high blood pressure, high BP, elevated BP, hypertensive, prehypertensive, white-coat hypertension, treatment, diagnosis

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Contributor Information and Disclosures

Author

Edwin Rodriguez-Cruz, MD, Assistant Professor, Department of Pediatrics, San Juan Bautista Medical School and Medical Center; Consulting Interventional/Clinical Pediatric Cardiologist, Department of Pediatrics, Hospital El Maestro and San Juan Bautista Medical Center; Consulting Interventional/Clinical Pediatric Cardiologist, Department of Cardiology, Cardiovascular Center of Puerto Rico and the Caribbean and Veterans Affairs Hospital and Medical Center of Puerto Rico
Edwin Rodriguez-Cruz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Heart Association, American Medical Association, American Society of Echocardiography, Puerto Rico Medical Association, Society of Cardiac Angiography and Interventions, and Society of Pediatric Echocardiography
Disclosure: Nothing to disclose.

Coauthor(s)

Leigh M Ettinger, MD, MS, Clinical Assistant Professor, Division of Pediatric Nephrology, The Joseph M Sanzari Children's Hospital, Hackensack University Medical Center
Disclosure: Nothing to disclose.

Adrian Spitzer, MD, Professor, Department of Pediatrics, Albert Einstein College of Medicine; Director of NIH Training Program, Children's Hospital at Montefiore Medical Center
Adrian Spitzer, MD is a member of the following medical societies: American Academy of Pediatrics, American Federation for Medical Research, American Pediatric Society, American Society of Nephrology, American Society of Pediatric Nephrology, International Society of Nephrology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Ira H Gessner, MD, Professor Emeritus, Pediatric Cardiology
Ira H Gessner, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

John W Moore, MD, MPH, Professor of Clinical Pediatrics, Section of Pediatric Cardiology, Department of Pediatrics, University of California San Diego School of Medicine; Director of Cardiology, Rady Children's Hospital
John W Moore, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

CME Editor

Gilbert Z Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center
Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM, Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine
Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association
Disclosure: Nothing to disclose.

 
 
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