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PEDIATRICS Vol. 114 No. 2 August 2004, pp. 555-576

SUPPLEMENT ARTICLE

The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents

Abbreviations: BP, blood pressure • NHBPEP, National High Blood Pressure Education Program • SBP, systolic blood pressure • DBP, diastolic blood pressure • NHANES, National Health and Nutrition Examination Survey • JNC 7, Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure • NHLBI, National Heart, Lung, and Blood Institute • ABPM, ambulatory blood pressure monitoring • CVD, cardiovascular disease • BMI, body mass index • PRA, plasma renin activity • DSA, digital-subtraction angiography • ACE, angiotensin-converting enzyme • MRA, magnetic resonance angiography • CT, computed tomography • LVH, left ventricular hypertrophy

The first 300 words of the full text of this article appear below.


   INTRODUCTION
 
Considerable advances have been made in detection, evaluation, and management of high blood pressure (BP), or hypertension, in children and adolescents. Because of the development of a large national database on normative BP levels throughout childhood, the ability to identify children who have abnormally elevated BP has improved. On the basis of developing evidence, it is now apparent that primary hypertension is detectable in the young and occurs commonly. The long-term health risks for hypertensive children and adolescents can be substantial; therefore, it is important that clinical measures be taken to reduce these risks and optimize health outcomes.

The purpose of this report is to update clinicians on the latest scientific evidence regarding BP in children and to provide recommendations for diagnosis, evaluation, and treatment of hypertension based on available evidence and consensus expert opinion of the working group when evidence was lacking. This publication is the fourth report from the National High Blood Pressure Education Program (NHBPEP) Working Group on Children and Adolescents and updates the previous 1996 publication, "Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents."1

This report includes the following information:

  • New data from the 1999–2000 National Health and Nutrition Examination Survey (NHANES) have been added to the childhood BP database, and the BP data have been reexamined. The revised BP tables now include the 50th, 90th, 95th, and 99th percentiles by gender, age, and height.
  • Hypertension in children and adolescents continues to be defined as systolic BP (SBP) and/or diastolic BP (DBP), that is, on repeated measurement, ≥95th percentile. BP between the 90th and 95th percentile in childhood had been designated "high normal." To be consistent with the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), this . . . [Full Text of this Article]

Reprint requests to Edward J. Roccella, National High Blood Pressure Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bldg 31, Room 4A10, Center Dr, MSC 2480, Bethesda, MD 20892. E-mail: roccelle@nhlbi.nih.gov


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T. H. Inge, G. Miyano, J. Bean, M. Helmrath, A. Courcoulas, C. M. Harmon, M. K. Chen, K. Wilson, S. R. Daniels, V. F. Garcia, et al.
Reversal of Type 2 Diabetes Mellitus and Improvements in Cardiovascular Risk Factors After Surgical Weight Loss in Adolescents
Pediatrics, January 1, 2009; 123(1): 214 - 222.
[Abstract] [Full Text] [PDF]

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 HypertensionHome page
A. L.B. Gunther, A. D. Liese, R. A. Bell, D. Dabelea, J. M. Lawrence, B. L. Rodriguez, D. A. Standiford, and E. J. Mayer-Davis
Association Between the Dietary Approaches to Hypertension Diet and Hypertension in Youth With Diabetes Mellitus
Hypertension, January 1, 2009; 53(1): 6 - 12.
[Abstract] [Full Text] [PDF]

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 Am J EpidemiolHome page
R. Bakker, S. L. Rifas-Shiman, K. P. Kleinman, S. E. Lipshultz, and M. W. Gillman
Maternal Calcium Intake During Pregnancy and Blood Pressure in the Offspring at Age 3 Years: A Follow-up Analysis of the Project Viva Cohort
Am. J. Epidemiol., December 15, 2008; 168(12): 1374 - 1380.
[Abstract] [Full Text] [PDF]

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 J. Clin. Endocrinol. Metab.Home page
G. P. August, S. Caprio, I. Fennoy, M. Freemark, F. R. Kaufman, R. H. Lustig, J. H. Silverstein, P. W. Speiser, D. M. Styne, and V. M. Montori
Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion
J. Clin. Endocrinol. Metab., December 1, 2008; 93(12): 4576 - 4599.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
S. J. Swartz, P. R. Srivaths, B. Croix, and D. I. Feig
Cost-Effectiveness of Ambulatory Blood Pressure Monitoring in the Initial Evaluation of Hypertension in Children
Pediatrics, December 1, 2008; 122(6): 1177 - 1181.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
M. B. Lande, T. A. Pearson, R. P. Vermilion, P. Auinger, and I. D. Fernandez
Elevated Blood Pressure, Race/Ethnicity, and C-Reactive Protein Levels in Children and Adolescents
Pediatrics, December 1, 2008; 122(6): 1252 - 1257.
[Abstract] [Full Text] [PDF]

