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June 2018

What Is the Prevalence of Childhood Hypertension?It Depends on the Definition

Author Affiliations
  • 1Department of Pediatrics, University of Colorado School of Medicine, Aurora
JAMA Pediatr. 2018;172(6):519-520. doi:10.1001/jamapediatrics.2018.0375

It has been known for some time that hypertension is a major risk factor for cardiovascular disease (CVD) in adults and that the reduction of elevated blood pressure is associated with the reduction of risk for CVD.1 This knowledge has led to the concept that elevated blood pressure in children and adolescents is also a source of concern and that children and adolescents should have their blood pressure measured and it should be lowered when it is elevated.2 Concern for blood pressure elevation in children is heightened by the cardiac, vascular, and neurocognitive target organ abnormalities observed in young individuals with hypertension. However, the level of blood pressure that defines hypertension has proven to be more complicated in both adults and children. In adults, epidemiologic studies have been able to link certain levels of blood pressure with degrees of risk for CVD, but this connection is complicated by the fact that there appears to be a continuous risk function associating blood pressure with the risk of CVD.3 This complication makes it difficult to determine specific blood pressure cutpoints for use in clinical practice. In children and adolescents, determining specific blood pressure cutpoints has been even more complicated because there are few data providing a direct link between blood pressure level in childhood and cardiovascular events in adulthood. This lack of data has led to the use of population normative data to define hypertension, usually using blood pressure that is persistently (on ≥3 occasions) above the 95th percentile based on sex, age, and height.2