Hypertension is a highly prevalent cardiovascular risk factor in the world and particularly overwhelming in low and middle-income countries. Recent reports from the WHO and the World Bank highlight the importance of chronic diseases such as hypertension as an obstacle to the achievement of good health status. It must be added that for most low and middle-income countries, deficient strategies of primary healthcare are the major obstacles for blood pressure control. Furthermore, the epidemiology of hypertension and related diseases, healthcare resources and priorities, the socioeconomic status of the population vary considerably in different countries and in different regions of individual countries. Considering the low rates of blood pressure control achieved in Latin America and the benefits that can be expected from an improved control, it was decided to invite specialists from different Latin American countries to analyze the regional situation and to provide a consensus document on detection, evaluation and treatment of hypertension that may prove to be cost-utility adequate. The recommendations here included are the result of preparatory documents by invited experts and a subsequent very active debate by different discussion panels, held during a 2-day sessions in Asuncion, Paraguay, in May 2008. Finally, in order to improve clinical practice, the publication of the guidelines should be followed by implementation of effective interventions capable of overcoming barriers (cognitive, behavioral and affective) preventing attitude changes in both physicians and patients.

The aggregation of arterial blood pressure, weight, and height were compared between family members of children and adolescents with blood pressure percentiles at or above 95 (group 1) and at or below 50 (group 2). Weight, height, and systolic and diastolic blood pressures were significantly higher in siblings and target individuals of group 1 (p less than 0.001). Weight and systolic and diastolic blood pressures were significantly higher in mothers of group 1 (p less than 0.001). Covariant analysis comparing the average systolic and diastolic blood pressures of both groups controlled by age, age and weight, and age and Quetelet index revealed that the arterial blood pressure of mothers, siblings, and target individuals remained higher in group 1 (p less than 0.05 to p less than 0.001). These observations show a strong familial aggregation of arterial blood pressure not dependent only on physical development and also raise the question of a genetic basis as a possible mechanism of systemic arterial hypertension.

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BP level in children and adolescents was a good marker for familial aggregation of metabolic RF, suggesting an interaction of genetic and environmental factors. Primary intervention should be carried out in early stages of life.