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Diagnosis and Management of Hypertension in Children with Chronic Kidney Disease

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Core Concepts in Hypertension in Kidney Disease

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Abstract

Hypertension is increasingly recognized as a common feature of pediatric chronic kidney disease (CKD) that is associated with CKD progression, early markers of cardiovascular disease and neurocognitive functioning. Recent studies have demonstrated that the prevalence of hypertension in this population is higher than previously thought, and frequently underdiagnosed and undertreated. Identifying and treating hypertension in children with CKD requires familiarity with correct measurement technique, use of normative values to determine hypertensive status, and appropriate application of ambulatory blood pressure monitoring (ABPM). Consensus guidelines issued over the past decade have incorporated research on the consequences of hypertension in recommendations for the diagnosis and treatment of hypertension in pediatric CKD, and include lower blood pressure (BP) targets. Agents which target the renin–angiotensin–aldosterone system (RAAS) should be considered first-line therapy in CKD-associated hypertension in children, though multiple medications may be required to achieve sufficient BP control.

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Authors and Affiliations

  1. Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, WA, USA

    Susan M. Halbach MD, MPH & Joseph T. Flynn MD, MS

  2. Division of Nephrology, Seattle Children’s Hospital, Seattle, WA, USA

    Susan M. Halbach MD, MPH & Joseph T. Flynn MD, MS

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  1. Susan M. Halbach MD, MPH
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  2. Joseph T. Flynn MD, MS
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Correspondence to Joseph T. Flynn MD, MS .

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Editors and Affiliations

  1. Global and Continuing Education, Harvard Medical School, Boston, Massachusetts, USA

    Ajay K. Singh

  2. VA Medical Center, Indiana University School of Medicine, Indianapolis, Indiana, USA

    Rajiv Agarwal

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Halbach, S.M., Flynn, J.T. (2016). Diagnosis and Management of Hypertension in Children with Chronic Kidney Disease. In: Singh, A., Agarwal, R. (eds) Core Concepts in Hypertension in Kidney Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6436-9_13

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