Author Affiliations: Department of Cardiology, Boston Children's Hospital, Harvard Medical School (Dr de Ferranti), and Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute and Department of Nutrition, Harvard School of Public Health (Dr Gillman), Boston, Massachusetts.
In 2011, the National Heart, Lung, and Blood Institute Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents reiterated the recommendations in the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents published in 2004.1,2 These guidelines recommend universal blood pressure screening in pediatric practice starting at age 3 years. If an initial blood pressure (BP) reading exceeds the 90th percentile for age, sex, and height, the practitioner is to repeat the measurement, preferably at least twice on separate occasions. Then he or she can categorize the patient into prehypertensive (90th to 95th percentile), stage 1 hypertension (95th percentile to 5 mm Hg above the 99thpercentile), or stage 2 hypertension (above that high cutpoint). For stage 1 and stage 2 hypertension, the guidelines recommend evaluation with renal and cardiac ultrasound, along with additional laboratory tests.
de Ferranti SD, Gillman MW. Hypertension in Children and Adolescents—More Questions Than Answers. Arch Pediatr Adolesc Med. 2012;166(9):872-874. doi:10.1001/archpediatrics.2012.1503