Cover of the guidelines report
The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents
Published May 2005
DownloadPDF 280 KB

This new research provides a comprehensive review for clinicians on the latest scientific evidence regarding high blood pressure in children, along with recommendations for diagnosis, evaluation, and treatment of hypertension based on available evidence and consensus expert opinion of the working group when evidence was lacking. The report was also initially published in Pediatrics, 2004;114:555-576 .

Version History:

  • Update on the Task Force Report (1987) on High Blood Pressure in Children and Adolescents: published 1996
  • Second Task Force Report on High Blood Pressure in Children and Adolescents: published 1987
  • Task Force Report on High Blood Pressure in Children and Adolescents: published 1977

This new research provides a comprehensive review for clinicians on the latest scientific evidence regarding high blood pressure in children, along with recommendations for diagnosis, evaluation, and treatment of hypertension based on available evidence and consensus expert opinion of the working group when evidence was lacking. The report was also initially published in Pediatrics, 2004;114:555-576 .

Version History:

  • Update on the Task Force Report (1987) on High Blood Pressure in Children and Adolescents: published 1996
  • Second Task Force Report on High Blood Pressure in Children and Adolescents: published 1987
  • Task Force Report on High Blood Pressure in Children and Adolescents: published 1977

Blood Pressure Tables for Children and Adolescents

From the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents*

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The updated blood pressure (BP) tables for children and adolescents are based on recently revised child height percentiles and also include the BP data from the 1999-2000 NHANES. The 50th, 90th, 95th, and 99th percentiles for systolic blood pressure (SBP) and diastolic blood pressure (DBP) according to height, sex, and age are given for boys and girls. The 50th percentile has been added to the tables to provide the clinician with the BP level at the midpoint of the normal range. Although the 95th percentile provides a BP level that defines hypertension, management decisions about children with hypertension should be determined by the degree or severity of hypertension. Therefore, the 99th percentile has been added to facilitate clinical decisionmaking in the plan for evaluation. 4 pages. May 2004.

* Full report expected in late Summer, 2004

Methodology

In response to the request of the NHBPEP Chair and Director of the National Heart, Lung, and Blood Institute (NHLBI) regarding the need to update the JNC 7 report,2 some NHBPEP Coordinating Committee members suggested that the NHBPEP Working Group Report on Hypertension in Children and Adolescents should be revisited. Thereafter, the NHLBI Director directed the NHLBI staff to examine issues that might warrant a new report on children. Several prominent clinicians and scholars were asked to develop background manuscripts on selected issues related to hypertension in children and adolescents. Their manuscripts synthesized the available scientific evidence. During the spring and summer of 2002, NHLBI staff and the chair of the 1996 NHBPEP Working Group report on hypertension in children and adolescents reviewed the scientific issues addressed in the background manuscripts as well as contemporary policy issues. Subsequently, the staff noted that a critical mass of new information had been identified, thus warranting the appointment of a panel to update the earlier NHBPEP Working Group Report. The NHLBI Director appointed the authors of the background papers and other national experts to serve on the new panel. The chair and NHLBI staff developed a report outline and timeline to complete the work in 5 months.

The background papers served as focal points for review of the scientific evidence at the first meeting. The members of the Working Group were assembled into teams, and each team prepared specific sections of the report. In developing the focus of each section, the Working Group was asked to consider the peer-reviewed scientific literature published in English since 1997. The scientific evidence was classified by the system used in the JNC 7.2 The chair assembled the sections submitted by each team into the first draft of the report. The draft report was distributed to the Working Group for review and comment. These comments were assembled and used to create the second draft. A subsequent onsite meeting of the Working Group was conducted to discuss further revisions and the development of the third draft document. Amended sections were reviewed, critiqued, and incorporated into the third draft. After editing by the chair for internal consistency, the fourth draft was created. The Working Group reviewed this draft, and conference calls were conducted to resolve any remaining issues that were identified. When the Working Group approved the final document, it was distributed to the Coordinating Committee for review.

Expert Panel Members and Disclosures

Chair

Bonita Falkner, MD
Thomas Jefferson University 
Philadelphia, PA

Members

Stephen R. Daniels, MD, PhD 
Cincinnati Children's Hospital Medical Center 
Cincinnati, OH

Joseph T. Flynn, MD, MS 
Montefiore Medical Center 
Bronx, NY

Samuel Gidding, MD 
DuPont Hospital for Children 
Wilmington, DE

Lee A. Green, MD, MPH 
University of Michigan 
Ann Arbor, MI

Julie R. Ingelfinger, MD 
MassGeneral Hospital for Children 
Boston, MA

Ronald M. Lauer, MD 
University of Iowa 
Iowa City, IA

Bruce Z. Morgenstern, MD 
Mayo Clinic 
Rochester, MN

Ronald J. Portman, MD 
University of Texas Health Science Center 
Houston, TX

Ronald J. Prineas, MD, PhD 
Wake Forest University School of Medicine 
Winston-Salem, NC

Albert P. Rocchini, MD 
University of Michigan 
C.S. Mott Children's Hospital 
Ann Arbor, MI

Bernard Rosner, PhD 
Harvard School of Public Health 
Boston, MA

Alan Robert Sinaiko, MD 
University of Minnesota Medical School 
Minneapolis, MN

Nicolas Stettler, MD, MSCE 
Children's Hospital of Philadelphia 
Philadelphia, PA

Elaine Urbina, MD 
Cincinnati Children's Hospital Medical Center 
Cincinnati, OH

Financial Disclosures

Dr. Joseph T. Flynn is a paid contributor to Pfizer, Inc., Novartis Pharmaceuticals, AstraZeneca, Inc., and ESP-Pharma.

The other authors have no financial relationships to disclose.

Text-only High Blood Pressure Information Slide Set

The 4th Report on High Blood Pressure in Children and Adolescents Slide Set

 

Title Page--Department of Health and Human Services
National Institutes of Health
National Heart, Lung, and Blood Institute
National High Blood Pressure Education Program
The 4th Report on High Blood Pressure in Children and Adolescents Slide Set