Pediatric hypertension: Current definition and knowledge gaps

Elevated blood pressure (BP) and hypertension are common in children and adolescents, significantly increasing the risk of cardiovascular disease (CVD) in adulthood. Accurately assessing the prevalence and significance of pediatric hypertension requires a clear definition. The use of age-, sex-, and height-dependent percentiles to define pediatric hypertension began in 1977. Since then, several national and international clinical practice guidelines have refined its classification, diagnosis, and management, with notable contributions from The Fourth Report in 2004, the European Society of Hypertension (ESH) in 2016, and the American Academy of Pediatrics (AAP) in 2017. The 2017 AAP guideline redefined pediatric hypertension, increasing the number of children classified with elevated BP or hypertension. Despite these advancements, a universal diagnostic criterion for pediatric hypertension is still lacking. This review aims to summarize recent research on pediatric hypertension, focusing on evolving definitions, persistent knowledge gaps, and future directions. Addressing pediatric hypertension early with a lifespan approach is essential to reducing the global prevalence of hypertension and its associated CVD burden. The need for continued study and innovative strategies is underscored by research gaps in the prevention, detection, classification, and treatment of pediatric hypertension.