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Body size is recognised as the highest correlate to blood pressure in childhood, leading the US National Institutes of Health sponsored Task Forces on Blood Pressure in Children and Adolescents to base their standard blood pressure tables on age, gender and height, with the understanding that increased levels of blood pressure result primarily from increases in weight. Because of the known tracking of blood pressure through childhood and into adult life, it is generally believed that early identification of hypertension in children can lead to introduction of antihypertensive strategies to reduce blood pressure levels and prevent or reduce hypertension-related cardiovascular disease. Thus, it makes sense to regularly measure blood pressure in overweight and obese children and to ensure that the definitions for hypertension are valid.
The paper by Wirix et al 1 is an important reminder of two issues currently associated with blood pressure measurement in childhood. The first is whether the protocols used to diagnose hypertension are reliable, accurate and standardised across research studies and clinical practice. Most physicians follow the definitions of hypertension developed by the US Expert Task Force panels, beginning in 1977. Despite these definitions being arbitrary, that is, primarily based on expert consensus because of a lack of available evidence from long-term outcome studies, most would agree that higher levels of blood pressure suggest a …