CE/CME

Pediatric Hypertension: Screening, Diagnosis and Management

Welcome to the training on Pediatric Hypertension: Screening, Diagnosis and Management provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).

Credit Hours: 1.25 CE

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Goal

The goal of this module is to equip Texas Health Steps providers and others to monitor blood pressure (BP) in children and adolescents, evaluate and follow up on elevated BP readings, and manage pediatric hypertension in collaboration with families.

Target Audience

Texas Health Steps providers and other interested health care professionals.

Specific Learning Objectives

After completing the activities of this module, you will be able to:

  1. Apply Texas Health Steps guidelines for routine blood pressure monitoring and age-based anticipatory guidance.
  2. Apply clinical best practices to evaluate all elevated blood pressure readings and to diagnose and manage pediatric hypertension.
  3. Integrate recommended prevention and intervention strategies and connect families with helpful resources.

NOTE: This module is based on the American Academy of Pediatrics (AAP) “Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents” (2017), the first set of guidelines for high blood pressure in children and adolescents developed by the AAP and still in use today. The module refers to the guidelines as the AAP Guideline.

Please note this module expires on 8/22/2025.

This module was released on 8/22/2022.

Featured

AlAbdulKader, A. M., Morse, E. F., Daley, M. F., & Rao, G. (2020). Pediatric Hypertension: Parent Perspectives. Global Pediatric Health, 7:2333794X20981340.

American Academy of Pediatrics, Institute for Healthy Childhood Weight. (2022). Obesity Treatment and Management Projects that Optimize Healthcare.

American Academy of Pediatrics. (2017). Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics, 140(3).

American Academy of Pediatrics. (2017). AAP issues new pediatric hypertension clinical practice guideline. (News release).

American Academy of Pediatrics, healthychildren.org. (2017). AAP Publishes New Guidelines on Identifying and Treating High Blood Pressure in Children.

American Heart Association. (2017). Monitoring Your Blood Pressure at Home: Choosing a home blood pressure monitor.

Bell, C. S., Samuel, J. P., & Samuels, J. A. (2019). Prevalence of Hypertension in Children. Hypertension, 73(1):148-52.

Centers for Disease Control and Prevention. (2021). Social Determinants of Health: Know What Affects Health.

Centers for Disease Control and Prevention. (2020). U.S. Surgeon General’s Call to Action to Control Hypertension (Executive Summary).

Centers for Disease Control and Prevention. (2018). Hypertension Among Youths – United States, 2001-2016. Morbidity and Mortality Weekly Report (MMWR), 67:758-762.

Goulding, M., Goldberg, R., & Lemon,  S. C. (2021). Differences in Blood Pressure Levels Among Children by Sociodemographic Status. Preventing Chronic Disease, 18:210058. Centers for Disease Control and Prevention.

Hope, K. D., & Zachariah,  J. P. (2019). Predictors and Consequences of Pediatric Hypertension: Have Advanced Echocardiography and Vascular Testing Arrived? Current Hypertension Reports, 21(7):54.

Muntner, P., Shimbo, D., Carey, R. M., Charleston, J. B., Gaillard, T., Misra, S., . . . Council on Quality of Care and Outcomes Research. (2019). Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension, 73(5):e35-e66.

National Library of Medicine. (2020). Understanding the DASH Diet.

Nemours Children’s Health. (2022). Hypertension (High Blood Pressure), a web page with information for parents, children and adolescents.

Song, P., Zhang, Y., Yu, J., Mingming, Z., Zhu, Y., Rahimi, K., & Rudan, I. (2019). Global Prevalence of Hypertension in Children: A Systematic Review and Meta-analysis. JAMA Pediatrics, 173(12):1154–1163.

World Health Organization. (2022). Social Determinants of Health.

Children and Families

American Academy of Pediatrics, healthychildren.org. Screening & Treating Kids for High Blood Pressure: AAP Report Explained.

American Heart Association. High Blood Pressure web page, which includes fact sheets and tips on how to measure blood pressure at home.

American Heart Association. Healthy Living web page, which includes recipes, exercise and fitness tips, and wellness and self-care.

Children’sHealth. High Blood Pressure in Kids.

DASH eating plan. National Library of Medicine web page with information about a diet developed to help lower high blood pressure and lose weight.

DASH eating plan, National Heart, Lung, and Blood Institute.

GotTransition.org. Resources are available to help youth, parents and providers plan for transitioning from pediatric to adult care.

Nemours Children’s Health. (2022). Hypertension (High Blood Pressure), a web page with information for parents, children and adolescents.

