High BP in Most Kids Can Be Controlled

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BALTIMORE—New data demonstrate that BP can be successfully managed in most adolescents who have essential hypertension.

The findings, described here at the Pediatric Academic Societies Annual Meeting 2009, also show that a single medication is usually sufficient to achieve BP control.

Amy DiPietro, MD, a resident in the divisions of pediatrics and internal medicine at Penn State Children's Hospital in Hershey, Pa., and colleagues presented data from 65 adolescents with essential hypertension who had made an average of seven clinic visits over a 25-month follow-up period since their initial diagnosis.

At their baseline visit, all patients presented with a systolic BP (SBP) exceeding the 95th percentile; diastolic BP (DBP) exceeded the 95th percentile in only about a third of subjects. Medication was usually prescribed at the first or second visit.

Results showed that BP control was achieved in 90% of patients during follow-up; 78% had an SBP in the 90th percentile or below by their fourth visit (at a mean of 330 days) and 80% had a DBP in the 90th percentile or below by the third visit. Six patients never achieved control.

In addition, of 32 patients whose pressure was not controlled at some point, noncompliance was responsible in 16 (50%). Patients were deemed noncompliant based on “self-admission” or a return to control without changing medications. “We strongly recommend that physicians carefully question adolescents and their parents before changing therapy,” Dr. DiPietro said.

ACE inhibitors and beta blockers were the most effective antihypertensive agents, whereas thiazides and calcium channel blockers were not significantly associated with BP control.

Of the 41 patients who were controlled at their last visit, 34 (83%) were on a single medication. “Notably, the attainment of BP control in most patients with only one medication contrasts with data showing that only a minority of adults achieve control with a single medication,” Dr. DiPietro observed.

The study found that nonpharmacologic BP control was usually unsuccessful and that BP control was not influenced by age, gender, or initial SBP or DBP.

Study findings support previous studies showing that hypertension and obesity are related and that the incidence of childhood obesity is increasing. “Our patients had significantly higher body mass index than normal, which is consistent with that hypothesis,” she said.

To her knowledge, the study is first to document the time needed to control BP in pediatric hypertension, she added.

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