番茄社区

ANAHEIM -- New guidelines addressing adult hypertension were finally released here at the American Heart Association (AHA) annual meeting, yet anyone taking a close look at August's blood pressure guidelines from the American Academy of Pediatrics (AAP) should have seen what was coming.

Together, the two documents redefine what counts as high blood pressure and emphasize lifestyle changes across every age group. The new were published online in the journals Hypertension and Circulation.

"The plan was for the adult guideline to come out in the spring first but was delayed by SPRINT," according to Samuel Gidding, MD, of Nemours/A.I. Dupont Hospital for Children in Wilmington, Delaware. A pediatric cardiologist who sat on the writing committee of both guidelines, he told 番茄社区 that the pediatrics guideline actually came out a month ahead of schedule.

Blood pressure classification is now identical in teenagers (ages ≥13) and adults. The two groups share 120/80 mm Hg as the maximum cutoff for normal blood pressure, followed by 130/80 mm Hg for elevated blood pressure and 140/90 mm Hg for stage 1 hypertension. Anything over that threshold is now stage 2 hypertension.

Gidding's group slipped references to the adult guidelines in the document released in August. The pediatric recommendations highlighted "a simplified blood pressure classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology (ACC) adult blood pressure guidelines."

"Additionally, the term 'prehypertension' has been replaced by the term 'elevated blood pressure,' to be consistent with the AHA and ACC guideline and convey the importance of lifestyle measures to prevent the development of hypertension," guideline writers had hinted.

The lifestyle modifications recommended now for children and adults include weight loss, a healthy 'DASH' diet, reduced sodium intake, enhanced potassium intake (dietary, not via supplemental pills), physical activity, and moderate alcohol intake (men limited to two drinks daily; women one drink daily).

"Lifestyle modification is the cornerstone of the treatment of hypertension," said adult guideline vice-chair Robert Carey, MD, of University of Virginia Health System School of Medicine in Charlottesville, during an AHA press conference.

Of note, children with healthy weight have different definitions for hypertension, stage 1 spanning the 95th percentile of blood pressure to 12 mm Hg on top of that (or 130/80 mm Hg to 139/89 mm Hg, whichever is lower); and stage 2 being anything over that.

"There are still no data to identify a specific level of blood pressure in childhood that leads to adverse cardiovascular outcomes in adulthood. Therefore, the subcommittee decided to maintain a statistical definition for childhood hypertension," the writing committee wrote at the time.

Importantly, the adult and pediatrics guidelines are not to be treated as one and the same, suggested Dmitriy Feldman, MD, of Weill Cornell Medicine/New York-Presbyterian Hospital in New York City.

"The blood pressure categories and stages of hypertension are similar in adults and children, however, there are important differences with respect to diagnosis (e.g. blood pressure devices used in children should have been validated in pediatric age group), work up of hypertension with close attention to secondary causes of hypertension in children as well as intensity of follow-up in children with hypertension," he commented.

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