Definitions

Medical definitions in this module were obtained or adapted from American Academy of Pediatrics, Mayo Clinic, Merriam-Webster, National Organization for Rare Disorders, Stanford Medicine, U.S. National Library of Medicine and WebMD.

Continuing Medical Education

The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians. 

The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development

The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of Nursing Continuing Professional Development by the American Nurses Credentialing Center’s Commission on Accreditation.

Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hours of Nursing Continuing Professional Development.

Social Workers

The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 hours of credit.

Certificate of Attendance

The Texas Department of State Health Services, Continuing Education Service has designated 1.25 hour(s) for attendance.

General Disclosure

One of the requirements of continuing education is disclosure of the following information to the learner:

  1. Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
    • Create a Texas Health Steps account.
    • Complete on-line registration process.
    • Thoroughly read the content of the module.
    • Complete the on-line examination.
    • Complete the evaluation.
  2. Commercial Support.
    The THSTEPS Web-based Continuing Education Series has received no commercial support.
  3. Disclosure of Relevant Financial Relationships.
    The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
  4. Non-Endorsement Statement.
    Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
  5. Off-Label Use.
    Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).

The following are policies and definitions of terms related to continuing education disclosure:

The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.

All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.

Glossary of Terms

Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.

Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.

Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).

Texas Health Steps courses are best viewed using a current browser. If you are using an out-of-date browser or a version of Internet Explorer less than 11, lesson progress and interactive features may not function properly.

Helpful Resources

American Academy of Pediatrics. (2017). Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics, 140(3).

Tables from the AAP Guideline (2017):

  • Table 3: Updated Definitions of BP Categories and Stages
  • Table 4: BP Levels for Boys by Age and Height Percentile
  • Table 5: BP Levels for Girls by Age and Height Percentile
  • Table 6: Screening BP Values Requiring Further Evaluation
  • Table 14: Examples of Physical Examination Findings and History Suggestive of Secondary HTN or Related to End Organ Damage Secondary to HTN
  • Table 16: DASH Diet Recommendations
  • Table 17: Dosing Recommendations for the Initial Prescription of Antihypertensive Drugs for Outpatient Management of Chronic HTN

Comprehensive Care Program (CCP), a package of Texas Medicaid services available to individuals based on medical necessity that goes beyond regular Medicaid services for all ages and is part of the Texas Health Steps benefit for individuals ages 20 and younger. Find information about the CCP in the Children’s Services Handbook of the Texas Medicaid Provider Procedures Manual (TMPPM).

CCP Prior Authorization Request for Non-Face-to-Face Clinician-Directed Care Coordination Services.

DASH eating plan. National Library of Medicine web page with information about a diet developed to help lower high blood pressure and lose weight.

Goulding, M., Goldberg, R., & Lemon,  S. C. (2021). Differences in Blood Pressure Levels Among Children by Sociodemographic Status. Preventing Chronic Disease, 18:210058. Centers for Disease Control and Prevention. See Table 3: Prevalence of Elevated and Hypertensive Blood Pressures by Sociodemographic Characteristics in U.S. Children Ages 8 to 17 years, (NHANES) 2011-2018.

GotTransition.org. Resources are available to help youth, parents and providers plan for transitioning from pediatric to adult care.

Texas Health and Human Services Commission. Medicaid for Transitioning Foster Care Youth, allows young adults through age 20 years who are leaving foster care and enrolled in Medicaid to receive services through the Comprehensive Care Program.

Texas Health and Human Services Commission. Medical Transportation Program.

Texas Health and Human Services Commission. Star Health, a Texas Medicaid health plan for children in foster care through the Texas Department of Family and Protected Services. In Spanish.

  • For more information, caretakers and guardians can call STAR Health at 866-912-6283.

Texas Health Steps, Anticipatory Guidance Provider Guide. A helpful flip chart designed to be used during medical checkups to review age-appropriate topics, elicit parent and patient concerns, and guide discussion of individualized anticipatory guidance.

Texas Health Steps, Periodicity Schedule.

Texas Medicaid & Healthcare Partnership. Online Provider Search offers a streamlined search process for finding Medicaid providers. The online search tool also enables providers to update their contact information. This lookup tool allows providers to:

  • Designate specialties and subspecialties that are not captured at enrollment
  • Search using provider-designated specialties and subspecialties

In addition, primary care providers in need of a specialist or subspecialist can call the Texas Health Steps toll-free help line at 877-847-8377 (877-THSTEPS) Monday through Friday, 8 a.m. to 6 p.m., Central Time.

Texas Medicaid & Healthcare Partnership. Texas Medicaid Provider Procedures Manual.