In the Hypertension Program at Boston Children’s Hospital, we employ a multidisciplinary approach to treating high blood pressure in the pediatric population. Our team works closely with specialists in other departments in the hospital to develop individualized care plans that meet each child’s medical needs.
The first step in the process involves a comprehensive consultation with a nephrologist to review the child’s medical history. If hypertension is confirmed, screening laboratory studies are typically performed which will guide further testing or imaging.
In most cases, our team will develop a plan for monitoring each patient’s blood pressure outside of a medical office setting. This is very important since many pediatric patients are anxious and nervous at physician visits, which may cause the blood pressure to be elevated at the time of their clinic appointments. We typically coordinate school and/or home blood pressure monitoring to get a better sense of blood pressure in a typical setting. In addition, many of our patients undergo 24 hour ambulatory blood pressure monitoring to further define any blood pressure variability or trends over the course of a full day.
Treatment depends on the results of this blood pressure monitoring and initial testing, in terms of both the cause and severity of hypertension. In most patients with mild blood pressure elevations, we initiate lifestyle modifications such as exercise and a healthy diet. We monitor these children for a period of time to track their progress to determine if medication will be required.
If there is a kidney problem identified, blood pressure therapy most often consists of nutritional counseling and antihypertensive medications. In these cases, we meet with the family and select a medicine that makes the most sense for the individual child. If we find the high blood pressure is being caused by a problem related to a heart or endocrine disorder, we’ll provide a referral to the appropriate specialist if that is needed.
Children with obesity-related hypertension also make up a significant part of our population. We provide these children and families with extensive guidance regarding lifestyle modification, including appropriate dietary choices and optimizing physical activity. Our physicians, dietitians, and nurses work with primary care physicians to provide ongoing support in these areas.