ERKNet

The European Rare Kidney Disease Reference Network

  

 

Thematic Area: Blood Pressure Control

 
The following guidance document has been adopted based on standardized reviews and is followed in all ERKNet centers:

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents.  

 J Hypertens 2016; 34:1887-920


Core Recommendations:
  1. BP goal in children with CKD:
         <75th percentile in children with nonproteinuric CKD
         <50th percentile in children with proteinuric CKD
  2. Use of Ambulatory BP Monitoring (ABPM) for diagnosis and monitoring of HTN is recommended. 
         Target BP percentiles above apply also to 24h BP..
  3. Use RAS blocking agents as first choice with appropriate risk counseling in all proteinuric patients with CKD. In hypertensive infants with nonproteinuric CKD, calcium channel blockers may be considered as first-line therapy for safety considerations. 
 
Comments by evaluators:
  • The risks and benefits of ACE/ARB use need to be clearly defined - the newer guideline must include the 2014 MHRA alert about the combination use of ACE/ARB-direct renin inhibitors and the collapse of large scale adult trials because of AKI and significant hyperkalaemia.
  • The elusive RCTs are sought and used where possible (i.e ESCAPE) for consensus; prospective cohorts and small reported trials were also used and the limitations are acknowledged. 
  • Editorial board and working group is well described - but contains no commissioners, parental or lay contributors. 
  • Not all statements have got high ratings, but mostly because there is a lack of evidence which the authors also address.