Peds HTN, Dislipidemia, and obesity
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What are 3 environmental causes of Increased Cardio risk?
- 1. Sedentary
- 2. sodium
- 3. stress
What are 3 comorbidities that increase cardio risk?
- 1. Obesity
- 2. DM
- 3. Sleep apnea
When should routine BP be started?
What is the proper cuff proportions?
What is the difference in HTN definition for peds versus adults?
- -Based on gender/weight/height & is a reflection of normal population
- -Adults--> reflect CV event morbidity and mortality
Normal BP is?
What are the 2 parameters for Pre-HTN?
- 1. >90th but < 95th OR
- 2. Systolic >120mmHg and <90th
- Diastolic >80mmHg and <90th
What are the 2 parameters for Stage 1 HTN in kids?
- 1. >95th and
- 2. Systolic -5mmHg >99th
- Diastolic -5mmHg >99th
What are the Stage II HTN parameters for kids?
-Between >99th plus 5mmHg (both systolic/diastolic)
T or F. Childhood HTN is most often secondary to other conditions.
What are 4 primary causes of HTN?
- 1. postpubertal
- 2. mild
- 3. Family hx
- 4. obesity/overweight
What are 4 secondary causes of Childhood HTN?
- 1. Renal
- 2. Endocrine
- 3. Renovascular
- 4. Pre-pubertal??
T or F. Pediatric BP PREDICTS adult BP.
An initial HTN assessment includes a BP in both arms and 1 leg, why?
KNOW: Define BEARS
- B- Bedtime problems
- E- Excessive daytime sleepiness
- A- Awakenings during the night
- R- Regularity and duration of sleep
- S- Snoring
What are 4 labs for HTN diagnostics?
- 1. CBC
- 2. Fasting Chem 21
- 3. UA
- 4. Fasting Lipid Panel
If a kid has a Pre-HTN BP, when should a recheck be performed?
When a Kid is diagnosed with Stage 1 HTN, when should an eval or referral be down?
Within 1 month
What is the goal of HTN treatment?
- Treat to get Primary HTN < 95th%
- -Secondary HTN should be treated to <90th%
T or F. Pharmocological HTN txt--> should titrate to highest recommended dose prior to adding 2nd agent.
True, if goal not met by 2 agents--> refer
T or F. A pharm dose should never exceed adult does despite weight.
Which HTN meds can be given in kids < 6yo?
Diuretics & B-blockers
T or F. In kids < 15yo or prepubertal, HTN is secondary until proven otherwise.
What TG level is considered high and what level is considered urgent?
- TG- >150mg/dl
- TG- > 500mg/dl
What is the normative level for Cholesterol, LDL, HDL?
- Cholesterol- <170
- LDL- <110
- HDL- >60
If a kid <1yo has dyslipidemia, what should your DD be?
1. Obstructive liver disease
With younger kids with dyslipidemia, what DD should you consider?
- 1. Endocrine
- 2. Medications
With adolescents who have dyslipidemou consideria, what etiology should you consider?
What 4 labs should be performed for dyslipidemia?
- 1. LFT/FLP
- 2. Renal function
- 3. UA
- 4. TSH
KNOW: When is a "selective" screening performed?
- High risk children initial screening between 2-8yo
- -Parents w/ TC >240
- -Unknown family hx
- -Personl risk factors
- -High risk parents/grandparents <55
KNOW: When is a universal screening given?
- -All children b/w 9-11 & 17-21yo
- -Lipid panel (fasting or non-)
- -If non-fasting (chol-HDL) = 145 or HDL <40, the must get fasting lipid panel
KNOW table 9-1 for lipids, txt based on risk factors
At what age should kids with dyslipidemia be referred for treatment?
What lipid levels in kids should be evaluated by a specialist?
- -LDL >250mg/dl
- -TG >500mg/dl
- -refractory or complicated
What is generally the only dyslipidemia med that can be used in kids?
- (bile acids as adjunctive only)
What percentile are kids considered "overweight"?
What percentile are kids considered "obese"?
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