Blood Pressure for the Pediatrician PowerPoint Presentation

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4 Hypertensive Kids in 45 Minutes

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it?

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it?

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting.

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right.

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading.

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma %

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation.

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it?

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon.

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it?

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors Teenager Stage 1 RFP Urinalysis Renal Ultrasound Quantitate any abnormal urine protein There’s no normal creatinine in pediatrics, but there is a normal GFR. Renal vessel doppler are of questionable value.

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors Teenager Stage 1 RFP Urinalysis Renal Ultrasound Quantitate any abnormal urine protein There’s no normal creatinine in pediatrics, but there is a normal GFR. Renal vessel doppler are of questionable value. Young Stage 1 or Stage 2 Renin Catecholamines Angiogram Urine Steroids Plasma renin is usually uninterpretable. Elevated urine catecholamines are usually transient and not subtle. Don’t bother with MRAs or nuclear scans; the gold standard is an angiogram.

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors Teenager Stage 1 RFP Urinalysis Renal Ultrasound Quantitate any abnormal urine protein There’s no normal creatinine in pediatrics, but there is a normal GFR. Renal vessel doppler are of questionable value. Young Stage 1 or Stage 2 Renin Catecholamines Angiogram Urine Steroids Plasma renin is usually uninterpretable. Elevated urine catecholamines are usually transient and not subtle. Don’t bother with MRAs or nuclear scans; the gold standard is an angiogram. Caleb Category of HTN: Young Stage 1 History & Symptoms: None Physical: Normal Labs: Normal Imaging: Echo: Mild LVH U/S: Left kidney < Right Angio: Normal

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors Teenager Stage 1 RFP Urinalysis Renal Ultrasound Quantitate any abnormal urine protein There’s no normal creatinine in pediatrics, but there is a normal GFR. Renal vessel doppler are of questionable value. Young Stage 1 or Stage 2 Renin Catecholamines Angiogram Urine Steroids Plasma renin is usually uninterpretable. Elevated urine catecholamines are usually transient and not subtle. Don’t bother with MRAs or nuclear scans; the gold standard is an angiogram. Caleb Category of HTN: Young Stage 1 History & Symptoms: None Physical: Normal Labs: Normal Imaging: Echo: Mild LVH U/S: Left kidney < Right Angio: Normal

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors Teenager Stage 1 RFP Urinalysis Renal Ultrasound Quantitate any abnormal urine protein There’s no normal creatinine in pediatrics, but there is a normal GFR. Renal vessel doppler are of questionable value. Young Stage 1 or Stage 2 Renin Catecholamines Angiogram Urine Steroids Plasma renin is usually uninterpretable. Elevated urine catecholamines are usually transient and not subtle. Don’t bother with MRAs or nuclear scans; the gold standard is an angiogram. Caleb Category of HTN: Young Stage 1 History & Symptoms: None Physical: Normal Labs: Normal Imaging: Echo: Mild LVH U/S: Left kidney < Right Angio: Normal Brittiney Category of HTN: Pre-Hypertension History & Symptoms: Snores Physical: Elevated BMI ~ 98%le Labs: Fasting BG 121 Imaging: Echo: Normal U/S: Normal

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors Teenager Stage 1 RFP Urinalysis Renal Ultrasound Quantitate any abnormal urine protein There’s no normal creatinine in pediatrics, but there is a normal GFR. Renal vessel doppler are of questionable value. Young Stage 1 or Stage 2 Renin Catecholamines Angiogram Urine Steroids Plasma renin is usually uninterpretable. Elevated urine catecholamines are usually transient and not subtle. Don’t bother with MRAs or nuclear scans; the gold standard is an angiogram. Caleb Category of HTN: Young Stage 1 History & Symptoms: None Physical: Normal Labs: Normal Imaging: Echo: Mild LVH U/S: Left kidney < Right Angio: Normal Brittiney Category of HTN: Pre-Hypertension History & Symptoms: Snores Physical: Elevated BMI ~ 98%le Labs: Fasting BG 121 Imaging: Echo: Normal U/S: Normal Life-style changes Give a TV target of 2 hours per day or less Write a prescription for PE DASH diet (http://www.nhlbi.nih.gov/) Surveillance Lipids, Blood Sugars, Weight, Urine Protein Ambulatory Blood Pressure Monitor (ABPM)

