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

Abstract

The Working Group on High Blood Pressure in Children and Adolescents has published the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents1 (www.nhlbi.nih.gov/guidelines/hypertension/child_tbl.htm). This publication, from the National High Blood Pressure Education Program, updates the previous 1996 publication.2 The purpose of the Fourth Report is to inform clinicians on the latest scientific evidence regarding blood pressure in children and to provide recommendations for evaluation and treatment of hypertension in the young. The Working Group reexamined the childhood blood pressure database with the addition of new data from the 1999 to 2000 National Health and Nutrition Examination Survey (NHANES). The Working Group also evaluated the recent information on instrumentation for blood pressure measurement in the young, the evidence of target-organ damage in children and adolescents with hypertension, and the results of recent studies on antihypertensive therapy in the young. The fourth report provides new guidelines to clinicians on evaluation and management of children with hypertension and also for children with significant risk for hypertension. The definition of hypertension in children and adolescents remains unchanged and is based on blood pressure percentile. Hypertension is defined as average systolic and/or diastolic blood pressure that is ≥95th percentile for gender, age, and height on 3 or more separate occasions. Blood pressure levels that are ≥90th percentile but 120 mm Hg by age 12 years. Adolescents with blood pressure ≥120/80 mm Hg (but <95th percentile) have prehypertension. The Fourth Report has added a method for staging the severity of hypertension by providing the range of blood pressure elevation for stage 1 and stage 2 hypertension. Stage 2 hypertension is generally ≈12 …