Table 10.

Therapeutic management of hypertension

Evidence in favor of therapeutic management
•	Reduce mortality and sequelae in the long-term
•	Reduce left ventricular hypertrophy
•	Reduce urinary albumin excretion
•	Reduce rate of progression to end-stage renal disease
When to start antihypertensive treatment
•	Non-pharmacological therapy should be initiated in all children with high normal blood pressure or hypertension
•	Non-pharmacological therapy should be continued after starting pharmacological therapy
•	Pharmacological therapy should be initiated when patients have symptomatic hypertension, target organ damage, secondary hypertension or diabetes mellitus type 1 or 2
•	Pharmacological therapy should be considered in the presence of clear increases in blood pressure levels or in the case of severe obesity with associated clinical conditions. Pharmacological therapy may be interrupted following positive results with lifestyle and dietary changes
BP targets
•	In general: blood pressure below the 90th percentile, specific for age, sex and height
•	Chronic kidney disease: blood pressure below the 75th percentile without proteinuria and below the 50th percentile in cases of proteinuria (urine total protein creatinine ratio >0.20 mg/mg)

Lurbe et al. “Management of High Blood Pressure in Children and Adolescents: recommendations of the ESH”. Journal of Hypertension 2009 [2] (modified).