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors Teenager Stage 1 RFP Urinalysis Renal Ultrasound Quantitate any abnormal urine protein There’s no normal creatinine in pediatrics, but there is a normal GFR. Renal vessel doppler are of questionable value. Young Stage 1 or Stage 2 Renin Catecholamines Angiogram Urine Steroids Plasma renin is usually uninterpretable. Elevated urine catecholamines are usually transient and not subtle. Don’t bother with MRAs or nuclear scans; the gold standard is an angiogram. Caleb Category of HTN: Young Stage 1 History & Symptoms: None Physical: Normal Labs: Normal Imaging: Echo: Mild LVH U/S: Left kidney < Right Angio: Normal Brittiney Category of HTN: Pre-Hypertension History & Symptoms: Snores Physical: Elevated BMI ~ 98%le Labs: Fasting BG 121 Imaging: Echo: Normal U/S: Normal Life-style changes Give a TV target of 2 hours per day or less Write a prescription for PE DASH diet (http://www.nhlbi.nih.gov/) Surveillance Lipids, Blood Sugars, Weight, Urine Protein Ambulatory Blood Pressure Monitor (ABPM) Ambulatory Blood Pressure Monitor

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors Teenager Stage 1 RFP Urinalysis Renal Ultrasound Quantitate any abnormal urine protein There’s no normal creatinine in pediatrics, but there is a normal GFR. Renal vessel doppler are of questionable value. Young Stage 1 or Stage 2 Renin Catecholamines Angiogram Urine Steroids Plasma renin is usually uninterpretable. Elevated urine catecholamines are usually transient and not subtle. Don’t bother with MRAs or nuclear scans; the gold standard is an angiogram. Caleb Category of HTN: Young Stage 1 History & Symptoms: None Physical: Normal Labs: Normal Imaging: Echo: Mild LVH U/S: Left kidney < Right Angio: Normal Brittiney Category of HTN: Pre-Hypertension History & Symptoms: Snores Physical: Elevated BMI ~ 98%le Labs: Fasting BG 121 Imaging: Echo: Normal U/S: Normal Life-style changes Give a TV target of 2 hours per day or less Write a prescription for PE DASH diet (http://www.nhlbi.nih.gov/) Surveillance Lipids, Blood Sugars, Weight, Urine Protein Ambulatory Blood Pressure Monitor (ABPM) Ambulatory Blood Pressure Monitor Anthony Category of HTN: Young Stage 2 History & Symptoms: Intermittent headaches Physical: Single Café au Lait Labs: Normal Imaging: Echo: Moderate LVH U/S: Normal Angio:

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors Teenager Stage 1 RFP Urinalysis Renal Ultrasound Quantitate any abnormal urine protein There’s no normal creatinine in pediatrics, but there is a normal GFR. Renal vessel doppler are of questionable value. Young Stage 1 or Stage 2 Renin Catecholamines Angiogram Urine Steroids Plasma renin is usually uninterpretable. Elevated urine catecholamines are usually transient and not subtle. Don’t bother with MRAs or nuclear scans; the gold standard is an angiogram. Caleb Category of HTN: Young Stage 1 History & Symptoms: None Physical: Normal Labs: Normal Imaging: Echo: Mild LVH U/S: Left kidney < Right Angio: Normal Brittiney Category of HTN: Pre-Hypertension History & Symptoms: Snores Physical: Elevated BMI ~ 98%le Labs: Fasting BG 121 Imaging: Echo: Normal U/S: Normal Life-style changes Give a TV target of 2 hours per day or less Write a prescription for PE DASH diet (http://www.nhlbi.nih.gov/) Surveillance Lipids, Blood Sugars, Weight, Urine Protein Ambulatory Blood Pressure Monitor (ABPM) Ambulatory Blood Pressure Monitor Anthony Category of HTN: Young Stage 2 History & Symptoms: Intermittent headaches Physical: Single Café au Lait Labs: Normal Imaging: Echo: Moderate LVH U/S: Normal Angio:

