Treatment of high blood pressure in the young.

Children with high normal or high BP should also be evaluated for other cardiovascular risk factors, and interventions should address overall cardiovascular risk. Nonpharmacologic interventions include weight reduction when appropriate, avoidance of dietary salt excess, and dynamic exercise. Drug treatment should be required in a minority of children with hypertension. There are concerns about the longterm effects of drug therapy on lipid and carbohydrate metabolism and on physical and cognitive growth and development. Beta adrenergic antagonists and diuretics are usually the first line drugs to be added to the nonpharmacologic therapeutic strategies for BP control in children. After a sufficient period of BP control, a stepped-down approach and discontinuation of drug therapy should be considered.