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High blood pressure in children and adolescents is a growing health problem that is often overlooked by physicians. Normal blood pressure values for children and adolescents are based on age, sex, and height, and are available in standardized tables. Prehypertension is defined as a blood pressure in at least the 90th percentile, but less than the 95th percentile, for age, sex, and height, or a measurement of 120/80 mm Hg or greater. Hypertension is defined as blood pressure in the 95th percentile or greater. A secondary etiology of hypertension is much more likely in children than in adults, with renal parenchymal disease and renovascular disease being the most common. Overweight and obesity are strongly correlated with primary hypertension in children. A history and physical examination are needed for all children with newly diagnosed hypertension to help rule out underlying medical disorders. Children with hypertension should also be screened for other risk factors for cardiovascular disease, including diabetes mellitus and hyperlipidemia, and should be evaluated for target organ damage with a retinal examination and echocardiography. Hypertension in children is treated with lifestyle changes, including weight loss for those who are overweight or obese; a healthy, low-sodium diet; regular physical activity; and avoidance of tobacco and alcohol. Children with symptomatic hypertension, secondary hypertension, target organ damage, diabetes, or persistent hypertension despite nonpharmacologic measures should be treated with antihypertensive medications. Thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta blockers, and calcium channel blockers are safe, effective, and well tolerated in children.
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PMID:High blood pressure in children and adolescents. 2296 55

The prevalence of hypertension is rising with age, and current evidence shows that the majority of elderly patients benefit from proper antihypertensive therapy. To support physicians in everyday care of elderly patients with hypertension, new guidelines were issued in Poland at the end of 2012. In 2013, the guidelines started to be implemented into practice. The aim of this article is to present an overview of the major recommendations included in these 2013 guidelines. Physicians should be aware of the key issues specific for the care of the elderly hypertensive population. Lowering blood pressure below 150/90 mmHg should be considered as the goal of therapy in hypertensive patients older than 80 years. Slight overweight (body mass index, 27-28 kg/m2) may be beneficial for patients older than 75 years and especially for octogenarians because it may prevent protein and calorie deficiency. Thiazide-like diuretics followed by angiotensin-converting-enzyme inhibitors, if needed, should be considered as a first-line therapy for hypertensive patients older than 80 years. Because of high risk of adverse effects, the pharmacological treatment of hypertension in the elderly should be started with lower doses of blood pressure-lowering agents, and treatment intensification should be careful. The guidelines on hypertension management were developed by 3 medical societies and specialists from different medical fields. The Delphi method was used to achieve consensus on controversial issues.
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PMID:Hypertension in the elderly: how to treat patients in 2013? The essential recommendations of the Polish guidelines. 2397 90