These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on
the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents."
Significant changes in these guidelines include (1) the replacement of the term "prehypertension"
with the term "elevated blood pressure," (2) new normative pediatric blood pressure
(BP) tables based on normal-weight children, (3) a simplified screening table for
identifying BPs needing further evaluation, (4) a simplified BP classification in
adolescents ≥13 years of age that aligns with the forthcoming American Heart Association
and American College of Cardiology adult BP guidelines, (5) a more limited recommendation
to perform screening BP measurements only at preventive care visits, (6) streamlined
recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded
role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension,
and (8) revised recommendations on when to perform echocardiography in the evaluation
of newly diagnosed hypertensive pediatric patients (generally only before medication
initiation), along with a revised definition of left ventricular hypertrophy. These
guidelines include 30 Key Action Statements and 27 additional recommendations derived
from a comprehensive review of almost 15 000 published articles between January 2004
and July 2016. Each Key Action Statement includes level of evidence, benefit-harm
relationship, and strength of recommendation. This clinical practice guideline, endorsed
by the American Heart Association, is intended to foster a patient- and family-centered
approach to care, reduce unnecessary and costly medical interventions, improve patient
diagnoses and outcomes, support implementation, and provide direction for future research.