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4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors Teenager Stage 1 RFP Urinalysis Renal Ultrasound Quantitate any abnormal urine protein There’s no normal creatinine in pediatrics, but there is a normal GFR. Renal vessel doppler are of questionable value. Young Stage 1 or Stage 2 Renin Catecholamines Angiogram Urine Steroids Plasma renin is usually uninterpretable. Elevated urine catecholamines are usually transient and not subtle. Don’t bother with MRAs or nuclear scans; the gold standard is an angiogram. Caleb Category of HTN: Young Stage 1 History & Symptoms: None Physical: Normal Labs: Normal Imaging: Echo: Mild LVH U/S: Left kidney < Right Angio: Normal Brittiney Category of HTN: Pre-Hypertension History & Symptoms: Snores Physical: Elevated BMI ~ 98%le Labs: Fasting BG 121 Imaging: Echo: Normal U/S: Normal Life-style changes Give a TV target of 2 hours per day or less Write a prescription for PE DASH diet (http://www.nhlbi.nih.gov/) Surveillance Lipids, Blood Sugars, Weight, Urine Protein Ambulatory Blood Pressure Monitor (ABPM) Ambulatory Blood Pressure Monitor Anthony Category of HTN: Young Stage 2 History & Symptoms: Intermittent headaches Physical: Single Café au Lait Labs: Normal Imaging: Echo: Moderate LVH U/S: Normal Angio: Chris Category of HTN: Teenager Stage 2 History & Symptoms: Transplant; On a drip Physical: Tachycardic Labs: Creatinine 1.7 Imaging: U/S:

Slide 53 -

4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors Teenager Stage 1 RFP Urinalysis Renal Ultrasound Quantitate any abnormal urine protein There’s no normal creatinine in pediatrics, but there is a normal GFR. Renal vessel doppler are of questionable value. Young Stage 1 or Stage 2 Renin Catecholamines Angiogram Urine Steroids Plasma renin is usually uninterpretable. Elevated urine catecholamines are usually transient and not subtle. Don’t bother with MRAs or nuclear scans; the gold standard is an angiogram. Caleb Category of HTN: Young Stage 1 History & Symptoms: None Physical: Normal Labs: Normal Imaging: Echo: Mild LVH U/S: Left kidney < Right Angio: Normal Brittiney Category of HTN: Pre-Hypertension History & Symptoms: Snores Physical: Elevated BMI ~ 98%le Labs: Fasting BG 121 Imaging: Echo: Normal U/S: Normal Life-style changes Give a TV target of 2 hours per day or less Write a prescription for PE DASH diet (http://www.nhlbi.nih.gov/) Surveillance Lipids, Blood Sugars, Weight, Urine Protein Ambulatory Blood Pressure Monitor (ABPM) Ambulatory Blood Pressure Monitor Anthony Category of HTN: Young Stage 2 History & Symptoms: Intermittent headaches Physical: Single Café au Lait Labs: Normal Imaging: Echo: Moderate LVH U/S: Normal Angio: Chris Category of HTN: Teenager Stage 2 History & Symptoms: Transplant; On a drip Physical: Tachycardic Labs: Creatinine 1.7 Imaging: U/S: Chris Hydronephrosis, Ureteral obstruction Blood pressure dramatically better (off drips) after nephrostomy

Slide 54 -

4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors Teenager Stage 1 RFP Urinalysis Renal Ultrasound Quantitate any abnormal urine protein There’s no normal creatinine in pediatrics, but there is a normal GFR. Renal vessel doppler are of questionable value. Young Stage 1 or Stage 2 Renin Catecholamines Angiogram Urine Steroids Plasma renin is usually uninterpretable. Elevated urine catecholamines are usually transient and not subtle. Don’t bother with MRAs or nuclear scans; the gold standard is an angiogram. Caleb Category of HTN: Young Stage 1 History & Symptoms: None Physical: Normal Labs: Normal Imaging: Echo: Mild LVH U/S: Left kidney < Right Angio: Normal Brittiney Category of HTN: Pre-Hypertension History & Symptoms: Snores Physical: Elevated BMI ~ 98%le Labs: Fasting BG 121 Imaging: Echo: Normal U/S: Normal Life-style changes Give a TV target of 2 hours per day or less Write a prescription for PE DASH diet (http://www.nhlbi.nih.gov/) Surveillance Lipids, Blood Sugars, Weight, Urine Protein Ambulatory Blood Pressure Monitor (ABPM) Ambulatory Blood Pressure Monitor Anthony Category of HTN: Young Stage 2 History & Symptoms: Intermittent headaches Physical: Single Café au Lait Labs: Normal Imaging: Echo: Moderate LVH U/S: Normal Angio: Chris Category of HTN: Teenager Stage 2 History & Symptoms: Transplant; On a drip Physical: Tachycardic Labs: Creatinine 1.7 Imaging: U/S: Chris Hydronephrosis, Ureteral obstruction Blood pressure dramatically better (off drips) after nephrostomy 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it?

