These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes ...in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.
The overall goal of this review is to summarize what is currently known regarding the tracking of blood pressure levels from early childhood into later adulthood and to describe the factors ...contributing to increased hypertension prevalence across the lifespan. This review describes 4 theoretical constructs of blood pressure trajectory across the lifespan: forward development, forward tracking, forward reversal, and maintenance of normal blood pressure levels.The overall goal of this review is to summarize what is currently known regarding the tracking of blood pressure levels from early childhood into later adulthood and to describe the factors contributing to increased hypertension prevalence across the lifespan. This review describes 4 theoretical constructs of blood pressure trajectory across the lifespan: forward development, forward tracking, forward reversal, and maintenance of normal blood pressure levels.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
This article outlines what is currently known regarding the relationship between neighborhood deprivation and pediatric obesity. It discusses the intersectionality between neighborhood deprivation, ...race, ethnicity, and pediatric obesity. We conclude by proposing several potential solutions to disparities in pediatric obesity related to neighborhood deprivation.
Neighborhood deprivation, independent of individual socioeconomic status, is a risk factor for pediatric obesity. The obesogenic characteristics of high deprivation neighborhoods (e.g., lack of safe spaces to be active, easy access to fast food) and the psychological aspects of residing within high deprivation neighborhoods may also contribute to this risk. Intervention strategies and policies designed to address neighborhood related risk for pediatric obesity are needed.
Pediatric obesity is a growing problem of complex etiology. Neighborhood risk factors should be considered when assessing risk burden and when designing intervention strategies.
To determine whether telehealth acceptance by parents of children with heart disease is predicted by sociodemographic and/or by parental digital literacy, and to assess parental perceptions of ...telehealth usability and reliability.
We conducted a single center study comparing telehealth acceptance versus visit cancellation/rescheduling for pediatric cardiology visits during the early phase of the COVID-19 pandemic. All parent/guardians who consented to survey completion received a validated survey assessing their digital literacy. Consenting parents who accepted telehealth received an additional validated survey assessing their perceptions of telehealth usability and reliability.
A total of 849 patients originally were scheduled for in-person visits between March 30 and May 8, 2020. Telehealth acceptance was highest among younger, publicly insured, Hispanic patients with primary diagnoses of arrhythmia/palpitations, chest pain, dysautonomia, dyslipidemia and acquired heart disease. Among parents who completed surveys, a determinant of telehealth acceptance was digital literacy. Telehealth was determined to be a usable and reliable means for health care delivery.
Although the potential for inequitable selection of telehealth due to sociodemographic factors exists, we found that such factors were not a major determinant for pediatric cardiology care within a large, diverse, free-standing pediatric hospital.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Obstructive sleep apnea (OSA) is a known risk factor for cardiovascular disease in adults. It is associated with incident systemic hypertension, arrhythmia, stroke, coronary artery disease, and heart ...failure. OSA is common in children and adolescents, but there has been less focus on OSA as a primary risk factor for cardiovascular disease in children and adolescents. This scientific statement summarizes what is known regarding the impact of sleep-disordered breathing and, in particular, OSA on the cardiovascular health of children and adolescents. This statement highlights what is known regarding the impact of OSA on the risk for hypertension, arrhythmia, abnormal ventricular morphology, impaired ventricular contractility, and elevated right heart pressure among children and adolescents. This scientific statement also summarizes current best practices for the diagnosis and evaluation of cardiovascular disease-related complications of OSA in children and adolescents with sleep apnea and highlights potential future research in the area of sleep-disordered breathing and cardiovascular health during childhood and adolescence.
Purpose of Review
Cardiovascular disease (CVD) can begin in youth. Prevention is essential to reducing the burden of CVD-related risk factors in childhood and disease development in adulthood. This ...review addresses the clinical scope of CVD prevention, including a review of conditions encountered, proposed diagnostic criteria, and management strategies. We also highlight the impact of the intrauterine environment on the development of CVD risk. Finally, we highlight the potential role of telehealth in the management of pediatric patients with risk factors for premature CVD.
