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Pediatric practice guidelines call for repeating an elevated office blood pressure (BP) at the same visit, but there are few data available to support this recommendation. We compared the visit results in children aged 3 to 17 years with a BP reading ≥95th percentile (n = 186 732) based on the initial BP and the mean of two BP readings, using electronic medical records from 2012-2015. Failure to repeat an initial BP reading ≥95th percentile would lead to a false "hypertensive" visit result in 54.1% of children who would require follow-up visits. After an initial visit result indicating hypertension, hypertension stage I or stage II was sustained in 2.3% and 11.3% of youth during their next visits, respectively. In conclusion, only approximately half of the pediatric patients would be correctly classified based on their initial BP. The recommendation to repeat high BP during the same visit needs to be emphasized because it saves unnecessary follow-up visits. | INTRODUCTIONHigh blood pressure (BP) is a major contributing risk factor for heart failure, heart attack, stroke, and chronic kidney disease and accounts for an estimated 18% of cardiovascular deaths in the United States. Initial BP readings can be high for various reasons including measurement error. Hence, BP readings should be repeated during the same visit and the mean of BP readings used as the visit result. 19Repeating a high BP during the same visit can prevent misclassification of a patient's visit result. This has implications for clinical practice because it is recommended that follow-up visits should be scheduled after a visit with a BP ≥95th percentile to confirm or rule out hypertension. Misclassification of a patient's visit result as hypertensive may result in unnecessary follow-up visits, which are a burden for both the patient and the healthcare system. However, studies are needed to quantify the magnitude of misclassification arising from the failure to repeat an initial high BP reading.To estimate the benefit of adhering to standardized protocols for BP screening as recommended by the American Academy of Pediatrics and others, [15][16][17][18][19] we assessed the misclassification of pediatric patients as hypertensive based on an initial BP reading, which could be avoided by a repeated reading during the same visit. The classification of an individual's BP as normotensive or hypertensive during the same

Secular trends from this large population-based cohort suggest that overweight and obesity in boys and girls are declining across age and racial/ethnic groups. However, the declines are less pronounced in adolescents compared with children, in girls, and in some minority groups. Programs addressing childhood obesity may need to be targeted.