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 Diabetes and Vascular Disease ResearchHome page
M. W. L. Strufaldi, E. M. K. Da Silva, and R. F. Puccini
Metabolic syndrome among prepubertal Brazilian schoolchildren
Diabetes and Vascular Disease Research, November 1, 2008; 5(4): 291 - 297.
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 PediatricsHome page
J. Wiesen, M. Adkins, S. Fortune, J. Horowitz, N. Pincus, R. Frank, S. Vento, C. Hoffman, B. Goilav, and H. Trachtman
Evaluation of Pediatric Patients With Mild-to-Moderate Hypertension: Yield of Diagnostic Testing
Pediatrics, November 1, 2008; 122(5): e988 - e993.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
M. Salvadori, J. M. Sontrop, A. X. Garg, J. Truong, R. S. Suri, F. H. Mahmud, J. J. Macnab, and W. F. Clark
Elevated Blood Pressure in Relation to Overweight and Obesity Among Children in a Rural Canadian Community
Pediatrics, October 1, 2008; 122(4): e821 - e827.
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 The Annals of PharmacotherapyHome page
A. M Franks, C. E O'Brien, C. D Stowe, T. G Wells, and S. F Gardner
Candesartan Cilexetil Effectively Reduces Blood Pressure in Hypertensive Children
Ann. Pharmacother., October 1, 2008; 42(10): 1388 - 1395.
[Abstract] [Full Text] [PDF]

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 HypertensionHome page
G. D. Simonetti, L. Raio, D. Surbek, M. Nelle, F. J. Frey, and M. G. Mohaupt
Salt Sensitivity of Children With Low Birth Weight
Hypertension, October 1, 2008; 52(4): 625 - 630.
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 HypertensionHome page
J. T. Flynn, M. Mitsnefes, C. Pierce, S. R. Cole, R. S. Parekh, S. L. Furth, B. A. Warady, and for the Chronic Kidney Disease in Children Study G
Blood Pressure in Children With Chronic Kidney Disease: A Report From the Chronic Kidney Disease in Children Study
Hypertension, October 1, 2008; 52(4): 631 - 637.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
M. Chinali, G. de Simone, M. J. Roman, L. G. Best, E. T. Lee, M. Russell, B. V. Howard, and R. B. Devereux
Cardiac Markers of Pre-Clinical Disease in Adolescents With the Metabolic Syndrome: The Strong Heart Study
J. Am. Coll. Cardiol., September 9, 2008; 52(11): 932 - 938.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
S. Javaheri, A. Storfer-Isser, C. L. Rosen, and S. Redline
Sleep Quality and Elevated Blood Pressure in Adolescents
Circulation, September 2, 2008; 118(10): 1034 - 1040.
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 GutHome page
M Manco, G Bedogni, M Marcellini, R Devito, P Ciampalini, M R Sartorelli, D Comparcola, F Piemonte, and V Nobili
Waist circumference correlates with liver fibrosis in children with non-alcoholic steatohepatitis
Gut, September 1, 2008; 57(9): 1283 - 1287.
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 PediatricsHome page
A. F. Duncan, C. R. Rosenfeld, J. S. Morgan, N. Ahmad, and R. J. Heyne
Interrater Reliability and Effect of State on Blood Pressure Measurements in Infants 1 to 3 Years of Age
Pediatrics, September 1, 2008; 122(3): e590 - e594.
[Abstract] [Full Text] [PDF]

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 Arch. Dis. Child.Home page
H Wang, J Necheles, M Carnethon, B Wang, Z Li, L Wang, X Liu, J Yang, G Tang, H Xing, et al.
Adiposity measures and blood pressure in Chinese children and adolescents
Arch. Dis. Child., September 1, 2008; 93(9): 738 - 744.
[Abstract] [Full Text] [PDF]

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 HypertensionHome page
E. Urbina, B. Alpert, J. Flynn, L. Hayman, G. A. Harshfield, M. Jacobson, L. Mahoney, B. McCrindle, M. Mietus-Snyder, J. Steinberger, et al.
Ambulatory Blood Pressure Monitoring in Children and Adolescents: Recommendations for Standard Assessment: A Scientific Statement From the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young and the Council for High Blood Pressure Research
Hypertension, September 1, 2008; 52(3): 433 - 451.
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 JAMAHome page
D. I. Feig, B. Soletsky, and R. J. Johnson
Effect of Allopurinol on Blood Pressure of Adolescents With Newly Diagnosed Essential Hypertension: A Randomized Trial
JAMA, August 27, 2008; 300(8): 924 - 932.
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 Eur Heart JHome page
O. Reich, P. Tax, H. Bartakova, V. Tomek, J. Gilik, J. Lisy, J. Radvansky, T. Matejka, T. Tlaskal, I. Svobodova, et al.
Long-term (up to 20 years) results of percutaneous balloon angioplasty of recurrent aortic coarctation without use of stents
Eur. Heart J., August 2, 2008; 29(16): 2042 - 2048.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
B. Falkner, S. S. Gidding, R. Portman, and B. Rosner
Blood Pressure Variability and Classification of Prehypertension and Hypertension in Adolescence
Pediatrics, August 1, 2008; 122(2): 238 - 242.
[Abstract] [Full Text] [PDF]

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 HypertensionHome page
J. T. Flynn, K. E.C. Meyers, J. P. Neto, R. de Paula Meneses, A. Zurowska, A. Bagga, L. Mattheyse, V. Shi, J. Gupte, S. Solar-Yohay, et al.
Efficacy and Safety of the Angiotensin Receptor Blocker Valsartan in Children With Hypertension Aged 1 to 5 Years
Hypertension, August 1, 2008; 52(2): 222 - 228.
[Abstract] [Full Text] [PDF]