Varying blood pressure in children: a diagnostic quandary interpreting the Fourth Report

Abstract Background Fourth Report guidelines on pediatric blood pressure (BP) are not clear when defining hypertension in children as "an average systolic BP and/or diastolic BP that is ≥ 95 th percentile for gender, age, and height on ≥ 3 occasions." We aimed to determine the prevalence of pediatric hypertension in a screening population based on two different guideline interpretations. Methods Prevalence of hypertension among 2, 094 students at 4 Houston area schools was calculated based on the summation or sustained model definition from Fourth Report guidelines. Summation hypertension definition required the single average of the blood pressures recorded across three visits to be elevated. Sustained hypertension definition required blood pressure at each of three visits to be elevated. Results Hypertension prevalence by the summation method was 7% while sustained prevalence was only 3.3%. Nearly a quarter of students had varying blood pressure and were not classifiable by the sustained method but most would be classified as normal or pre-hypertensive by the summation method. Conclusions The prevalence of hypertension among adolescents doubled depending on the interpretation of Fourth Report guidelines. While methods in research studies can be clearly examined upon publication of results, it is unknown which interpretation method is being used in clinical practice.