Table 1.

Chart of the guidelines for the management of dyslipidemia and hypertension.

Organization	Screening	Initial Treatment	When to Start Medication
Lipid Guidelines			Statin Therapy
American Diabetes Association(American Diabetes Association S5–S87)	-Check lipid profile in children ≥2 years of age after diagnosis -Check annually if ≥100 mg/dl, or every 5 years <100 mg/dl	-Initial treatment is: MNT to decrease saturated fat optimizing glycemic control	-After age 10 years and after trial of MNT and lifestyle change if: LDL >160 mg/dl LDL >130 mg/dl and ≥1 CVD risk factor -Goal: LDL <100 mg/dl
American Heart Association(Kavey et al. 1562–66)		-Nutritional management focused on limiting fat, especially saturated and trans fat and management of weigh for 6 months to achieve LDL ≤100 mg/dl	-Statin Rx if >10 years old to achieve LDL ≤100 mg/dl if not achieved via initial treatment.
National Heart, Lung and Blood Institute(Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents S213– S256)	-Average fasting lipid profile × 2 at age 2–8 years, 9–11 years, 12–16 years, and 17–21 years	-If LDL ≥130 and <250, start lifestyle therapy including diet targeting limiting fat especially saturated and trans fat, physical activity, and possibly plant sterol esters × 6 months	-If age ≥10 years and LDL≥160 after 6 months or LDL≥130 and ≥2 moderate level RFs or 1 additional high level RF
BP Guidelines			ACE Inhibitor/Angiotensin Receptor Blocker
American Diabetes Association(American Diabetes Association S5–S87)	-BP measured at every visit -If elevated ≥90th percentile, it should be confirmed on 3 separate days	-If ≥90%tile but <95%tile, 3–6 months of lifestyle intervention -If ≥95%tile, start medication as soon as diagnosis confirmed	-If ≥90%tile but <95%tile and lifestyle change not successful -If >95%tile, medication is initial therapy -Goal: BP <90%tile
American Heart Association(Kavey et al. 1562–66)	-If BP ≥90%tile or >120/80, repeat on 3 separate occasions within 1 month -If BP >95%tile, confirm within 1 week	-Initial BP ≥90%tile for age/sex/height: decreased caloric intake, increased activity, no added salt for 6 months -if BP >95%tile × 2, start medication	-BP consistently >95%tile, ACEI with goal of <90th %tile or <130/80 mmHg, whichever lower
National Heart, Lung and Blood Institute(Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents S213– S256)	-BP at each well visit at age >3 years -If elevated, repeat at that visit and average both BPs -If average elevated, repeat BP in 6 months if ≥90%tile, in 1–2 weeks if ≥95%tile or evaluate or refer within 1 week if ≥99%tile + 5 mmHg	-If ≥95%tile, work-up with history, physical exam, laboratory studies, renal/cardiac US -Initial BP >90%tile: diet, increased activity and weight management -If ≥99%tile + 5 mmHg, start ACEI immediately or refer	-BP persistently ≥95%tile after 6 months or LVH: Begin ACEI with goal of <90%ile -If ≥99%tile + 5 mmHg: Refer or treat with medication within 1 week of diagnosis

Reference List

American Diabetes Association. "Standards of medical care in diabetes--2015." Diabetes Care 38 Suppl 1 (2015): S5–S87.

Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents. "Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report." Pediatrics 128 Suppl 5 (2011): S213–S256.

Kavey, R. E., et al. "American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood." Circulation 107.11 (2003): 1562–66.