BP-CATCH: Boosting Primary Care Awareness and Treatment of Childhood Hypertension: Hype...



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BP-CATCH: Boosting Primary Care Awareness and Treatment of Childhood Hypertension: Hypertension Diagnosis and Management Algorithm

Weight and Nutrition Counseling & Lifestyle Modification (Consider Ambulatory Blood Pressure Monitoring if Available)

BP in Stage I Range? (avg. 2 auscultatory measurements)

Weight and Nutrition Counseling & Lifestyle Modification

Upper and Lower Extremity BPs Normal?

Repeat BP in 6 months

BP in Stage I Range? (avg. 2 auscultatory measurements)

Normal BP Recheck BP at next Healthcare maintenance visit if no other risk factors

Upper and Lower Extremity BPs Normal?

Weight and Nutrition Counseling & Lifestyle Modification

Echocardiogram when considering Pharmacologic management

Subspecialist communicate back to PMD

BP in Elevated Range? (avg. 2 auscultatory measurements)

Repeat BP in 1-2 weeks

Diagnose Elevated Blood Pressure, Stage I or Stage II Hypertension

Remeasure BP twice by using auscultatory technique and average results

BP in Elevated Blood Pressure Range

  • ≥ 90th to <95th Percentile or >120/80 to <129/<80

First BP taken by Oscillometry?

Avg of 2 results ≥ 90th Percentile or ≥120/80

History and Physical for underlying causes: heart, kidney, renovascular, endocrine, medications, OSA?Family history of HTN?Physical activity? Perinatal hx?Alcohol or Drug use? Pregnancy?

Repeat BP in 6 months

Upper & lower extremity BPs normal?

Repeat BP in 1 week

BP in Elevated Range? (avg. 2 auscultatory measurements)

Repeat BP in 3 months

Abnormal extremity blood pressures: any leg BP same or lower than arm

Subspecialist evaluation as needed

Repeat Visit every 4-6 weeks for medication adjustments until BP<90th Percentile or <130/90 if patient >13 yrs oldConsider sooner for lab checks as needed (e.g. BMP/CBC/retic for ACEI)

Pharmacologic Management: Initiate treatment with ACEI, ARB, Ca Channel Blocker or Thiazide(Females who could get pregnant counsel re: ACEI/ARB and birth control; African Americans may require higher ACEI dosages, Avoid Thiazides in DM and conditions with increased uric acid)

BP in Stage I Hypertension Range

  • ≥ 95th to <95th+ 12mm or 130/80 to 139/89

Abnormal extremity blood pressures: any leg BP same or lower than arm

Severe

  • BP ≥95th+30mm or >180/120 or symptomatic
  • Anytime -> Refer to the ED and excluded from BP-CATCH

Remeasure twice with Oscillometry and average results

Weight and Nutrition Counseling & Lifestyle Modification

BP in Stage II Range? (avg. 2 auscultatory measurements)

AHRQ Grant R01HS026239 Based on AAP’s CPG for Screening and Management of High Blood Pressure in Children and Adolescents, Pediatrics, 2017

Is avg BP ≥ 120/80 or ≥ 90th Percentile for Ht., Age, & Sex?

Weight and Nutrition Counseling & Lifestyle Modification

If you have questions about this BP-CATCH BP tool or about the process of creating a tool please contact Peterkaye Kelly at pekelly@montefiore.org.

Disclaimer: All tools are intended as a resource to guide diagnosis, treatment and management in order to improve quality of care and promote better patient outcomes. They are based on available medical evidence at the time of development; they are not intended to provide medical advice or consultation regarding the care of any individual patient, and should not replace or supersede a practitioner’s professional opinion or clinical judgment. Because medical knowledge is constantly evolving, and accepting the possibility of error, BP-CATCH does not warrant or represent that any tools are complete or accurate. Neither BP-CATCH, its associated medical centers, nor the individuals involved in the development or production of the tools is responsible for results or outcomes related to their use.

Normal BP Recheck BP at next Healthcare maintenance visit if no other risk factors

BP in Stage II Hypertension Range

  • ≥ 95th+12mm to <95th+30mm or >140/90 to <180/120

BP Measurement:

  • Sit and relax comfortably for at least 3 minutes
  • Feet flat on floor
  • Back supported
  • Legs uncrossed
  • Determine cuff is the correct size (width encircles at least 40% of mid-arm circumference and cuff length at least 80-100%)
  • BP cuff placed over bare arm
  • Mid-cuff at heart level
  • No smartphones
  • No talking
  • Both the systolic and diastolic BP recorded in EHR

Refer to subspecialist

Refer to Subspecialist (use standard template for referral)

Evaluation for secondary HTN & comorbidities:

  • All Patients: Perform UA, Chemistry Panel, Lipids
  • <6yrs or abnl UA/renal function: Renal US
  • Obese: Hg A1c, fasting lipids, Liver enzymes
  • Possible DM: Fasting serum Glucose
  • Possible OSA: Sleep study, HgA1C
  • Growth delay or abnl renal function: CBC Endocrine
  • History: TSH
  • Social Concerns: Drug screen

Inclusion Criteria
  • A patient age ≥ 3 years old and ≤ 21 years old
  • Blood pressure (BP) is elevated ≥ 90th percentile for patient’s sex, age, and height, or ≥120/80 (regardless of sex/age/ height) at a healthcare maintenance visit or non-acute care visit (e.g. chronic disease follow-up visit). NOTE: This elevated BP measurement can result from oscillometry or auscultation; and it meets inclusion criteria even if a repeated measurement at that visit is normal.
Exclusion Criteria
  • Prior hypertension/elevated BP diagnosis. NOTE: Patient can have prior elevated BP measurements as long as no diagnosis has been made
  • BP≥95th percentile + 30mm or >180/120 or symptomatic patient
  • Prior diagnosis of congenital heart disease, chronic kidney disease, urologic disease (e.g. posterior urethral valve, vesicoureteral reflux) or organ transplant
  • Previously included in BP-CATCH data entry
  • Acute care visit (e.g., fever, viral illness, asthma attack, pain in any body part, etc.)



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