Pediatric hypertension continues to be a prevalent condition in the United States. The correlation between the rise in pediatric hypertension is directly associated with pediatric obesity. Hypertension, also known as elevated blood pressure, is increased pressure of the blood exerted on the arterial walls. Children with high blood pressure have an increased risk for persistent hypertension as they transition into adulthood. In addition, untreated hypertension in pediatrics can lead to an increased risk of metabolic syndrome, chronic kidney disease, and stroke mortality.
The American Academy of Pediatrics (AAP) has updated their 2017 guidelines for diagnosing, screening, and managing pediatric hypertension. The diagnosis of pediatric hypertension is based on the blood pressure distribution values from both normal and obese children. Normal blood pressure for pediatric patients (aged 1 to younger than 13 years) falls into the 90th percentile or less. In the guidelines, types of hypertensions have been specified such as white coat, masked, primary. and secondary. Primary hypertension, also known as essential hypertension, is defined as blood pressure greater than or equal to the 95th percentile or 130/80 to 139/89 mmHg (whichever value is lower). This defined interval is applicable for pediatric patients aged 1 to younger than 13 years.
To manage primary hypertension, lifestyle modifications should be done prior to initiating pharmacologic agents. Lifestyle modifications includes an exercise regimen and diet changes. Pharmacologic agents should be utilized once a pediatric patient has been medically diagnosed as hypertensive and has trialed on lifestyle modifications. The current guideline recommends a single antihypertensive agent at the lowest dose. The initial pharmacologic agents recommended are an angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blockers, long-acting calcium channel blockers, or a thiazide diuretic (at pediatric doses). It is noted that comorbid conditions need to be assessed prior to starting initial therapy. The goal of managing high blood pressure is to decrease organ damage and cardiovascular complications as pediatric patients transition into adolescence and adulthood, respectively. The goal blood pressure for pediatric patients younger than age 13 years should be below the 90th percentile.
In the field of pediatric medications, compounding plays a crucial role by offering alternate methods for specific patient needs. When a commercially available medication is unable to meet the needs of pediatric patients, a solution would be to utilize compounded products. Tailored medication can enhance patient compliance. Oftentimes, appropriate dosage forms serve as a challenge for the pediatric population. Manufacturers may only offer solid oral dosage forms, but pediatric patients may have trouble swallowing. For example, if a pediatric patient is unable to swallow the tablet form of an ACE inhibitor, using it as an initial treatment for primary hypertension may be difficult. This can serve as a barrier to the patient's outcome. Altering the dosage into a form such as suspension, lozenge, or suppository may seem a more feasible treatment for the patient. Other scenarios that may lead to compounding as a permissible option would be food allergies, diet modifications, or other developmental disorders.
Compounding is a vital piece to increasing more options for the pediatric population who experience hypertension. When commercially available options have been exhausted, compounding the medication into an alternate form may serve to be a valuable solution to suit the patient's needs.
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
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