Pre-hypertension and Hypertension in Pediatrics: Don't Let the Statistics Hide the Pathology

Cardiovascular diseases (CVD) are the leading cause of death in western societies.¹ These diseases are associated with a number of risk factors, such as hypertension (HTN), a leading cause of cardiovascular (CV) morbidity and mortality in adults.² Pre-hypertension (PHTN), white coat hypertension (WCH), and sustained HTN in pediatric patients have pathologic effects on the heart and arterial tree. Pediatric HTN frequently goes underdiagnosed.³ The current approach to the diagnosis and treatment of pediatric HTN is not based on evidence of long-term CV risk. In our opinion, the approach to HTN in pediatrics needs to be changed; the diagnosis of all forms of HTN (PHTN, WCH, HTN) needs to be given more attention. Interventions such as dietary modification and lifestyle changes should be initiated sooner rather than later. Greater research efforts are needed to determine physiologically appropriate cutoffs for the diagnosis of PHTN and HTN on the basis of long-term outcomes and CV risk.

ABPM, Ambulatory blood pressure monitoring, BP, Blood pressure, CV, Cardiovascular, CVD, Cardiovascular disease, HTN, Hypertension, JNC7, Seventh Report by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, PHTN, Pre-hypertension, SBP, Systolic blood pressure, WCH, White coat hypertension