Slide 55 -

4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors Teenager Stage 1 RFP Urinalysis Renal Ultrasound Quantitate any abnormal urine protein There’s no normal creatinine in pediatrics, but there is a normal GFR. Renal vessel doppler are of questionable value. Young Stage 1 or Stage 2 Renin Catecholamines Angiogram Urine Steroids Plasma renin is usually uninterpretable. Elevated urine catecholamines are usually transient and not subtle. Don’t bother with MRAs or nuclear scans; the gold standard is an angiogram. Caleb Category of HTN: Young Stage 1 History & Symptoms: None Physical: Normal Labs: Normal Imaging: Echo: Mild LVH U/S: Left kidney < Right Angio: Normal Brittiney Category of HTN: Pre-Hypertension History & Symptoms: Snores Physical: Elevated BMI ~ 98%le Labs: Fasting BG 121 Imaging: Echo: Normal U/S: Normal Life-style changes Give a TV target of 2 hours per day or less Write a prescription for PE DASH diet (http://www.nhlbi.nih.gov/) Surveillance Lipids, Blood Sugars, Weight, Urine Protein Ambulatory Blood Pressure Monitor (ABPM) Ambulatory Blood Pressure Monitor Anthony Category of HTN: Young Stage 2 History & Symptoms: Intermittent headaches Physical: Single Café au Lait Labs: Normal Imaging: Echo: Moderate LVH U/S: Normal Angio: Chris Category of HTN: Teenager Stage 2 History & Symptoms: Transplant; On a drip Physical: Tachycardic Labs: Creatinine 1.7 Imaging: U/S: Chris Hydronephrosis, Ureteral obstruction Blood pressure dramatically better (off drips) after nephrostomy 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 7 Classes of Anti-hypertensives Diuretics Beta-blockers IV labetolol Central Alpha-Blockers Calcium Channel Blockers nicardipine drip ACE Inhibitors Direct Vasodilators IV hydralazine Angiotensin Receptor Blockers Peripheral Blockers

