Hypertension in the young: epidemiology, sequelae and therapy

The first hint of a shift in the epidemiology of childhood hypertension was seen in a 2004 analysis 1 of National Health and Nutrition Examination Survey (NHANES) data in the United States (US) that demonstrated that overall blood pressure (BP) levels in US children and adolescents have increased over the past decade: Systolic blood pressure (SBP) was found to be 1.4 mmHg higher in 1999–2000 compared to 1988–1994 and diastolic blood pressure (DBP) was found to be 3.3 mmHg higher. This increase in overall BP levels was more pronounced in non-Hispanic black and Mexican-American children, particularly in girls. The difference for black children has previously been described 2, but prior studies had generally shown similar blood pressures for Mexican-American children compared to other ethnic groups 3. While some of the increase in childhood BP levels was attributed to obesity, particularly among the Mexican-American children 1, much of it could not, implying that other, as yet unidentified, forces were at work among American children resulting in the increased BP levels. A more recent review of BP data in 8to 17-year-old children from the NHANES and other related populationbased studies conducted in the United States from 1963 to 2002 clearly demonstrates an increase in the prevalence of high BP in children (Figure 1) 4, countering earlier suggestions that the prevalence of childhood hypertension has remained stable over time 5. A significant strength of this analysis was the application of current BP criteria for hypertension and pre-hypertension in childhood to all of the data in the various surveys included, thereby elim-