A 12-year-old with BMI above the 95th percentile and persistent hypertension after lifestyle changes. What is the next step?

A 12-year-old with BMI above the 95th percentile and persistent hypertension after lifestyle changes. What is the next step?

• A. Continued close monitoring
• B. Echocardiogram or MRI
• C. Prescribing an ACE inhibitor
• D. Referral to a nephrologist or cardiologist

Answer: (D)

Persistent hypertension in a child who remains hypertensive after lifestyle changes raises concern for an underlying secondary cause or organ involvement. The best next step is to involve specialists—nephrology or cardiology—for a thorough evaluation. These clinicians can uncover potential causes such as renal disease, vascular issues, or endocrine problems, and they coordinate the appropriate tests and management. They’ll determine what imaging or labs are needed and whether targeted therapy is required. Starting an ACE inhibitor without first clarifying the underlying cause can be premature, and simply watching and waiting risks missing a treatable secondary problem. Imaging like an echocardiogram or MRI may be part of the workup, but the decision and coordination come best through specialist evaluation.

Persistent hypertension in a child who remains hypertensive after lifestyle changes raises concern for an underlying secondary cause or organ involvement. The best next step is to involve specialists—nephrology or cardiology—for a thorough evaluation. These clinicians can uncover potential causes such as renal disease, vascular issues, or endocrine problems, and they coordinate the appropriate tests and management. They’ll determine what imaging or labs are needed and whether targeted therapy is required. Starting an ACE inhibitor without first clarifying the underlying cause can be premature, and simply watching and waiting risks missing a treatable secondary problem. Imaging like an echocardiogram or MRI may be part of the workup, but the decision and coordination come best through specialist evaluation.