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Supplemental Information FROM THE AMERICAN ACADEMY OF PEDIATRICS Supplemental Information SUPPLEMENTAL TABLE 1 Content Outline Topics Addressed by PICOT 1 Question CPG Section How should HTN in children and adolescents 1 to <18 years of age be diagnosed in the office? 4.1, 4.2, 4.3, 4.8 Among children and adolescents 1 to <18 years of age, are oscillometric devices comparable to HgS devices for diagnosing systemic 4.5 HTN? Among children and adolescents 1 to <18 years of age, are wrist devices comparable to HgSs for diagnosing systemic HTN? 4.6 Among children and adolescents 1 to <18 years of age, what is the role of ABPM in the diagnosis of systemic HTN? What is the role of 4.7 ABPM in diagnosing MH or WCH? Among children and adolescents 1 to <18 years of age, are home BP assessments comparable to in-office measurements obtained by 4.9 medical personnel using a HgS? Among children and adolescents 1 to <18 years of age, can school-based and/or school nurse measurements serve as effective and 4.10 comparable (compared with in-office HgS) method(s) for diagnosing HTN? Among neonates 0–1 mo of age and among infants 1–12 mo of age, what is the best method for diagnosing HTN? 4.1a, 3.3 Among children and adolescents 1 to <18 years of age, does the use of ABPM identify children with HTN who are otherwise missed by 4.2, 4.7 routine office measurements (ie, MH), particularly among at-risk and children at high risk (eg, children who have obesity, children with OSA, children with CKD, children with repaired aortic coarctation, and children with a history of renal or heart transplantation)? Can use of the EHR assist with improved diagnosis of HTN in youth? Added (section 4.4) SUPPLEMENTAL TABLE 2 Content Outline Topics Addressed by PICOT 2 Question CPG Section Among children and adolescents 1 to <18 years of age with suspected renovascular HTN, what is the recommended diagnostic evaluation 5.2, 6.8 (a–b) (eg, renal ultrasonography, computed tomographic angiography, magnetic resonance angiography, renography)? Among children and adolescents with a history of repaired aortic coarctation, what is the recommended method for diagnosing (and 5.3 evaluating for the presence of) systemic HTN? What is the recommended diagnostic evaluation for systemic HTN in children and adolescents (including history, diagnostic evaluation 5.4, 6.1, 6.9, 6.10 for secondary causes of HTN, including endocrine related causes?) What is the role of perinatal history, nutrition history, physical activity history, and psychosocial history in the diagnosis of systemic HTN 6.2 in children and adolescents? What is the role of physical examination in the diagnosis of systemic HTN in children and adolescents? 6.3 What is the role of laboratory evaluation in the diagnosis of systemic HTN in children and adolescents? 6.4 What is the role of the ECG in the evaluation of systemic HTN in children and adolescents? 6.5 What is the role of the echocardiogram in the evaluation of systemic HTN in children and adolescents? 6.6 Are children and adolescents 1 to <18 years of age who have been exposed to particular environmental toxins (eg, lead, cadmium, 5.5 phthalates) at greater risk for developing systemic HTN? Among children and adolescents 1 to <18 years of age with suspected endocrine-related causes of systemic HTN, what tests are best for 5.4, 5.6 diagnosing these various conditions? Among children and adolescents 1 to <18 years of age, what over-the-counter medications are associated with elevated BP or systemic 5.7 HTN? When should monogenic forms of HTN be considered among children and adolescents with systemic HTN? 5.8 ECG, electrocardiogram. APPENDIX A NoExp] OR preHTN[tiab] OR neonate[tiab] OR adolescent[tiab] AND preHTN[mesh] OR HTN, renal[Mesh] OR adolescents[tiab] OR Search Terms “ ” OR HTN, renovascular[Mesh] OR adolescent[mesh]) “ ” white coat HTN[Mesh] OR masked ( BP monitor [tiab] OR PICOT 1: Searches Run on September “ ” 1, 2015 HTN[Mesh]) AND (child[tiab] OR BP monitoring [tiab] OR children[tiab] OR child[mesh] ambulatory BP [tiab] OR BP “ ” “ OR child, preschool[mesh] OR monitoring, ambulatory[mesh] ” “ ” “ ” PubMed: (HTN[tiab] OR high pediatric[tiab] OR infant[tiab] OR BP measurement [tiab] “ ” BP [tiab] OR elevated BP [tiab] OR OR infants[tiab] OR infant[mesh] OR BP screening [tiab] OR BP hypertensive[tiab] OR HTN[Mesh: OR infant, newborn[mesh] OR determination[mesh] OR office BP PEDIATRICS Volume 142, number 3, September 2018 1 SUPPLEMENTAL TABLE 3 Content Outline Topics Addressed by PICOT 3 Question CPG Section What nonpharmacologic therapies are available for the treatment of systemic HTN in children and adolescents? 7.1, 7.2 (a–d) What pharmacologic therapies are available for treatment of systemic HTN in children and adolescents? 