Identifying elevated blood pressure and hypertension in children and adolescents

Abstract

A large body of evidence has shown that cardiovascular disease begins in early life, [1][2][3] and multiple cardiovascular risk factors, including elevated blood pressure (BP), exacerbate the effects of age on the progression of cardiovascular disease from childhood to adulthood. 4 Elevated BP in childhood tends to persist into adult life 5 and is the single most significant risk factor for adult hypertension. 6 It also contributes to damages in the cardiovascular system in childhood in the short term 7 and to increased risk of cardiovascular disease in adult life in the long term. 8,9 As a result, the importance of identifying elevated BP and hypertension in children and adolescents has long been recognized. However, how to define elevated BP and hypertension in children and adolescents has been a challenge and remains controversial.Many professional organizations or research groups have developed various criteria for the identification of elevated BP and hypertension in children and adolescents. 6,[10][11][12][13][14][15] The current standards used to define elevated BP in children are mostly determined by age-, sex-, and height-specific percentiles, without reference to adult cardiovascular outcomes because of limited investigations on the performance of the standards in predicting adult cardiovascular events.

Assessment of Cardiovascular Disease Risk Factors in Korean Children: Impact of Various Pediatric Hypertension Guidelines and Application of the Korean Blood Pressure Reference

“…43 Studies comparing local and international references as well as the inclusion/exclusion of overweight or obese children's BP data have revealed significant discrepancies in high BP prevalence across different reference tables. [44][45][46][47][48][49] A study conducted by Fan et al 48 in China applied a local reference table, the AAP, the fourth report (a previous version of the BP guidelines before the AAP 2017), and international BP reference tables to a longitudinally followed cohort. This study found that high BP, as defined by the AAP and local BP references, effectively predicted subclinical CVD in adulthood.…”