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2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

Lurbe, Empar; Agabiti-Rosei, Enrico; Cruickshank, J. Kennedy; Dominiczak, Anna; Erdine, Serap; Hirth, Asle; Invitti, Cecilia; Litwin, Mieczyslaw; Mancia, Giuseppe; Pall, Denes; Rascher, Wolfgang; Redon, Josep; Schaefer, Franz; Seeman, Tomas; Sinha, Manish; Stabouli, Stella; Webb, Nicholas J.; Wühl, Elke; Zanchetti, Alberto

doi: 10.1097/HJH.0000000000001039

Increasing prevalence of hypertension (HTN) in children and adolescents has become a significant public health issue driving a considerable amount of research. Aspects discussed in this document include advances in the definition of HTN in 16 year or older, clinical significance of isolated systolic HTN in youth, the importance of out of office and central blood pressure measurement, new risk factors for HTN, methods to assess vascular phenotypes, clustering of cardiovascular risk factors and treatment strategies among others. The recommendations of the present document synthesize a considerable amount of scientific data and clinical experience and represent the best clinical wisdom upon which physicians, nurses and families should base their decisions. In addition, as they call attention to the burden of HTN in children and adolescents, and its contribution to the current epidemic of cardiovascular disease, these guidelines should encourage public policy makers to develop a global effort to improve identification and treatment of high blood pressure among children and adolescents.

aPediatric Department, Consorcio Hospital General, University of Valencia, Valencia

bCIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Madrid, Spain

cClinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Italy

dDiabetes and Nutritional Science Division, Kings College, London

eCollege of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK

fCardiology Department, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey

gDepartment of Pediatrics, Haukeland University Hospital, Bergen, Norway

hDepartment of Medical Sciences and Rehabilitation, IRCCS Istituto Auxologico Italiano, Milan, Italy

iDepartment of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland

jCenter of Epidemiology and Clinical Trials, IRCCS Istituto Auxologico Italiano, Milano, Italy

kDepartment of Medicine and Coordination Centre for Drug Development, University of Debrecen, Debrecen, Hungary

lDepartment of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany

mDepartment of Internal Medicine, Hospital Clinico de Valencia, University of Valencia

nINCLIVA Research Institute, Valencia, Spain

oDivision of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany

pDepartment of Paediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic

qDepartment of Paediatric Nephrology, Evelina London Children's Hospital, Guys and St Thomas’ NHS Foundation Trust, London, UK

r1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece

sDepartment of Paediatric Nephrology and NIHR/Wellcome Trust Clinical Research Facility, University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester, UK

tDivision of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany

uIstituto Auxologico Italiano IRCCS, and Centro Interuniversitario di Fisiologia Clinica e ipertensione, University of Milan, Milan, Italy

Correspondence to Empar Lurbe, Prof, MD, PhD, Pediatrics Department, Consorcio Hospital General, Universitario de Valencia, Avenida Tres Cruces s/n, Valencia 46014, Spain. Tel: +34 963 131 800; e-mail:

Abbreviations: ABPM, ambulatory blood pressure measurement; ACE, angiotensin-converting enzyme; ACEi, angiotensin-converting enzyme inhibitor; ACTH, adeenocorticotropic hormone; ARB, AT1 blocker; BP, blood pressure; cIMT, carotid intima-media thickness; CKD, chronic kidney disease; CoA, coarctation of aorta; CPAP, continuous positive airway pressure; cPP, central pulse pressure; CS, Cushing syndrome; cSPB, central or aortic SBP; CT, computed tomography; CV, cardiovascular; DIH, drug-induced hypertension; DM1, type 1 diabetes; DM2, type 2 diabetes; EM, ethnic minorities; ENaC, epithelial sodium channel; ESC, European Society of Cardiology; ESCAPE, Effect of Strict Blood Pressure Control and ACE Inhibition on Progression of Chronic Renal Failure in Pediatric Patients; ESH, European Society of Hypertension; ESRD, end stage renal disease; EU, European Union; FH-1,2,3, familial hyperaldosteronism type 1,2,3; GFR, glomerular filtration rate; HTN, hypertension; HTNR, hypertensive retinopathy; ISH, isolated systolic hypertension; LDL-C, LDL cholesterol; LV, left ventricle; LVH, left ventricular hypertrophy; LVM, left ventricular mass; LVMI, left ventricular mass index; MR, mineralocorticoid receptor; OSA, obstructive sleep apnea; PRES, posterior reversible encephalopathy syndrome; PUMA, pediatric use marketing authorization; PWV, pulse wave velocity; RAS, renin–angiotensin system; SNP, single nucleotide polymorphisim; SPRINT, SBP Intervention Trial; TOD, target organ damage; UAE, urinary albumin excretion; VEGF, vascular endothelial growth factor

Received 8 June, 2016

Accepted 15 June, 2016

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