Hypertension in Children and Adolescents—Diagnostic Challenges and Management Table 3: Hypertension Toolkit for Patients, their Caregivers and Clinicians


Tools for Patients and Caregivers General


information Exercise


www.heart.org/HEARTORG • Information about high blood pressure from the American Heart Association


www.cdc.gov/Healthyyouth/physicalactivity/guidelines.htm#1 • Physical activity guidelines from the US Centers for Disease Control and Prevention www.nhlbi.nih.gov/health/public/heart/obesity/wecan/get-active/index.htm www.phac-aspc.gc.ca/hp-ps/hl-mvs/pa-ap/04paap-eng.php • Information on getting active from the US National Heart Lung and Blood Institute (NHLBI)’s Ways to Enhance Children’s Activity and Nutrition (We Can!) national movement, and from the Public Health Agency of Canada, respectively www.nhlbi.nih.gov/health/public/heart/obesity/wecan/reduce-screen-time/index.htm • Information on reducing time spent in front of television/computer screens from the NHLBI’s We Can!


Diet


www.nhlbi.nih.gov/health/public/heart/obesity/wecan/eat-right/index.htm • Information on eating well from the NHLBI’s We Can! www.nhs.uk/Livewell/Goodfood/Pages/salt.aspx • Information on reducing salt consumption from the UK National Health Service www.cnpp.usda.gov/dietaryguidelines.htm • 7th edition of the Dietary Guidelines for Americans published in 2010 by the US Department of Agriculture and the US Department of Health and Human Services


www.fda.gov/food/labelingnutrition/consumerinformation/ucm078889.htm www.nhs.uk/Livewell/Goodfood/Pages/food-labelling.aspx www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/cons/index-eng.php • Information on how to read and use nutrition fact labels from the US Food and Drug Administration, the UK National Health Service and Health Canada, respectively


Tools for Clinicians


Clinical www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.pdf guidelines


• The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents from the US Department of Health and Human Services


www.nhlbi.nih.gov/health/public/heart/hbp/bp_child_pocket/bp_child_pocket.pdf • A Pocket Guide to Blood Pressure Measurement in Children from the US Department of Health and Human Services http://pediatrics.aappublications.org/content/122/1/198.full www.aafp.org/afp/2009/0415/p703.html • American Academy of Pediatrics clinical report on lipid screening in children59 Physician,60


respectively


Dietary counselling should also be made available to the patient and family. Interprofessional teams, including a dietician or nutritionist, may be optimally inclined to handle this avenue where educational programmes directed at parents, caregivers and schools are paramount. Decreasing salt and sugar intake and increasing fruit, vegetable, fibre, and low-fat dairy products intake, as advocated by the Dietary Approaches to Stop Hypertension (DASH) diet, should be encouraged in all children, especially those with hypertension.10,33


The DASH study


demonstrated that, with an increase in fruit and vegetable of 8–10 servings per day, systolic and diastolic blood pressure was lowered by 2.8 and 1.1 mmHg, respectively, in all participants and by 7.2 and 2.8 mmHg, respectively, in hypertensive participants.34


This blood


pressure lowering effect is similar to that obtained from taking medication. All caregivers should be educated in calorie restriction, portion control and interpreting food package labels (see Table 3). Understanding how to read nutrition fact labels and being aware of the confusing jargon used on those labels, can help patients and caregivers make healthier food choices when shopping and planning their meals. This will enable families to ensure they are eating a low-sodium, low-fat, and well-balanced diet. Furthermore, patients and their families should consider adopting strategies to reduce salt in their diet such as rinsing canned foods in water prior to eating, flavouring food with spices instead


US NEPHROLOGY


of salt and requesting that no salt be added in restaurant meals. Not all families will have the possibility to participate in intense obesity programmes conducted by multidisciplinary teams in specialized medical institutions. Thus counselling families to promote a heart-healthy diet on a regular basis is important to stimulate changes in daily living. In summary, the slogan ‘Eat less, eat better, and move more’, used by some to describe the Dietary Guidelines for Americans, is one everyone should adhere to daily.


Other management strategies to decrease high blood pressure through a healthy lifestyle include better sleep practices, techniques for handling stress, and the avoidance of smoking and excessive alcohol intake.8 Screening for alcohol and smoking is not often carried out in childhood or adolescence, yet the estimated rates of alcohol and tobacco use among youths aged 12–17 in the US in 2006 were 16.6 and 10.4 %, respectively.36


These figures vary according to the community, but they still indicate the need for pediatricians to consider risky social behaviors as contributing factors.


When managing high blood pressure associated with unhealthy lifestyle, education is imperative. There are numerous books, websites and groups offering information on hypertension; however, many of these


113


and practice guidelines published in the American Family


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