Guideline lead author, Dr. Joseph Flynn, MD, FAAP reviews the major updates to the recommendations.

Joseph Flynn, MD: So we updated the hypertension guidelines because well first of all they haven’t been updated since 2004 and secondly there’s been a lot of new studies published in the last 13 years. We did reduce the recommendation for checking blood pressure in otherwise healthy children from every time they see a provider to once a year at their well child check up. Ambulatory blood pressure monitoring is now recommended to confirm the diagnosis of white coat hypertension in a child or adolescent who has had elevated office blood pressure readings; those children with white coat hypertension don’t need further workup and they certainly don’t need treatment.

We did change the recommendation for when to obtain an echocardiogram — we are now recommending that the echocardiogram be delayed until such time as you’re planning to start the child on antihypertensive medication. The reason for doing that is really to focus the provider’s attention on what the blood pressure is as opposed to what the diagnostic test shows. We want people to be treating the blood pressure and not treating the echocardiogram.