From the Guidelines
The best evaluation for adolescent hypertension involves a comprehensive approach, including proper blood pressure measurement, thorough medical history, complete physical examination, and basic laboratory tests, with additional testing such as echocardiography and ambulatory blood pressure monitoring as needed, as recommended by the 2017 clinical practice guideline for screening and management of high blood pressure in children and adolescents 1.
Key Components of Evaluation
- Proper blood pressure measurement using an appropriately sized cuff after the patient has been seated quietly for 3-5 minutes, with at least three separate measurements on different occasions
- Thorough medical history focusing on risk factors, family history, and symptoms
- Complete physical examination looking for signs of secondary causes
- Basic laboratory tests including urinalysis, complete blood count, electrolytes, blood urea nitrogen, creatinine, fasting glucose, and lipid profile
Additional Testing
- Echocardiography to evaluate cardiac structure and function
- Ambulatory blood pressure monitoring to confirm hypertension and rule out white coat hypertension
- Renal ultrasound particularly in younger adolescents or those with abnormal urinalysis
- More specialized tests like plasma renin activity, aldosterone levels, or imaging studies may be indicated based on initial findings
Importance of Comprehensive Evaluation
Adolescent hypertension differs from adult hypertension, with a higher likelihood of secondary causes that require specific treatment approaches, and early identification can prevent long-term cardiovascular complications, as supported by the 2025 standards of care in diabetes 1.
Recent Guidelines
The 2017 clinical practice guideline for screening and management of high blood pressure in children and adolescents 1 provides a comprehensive framework for the evaluation and management of adolescent hypertension, emphasizing the importance of proper blood pressure measurement, thorough medical history, and complete physical examination, as well as the use of additional testing such as echocardiography and ambulatory blood pressure monitoring as needed.
From the Research
Evaluation of Adolescent Hypertension
The evaluation of adolescent hypertension involves a thorough clinical and diagnostic approach, including:
- Screening urinalysis, blood chemistries, and renal sonography 2
- A thorough history and physical examination, laboratory tests, and specialized studies 3
- The use of normative blood pressure tables for diagnosis and classification 4
- The identification of risk factors, comorbidities, and/or target organ damage 4
Diagnostic Approaches
Diagnostic approaches for adolescent hypertension include:
- Casual blood pressure measurements, although there are pitfalls in interpreting these measurements 2
- Ambulatory blood pressure monitoring, whose role is evolving 2
- Office-based blood pressure measurements, which have a sensitivity of 0.82 and a specificity of 0.70 5
Importance of Early Identification and Treatment
The early identification and treatment of hypertension in adolescents is crucial for preventing long-term cardiovascular and renal morbidity and mortality 2, 6
- Hypertension in childhood is associated with the presence and burden of atherosclerosis, and tracks from childhood to adulthood 6
- The presence of hypertension in childhood is associated with adverse cardiac changes and vascular damage, which can lead to premature cardiovascular disease in adulthood 6