Evidence-based guidelines for the management of hypertension in children with chronic kidney disease

• Published in: Pediatric nephrology (Berlin, West) Vol. 30; no. 11; pp. 1919 - 1927
• Main Author: Dionne, Janis M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2015; Springer; Springer Nature B.V
• Subjects: Antihypertensive Agents - therapeutic use; Antihypertensives; Blood pressure; Child; Chronic kidney failure; Clinical medicine; Clinical practice guidelines; Control; Diagnosis; Educational Review; Humans; Hypertension; Hypertension - drug therapy; Hypertension - etiology; Kidney diseases; Medical protocols; Medicine; Medicine & Public Health; Nephrology; Patients; Pediatrics; Practice Guidelines as Topic - standards; Renal Insufficiency, Chronic - complications; Risk factors; Task forces; Teenagers; Urology; Canada; Target blood pressure; Treatment; Clinical practice guideline; Angiotensin-converting enzyme inhibitor; Angiotensin receptor blocker; Clinic blood pressure; Ambulatory blood pressure monitoring
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-015-3077-7

Hypertension is common in children with chronic kidney disease and early evidence suggests that it is a modifiable risk factor for renal and cardiovascular outcomes. Recommendations for blood pressure management in children with chronic kidney disease can be found in various clinical practice guidelines including the 4th Task Force Report, the European Society of Hypertension pediatric recommendations, and the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for the management of blood pressure in chronic kidney disease. Unfortunately, as pediatric trial evidence is limited, there are discrepancies in the recommendations that may lead to inconsistent clinical care and practice variation. This article reviews the strength of evidence behind each of the clinical practice guideline recommendations regarding blood pressure assessment, treatment targets, and first-line antihypertensive medications. The benefits and cautions of use of clinical practice guidelines are described with emphasis on the importance of reading beyond the summary statements.