HypertensionAHA SCIENTIFIC STATEMENTPediatric Primary Hypertension:AnUnderrecognized Condition:A ScientificStatement From the American Heart AssociationBonita Falkner,MD,FAHA Chair;Samuel S.Gidding,MD,FAHA,Vice Chair;Carissa M.Baker-Smith,MD,MPH FAHA;Tammy M.Brady,MD,PhD,FAHA;Joseph T.Flynn,MD,MS,FAHA;Leslie M.Malle,MSN,FAHA;Andrew M.South,MD,MS,FAHA;Andrew H.Tran,MD,MS FAHA;Elaine M.Urbina MD,MS FAHA;on behalf of the American Heart Association Council onHypertension;Council on Lifelong Congenital Heart Disease and Heart Health in the Young;Council on Kidney in CardiovascularDisease;Council on Lifestyle and Cardiometabolic Health;and Council on Cardiovascular and Stroke NursingABSTRACT:The overall prevalence of hypertension in childhood is 2%to 5%,and the leading type of childhood hypertension isprimary hypertension,especially in adolescence.As in adults,the leading risk factors for children with primary hypertensionare excess adiposity and suboptimal lifestyles;however,environmental stress,low birth weight,and genetic factors mayalso be important.Hypertensive children are highly likely to become hypertensive adults and to have measurable targetorgan injury,particularly left ventricular hypertrophy and vascular stiffening.Ambulatory and home blood pressure monitoringmay facilitate diagnosis.Primordial prevention of hypertension through public health implementation of healthier diet andincreased physical activity will reduce the prevalence of primary hypertension,and evidence-based treatment guidelinesshould be implemented when hypertension is diagnosed.Further research to optimize recognition and diagnosis and clinicaltrials to better define outcomes of treatment are needed.wnloadedVords:AHA Scientific Statements■blood pressure■cardiovascular diseases■child■hypertension■obesityfromhttp:/here is now evidence that high blood pressure (BP)inand consequences of abnormal BP beginning in childhood.childhood is associated with both cardiovascular dis-The evolving evidence has reshaped our perspective onease (CVD)events and intermediate markers of CVDabnormal BP in childhood to an understanding that adultin adulthood.12 Before the mid-1970s,BP was not com-primary(essential hypertension can originate in childhood.monly measured in asymptomatic children.When BP wasmeasured,no pediatric BP reference datawere available todesignate abnormal BP levels in children,and adult criteriaDEFINITION,DIAGNOSIS,ANDwere used to define hypertension.Therefore,children diag-Marchnosed with hypertension,according to the adult thresholdPREVALENCEin use at that time(140/90 mm Hg),had severe hyperten-The definition of childhood-onset hypertension in mostsion that was generally secondary to kidney disease,car-current pediatric guidelines is based on the percentile ofdiac/vascular abnormality,or endocrinopathy.It was thenthe distribution of BP values in healthy children,typicallyassumed that hypertension in childhood was always sec-based on age,sex,and height.Hypertension is defi