Recent Findings
Growing evidence suggests that maternal obesity, diabetes, and preeclampsia may play an important role in the development of CVD risk among offspring contributing to the development of known traditional CVD risk factors among offspring.
Summary
As the prevalence of CVD continues to rise, knowledge as well as appropriate diagnosis and management of primordial and traditional risk factors for CVD is needed. The diagnosis and management of CVD risk factors is a central role of the preventive pediatric cardiologist, but it is imperative that the general physician and other pediatric subspecialists be aware of these risk factors, diagnoses, and management strategies. Finally, telehealth may offer an additional method for providing preventive care, including screening and counseling of at risk children and adolescents for traditional risk factors and for providing education regarding risk factors in cases of long distance care and/or during periods of social distancing.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Cardiovascular-kidney-metabolic health reflects the interplay among metabolic risk factors, chronic kidney disease, and the cardiovascular system and has profound impacts on morbidity and mortality. ...There are multisystem consequences of poor cardiovascular-kidney-metabolic health, with the most significant clinical impact being the high associated incidence of cardiovascular disease events and cardiovascular mortality. There is a high prevalence of poor cardiovascular-kidney-metabolic health in the population, with a disproportionate burden seen among those with adverse social determinants of health. However, there is also a growing number of therapeutic options that favorably affect metabolic risk factors, kidney function, or both that also have cardioprotective effects. To improve cardiovascular-kidney-metabolic health and related outcomes in the population, there is a critical need for (1) more clarity on the definition of cardiovascular-kidney-metabolic syndrome; (2) an approach to cardiovascular-kidney-metabolic staging that promotes prevention across the life course; (3) prediction algorithms that include the exposures and outcomes most relevant to cardiovascular-kidney-metabolic health; and (4) strategies for the prevention and management of cardiovascular disease in relation to cardiovascular-kidney-metabolic health that reflect harmonization across major subspecialty guidelines and emerging scientific evidence. It is also critical to incorporate considerations of social determinants of health into care models for cardiovascular-kidney-metabolic syndrome and to reduce care fragmentation by facilitating approaches for patient-centered interdisciplinary care. This presidential advisory provides guidance on the definition, staging, prediction paradigms, and holistic approaches to care for patients with cardiovascular-kidney-metabolic syndrome and details a multicomponent vision for effectively and equitably enhancing cardiovascular-kidney-metabolic health in the population.
The overall prevalence of hypertension in childhood is 2% to 5%, and the leading type of childhood hypertension is primary hypertension, especially in adolescence. As in adults, the leading risk ...factors for children with primary hypertension are excess adiposity and suboptimal lifestyles; however, environmental stress, low birth weight, and genetic factors may also be important. Hypertensive children are highly likely to become hypertensive adults and to have measurable target organ injury, particularly left ventricular hypertrophy and vascular stiffening. Ambulatory and home blood pressure monitoring may facilitate diagnosis. Primordial prevention of hypertension through public health implementation of healthier diet and increased physical activity will reduce the prevalence of primary hypertension, and evidence-based treatment guidelines should be implemented when hypertension is diagnosed. Further research to optimize recognition and diagnosis and clinical trials to better define outcomes of treatment are needed.
Purpose of the Review
Family meals represent a novel strategy for improving cardiovascular health in youth. The purpose of this paper is to describe the association between family meals, dietary ...patterns, and weight status in youth.
Review Findings
According to the American Heart Association’s Life’s Essential 8, poor diet quality and overweight/obesity status are key contributors to suboptimal cardiovascular health. Current literature highlights a positive correlation between the number of family meals and healthier eating patterns, including greater consumption of fruits and vegetables, and a reduced risk of obesity in youth. However, to date, the role of family meals in improving cardiovascular health in youth has been largely observational and prospective studies are needed to assess causality.
Summary
Family meals may be an effective strategy for improved dietary patterns and weight status in youth.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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