Slide 56 -

4 Hypertensive Kids in 45 Minutes Name: Anthony Age: 6 Sex: Male Place: Allergy Clinic BP: 145/87 Name: Chris Age: 17 Sex: Male Place: Inpatient BP: 180/115 Name: Brittiney Age: 13 Sex: Female Place: Clinic BP: 125/78 Name: Caleb Age: 3 Sex: Male Place: Phone Call BP: 118/75 Caleb Anthony Brittiney Chris The Fourth Task Force Report on Pediatric High Blood Pressure 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Blood Pressure Measurement Technology is in the Dark Ages. Confirm all blood pressure readings before acting. It’s a Pain in the A** to Detect HTN Equipment is inherently flawed, hard to find Or gives inaccurate readings if not used right. It’s a Pain in the A** to Detect HTN Spurious elevations are common It’s a Pain in the A** to Detect HTN Not everyone has a BP reading. It’s a Pain in the A** to Detect HTN Mild Hypertension takes weeks to confirm It’s a Pain in the A** to Detect HTN Norms for Pediatric BP are found in a 4-D table It’s a Pain, But you Got to Do it http://www.statcoder.com/growthcharts.htm Normal < 90% le Pre-Hypertension 90-95% le Stage 1 Hypertension 95% to 5 mm above 99%le Stage 2 Hypertension > 5 mm above 99%le Hypertension is Common Hypertension Asthma % Caleb 118/75 Anthony 145/87 Brittiney 125/78 Chris 180/115 161 cm (72%le) 95% BP = 126/82 90% BP = 122/78 114 cm (75%le) 168 cm (16%le) 98 cm (64%le) 95% BP = 113/74 99% BP = 120/82 95% BP = 133/85 99% BP = 141/93 95% BP = 110/67 99% BP = 118/75 Recognizing or ruling out a hypertensive emergency is the 1st order of business in any hypertension evaluation. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? Is this an Emergency? Hypertensive Emergency Elevated Blood Pressure with symptoms of end-organ damage Hypertensive Urgency A high BP that makes you uncomfortable Hypertensive Emergencies Drop the Blood Pressure no more than 10% Use short acting IV medications IV Labetolol IV Hydralazine IV Nicardipine drip Start small and then escalate your dose Get the patient to a PICU Chris Chest Pain and a splitting headache Labetolol and hydralazine given on the floor – no effect. Nicardipine drip in PICU. BP 150s/80s by noon. 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? School Age Teenager Chronic UTIs Glomerular Disease Renovascular Disease Aortic Coarctation Essential Hypertension Essential Hypertension Glomerular Disease Renovascular Disease Other Causes of Pediatric Hypertension that you still think about Inpatients Increased ICP Pain Iatrogenic steroid-induced Uncommon outpatient causes Endocrine causes (Cushing, Pheo) Pre-eclampsia The Younger the Patient with Hypertension, the More Likely you’ll find a Cause Rule of Thumb #1 The Higher the Blood Pressure, the more likely there’s a cause Rule of Thumb #2 Symptoms to Ask About History UAC as a newborn UTIs or febrile illnesses Medications Supplements Family History Physical Arm & Leg BPs A B C What’s Normal? A = B = C A = B > C A = B < C A > B > C What’s Normal? A = B = C A = B > C A = B < C A > B > C Eye Grounds Heart Findings Listen for a Bruit Skin CALMs of NF-1 Acanthosis Nigricans Skin Labs & Imaging Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam Pre-Hypertension Lipids Fasting Glucose Echocardiogram Retinal Exam LVH on an echocardiogram is the most common end-organ manifestation in pediatric hypertension Essential hypertension almost always occurs with other risk factors Teenager Stage 1 RFP Urinalysis Renal Ultrasound Quantitate any abnormal urine protein There’s no normal creatinine in pediatrics, but there is a normal GFR. Renal vessel doppler are of questionable value. Young Stage 1 or Stage 2 Renin Catecholamines Angiogram Urine Steroids Plasma renin is usually uninterpretable. Elevated urine catecholamines are usually transient and not subtle. Don’t bother with MRAs or nuclear scans; the gold standard is an angiogram. Caleb Category of HTN: Young Stage 1 History & Symptoms: None Physical: Normal Labs: Normal Imaging: Echo: Mild LVH U/S: Left kidney < Right Angio: Normal Brittiney Category of HTN: Pre-Hypertension History & Symptoms: Snores Physical: Elevated BMI ~ 98%le Labs: Fasting BG 121 Imaging: Echo: Normal U/S: Normal Life-style changes Give a TV target of 2 hours per day or less Write a prescription for PE DASH diet (http://www.nhlbi.nih.gov/) Surveillance Lipids, Blood Sugars, Weight, Urine Protein Ambulatory Blood Pressure Monitor (ABPM) Ambulatory Blood Pressure Monitor Anthony Category of HTN: Young Stage 2 History & Symptoms: Intermittent headaches Physical: Single Café au Lait Labs: Normal Imaging: Echo: Moderate LVH U/S: Normal Angio: Chris Category of HTN: Teenager Stage 2 History & Symptoms: Transplant; On a drip Physical: Tachycardic Labs: Creatinine 1.7 Imaging: U/S: Chris Hydronephrosis, Ureteral obstruction Blood pressure dramatically better (off drips) after nephrostomy 6 Questions Does the child really have high blood pressure? Do I have time to ask any more questions? Why does the child have high blood pressure? Does the child have other risk factors? What has high blood pressure already done to the child's body? What should we do about it? 7 Classes of Anti-hypertensives Diuretics Beta-blockers IV labetolol Central Alpha-Blockers Calcium Channel Blockers nicardipine drip ACE Inhibitors Direct Vasodilators IV hydralazine Angiotensin Receptor Blockers Peripheral Blockers Take Home Points Report the percentile of Blood Pressure on Any BP you get Recognize a hypertensive emergency Refer to the 4th Task Force Report or your local pediatric nephrologist once you recognize a high blood pressure