7.3 (a–c) What therapies are available for children and adolescents with systemic HTN who are poorly responsive to a single agent? 7.4 What nonpharmacologic and pharmacologic therapies are available for the treatment of systemic HTN in children and adolescents with CKD? 8.1a What nonpharmacologic and pharmacologic therapies are available for the treatment of systemic HTN in children and adolescents with 8.1b proteinuria? What nonpharmacologic and pharmacologic therapies are available for the treatment of systemic HTN in children and adolescents with 8.2 diabetes? Does recommended pharmacologic therapy for the treatment of systemic HTN in children and adolescents vary by race, sex, or ethnicity? 10 What pharmacologic therapies are available for treatment of systemic HTN in children and adolescents with acute severe HTN? 11.1 What pharmacologic therapies are available for treatment of systemic HTN in the athlete? 11.2 What pharmacologic therapies are available for treatment of systemic HTN in children and adolescents after heart or kidney transplantation? 11.3 SUPPLEMENTAL TABLE 4 Content Outline Topics Addressed by PICOT 4 Question CPG Section How does the presence and the severity of systemic HTN influence indirect markers of CVD and vascular dysfunction? 6.7 Among children and adolescents with systemic HTN, how does the presence and severity of systemic HTN influence comorbidities such as 9.1 dyslipidemia? Among children and adolescents with systemic HTN, how does the presence and severity of systemic HTN influence comorbidities such as 9.2 OSA? Among children and adolescents with systemic HTN, how does the presence and severity of systemic HTN influence comorbidities such as 9.3 cognitive impairment? How does the diagnosis of systemic HTN in children and adolescents impact the long-term risk of HTN into adulthood? 12 SUPPLEMENTAL TABLE 5 Topics Without Specific KASs Section Topic Reason for Absence of KAS 3.1, 3.2 Definition of hypertension Expert opinion; population data analysis 4.1 BP measurement technique (including measurement in a neonate) Expert opinion 4.6 Forearm or wrist BP measurement Lack of sufficient evidence 4.8 Measurement in children with obesity Lack of sufficient evidence 4.10 School measurement and the role of school-based health professionals Lack of sufficient evidence 5.2 Secondary causes: renal and/or renovascular Lack of sufficient evidence 5.4 Secondary causes: endocrine hypertension Lack of sufficient evidence 5.5 Secondary causes: environmental exposures Lack of sufficient evidence 5.6 Secondary causes: neurofibromatosis Lack of sufficient evidence 5.7 Secondary causes: medication-related Lack of sufficient evidence 5.8 Monogenic hypertension Lack of sufficient evidence 6.2 History: perinatal, nutrition, physical activity, psychosocial, and family history Expert opinion 6.7 Vascular structure and function Insufficient normative data to define clinically actionable cut-points between normal and abnormal vascular parameters 6.9 Uric acid Lack of sufficient evidence 7.2c Wt loss and related cardiovascular risk factors Equivocal data 7.2d Stress reduction Lack of sufficient data to support a particular intervention 9.1 Comorbidities: dyslipidemia Lack of sufficient evidence 9.2 Comorbidities: OSA Lack of sufficient evidence 9.3 Comorbidities: cognitive impairment Lack of sufficient evidence 10 Sex, racial, and ethnic differences in BP and medication choice Lack of sufficient evidence to support varying treatment by sex, race, or ethnicity 11.3 Hypertension and the posttransplant patient Lack of sufficient evidence 13.1 Importance of preventing hypertension N/A 13.2 Strategies for prevention Lack of sufficient evidence in youth 14 Challenges in the implementation of pediatric hypertension guidelines N/A 15.1 Economic impact of BP management N/A 15.2 Patient perspective and pediatric hypertension N/A 15.3 Parental perspective and pediatric hypertension N/A OSA, obstructive sleep apnea; N/A, not available. 2 FROM THE AMERICAN ACADEMY OF PEDIATRICS SUPPLEMENTAL TABLE 6 Criteria for Reference Selection, Target Population for Each PICOT Question Population PICOT 1 PICOT 2 PICOT 3 PICOT 4 Infants (0–1 y) X X X Children (1–13 y) X X X X Adolescents (13–18 y) X X X X Subpopulations of interest X X X X Sex (boys or girls) Race and/or ethnicity (white, non-Hispanic African American, Hispanic, Asian American, and other groups, if specified) Obesity status (overweight or obese) Presence of comorbidities (DM, CKD, dyslipidemia, and history of transplant [renal or cardiac]) Intervention Not applicable Use of blood tests, Lifestyle modification Treatment of hypertension ECG, echo, only versus placebo; with lifestyle and MRA, and other 1 antihypertensive antihypertensive diagnostic tests in medication therapy the identification of versus
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