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Definition and diagnosis of hypertension in children and adolescents

Author
Tej K Mattoo, MD, DCH, FRCP
Section Editors
F Bruder Stapleton, MD
David R Fulton, MD
Deputy Editor
Melanie S Kim, MD

INTRODUCTION

There is increasing evidence that adult hypertension (HTN) has its antecedents during childhood, as childhood blood pressure (BP) predicts adult BP [1-3]. HTN in childhood and adolescence may contribute to premature atherosclerosis and the early development of cardiovascular disease (CVD). As a result, identifying children with HTN and successfully treating their HTN may have an important impact on long-term outcomes of CVD. (See "Risk factors and development of atherosclerosis in childhood", section on 'Atherosclerotic changes in childhood' and "Risk factors and development of atherosclerosis in childhood", section on 'Hypertension' and "Nonemergent treatment of hypertension in children and adolescents", section on 'Rationale for intervention'.)

The definition and diagnosis of HTN in children will be reviewed here. The risk factors, epidemiology, etiology, evaluation, and treatment of HTN in children are discussed separately. (See "Epidemiology, risk factors, and etiology of hypertension in children and adolescents" and "Evaluation of hypertension in children and adolescents" and "Nonemergent treatment of hypertension in children and adolescents".)

DEFINITION

United States — In 2017, the American Academy of Pediatrics (AAP) published revised guidelines for screening and managing high blood pressure (BP) for children and adolescents (table 1)[4]. As was true with previous guidelines, high BP, including HTN, is defined from normative distribution of BP data in healthy children that includes children from the National Health and Nutrition Examination Survey (NHANES) and other screening studies. This is in contrast to adult HTN, which is primarily defined by clinical outcome data (ie, risk of cardiovascular disease [CVD] and mortality) from large trials of antihypertensive therapy. However, these outcome measures cannot be applied to children because cardiovascular (CV) events other than left ventricular hypertrophy do not typically occur in childhood. (See "Overview of hypertension in adults".)

Because height and gender are important determinants of pediatric BP, BP levels are interpreted based on gender, age, and height. In the 2017 AAP guidelines, normative tables (table 2 and table 3) were revised by using data only from normal-weight children. The revised tables excluded BP data from overweight and obese children (ie, children with BMI ≥85th percentile) that were previously included in normative BP databases. As a result, BP values are several mmHg lower than similar tables in previously published normative values by the National High Blood Pressure Education Program (NHBPEP) Working Group [4,5].

In children, definitions that categorize BP values were modified by the 2017 AAP guidelines (table 1) into two age groups [4]. Of note, the newly revised definitions for adolescents are aligned with adult guidelines for the detection of chronic elevated BP. With an acute elevation of BP, it is the magnitude and the rate of increase above baseline that determines the risk of serious morbidity and, at times, mortality. (See "Management of hypertensive emergencies and urgencies in children".)

                  
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Literature review current through: Nov 2017. | This topic last updated: Oct 17, 2017.
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