1. Hayman, Laura L. PhD, RN, FAAN
  2. Callister, Lynn Clark PhD, RN, FAAN

Article Content

Munter, P., He, J. Cutler, J. A., Wildman, R. P., & Whelton, P. K. (2004).Journal of the American Medical Association, 291, 2107-2113

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Prompted in part by the prevalence and trends of overweight in children and youth in the United States, this research was designed to examine changes in systolic and diastolic blood pressure over the past decade. The nationally representative sample (N = 5,582) included children 8 to 17 years of age who participated in the Third National Health and Nutrition Examination Survey (NHANES III), conducted in 1988 to 1994 and the most recent survey (1999 - 2000). In both surveys, the mean age of participants was 12.7 years, 51% were males, 16 to 17% were black, and 9 to 12% were Mexican-American. Blood pressure was measured by trained, certified observers in both surveys using standardized protocols. In the 1988 to 1994 survey period, the children's average systolic blood pressure was 104.6 mm Hg; average diastolic blood pressure was 58.4 mm Hg. In the 1999 to 2000 period, the mean systolic blood pressure was 106 mm Hg and the mean diastolic blood pressure was 61.7 mm Hg. After adjustment for differences in age, race, and sex, mean systolic blood pressure was 1.4 mm Hg (95% confidence interval [CI], 0.6 - 2.2 mm Hg; p < .001) higher and diastolic blood pressure was 3.3 mm Hg (95% CI, 2.1 - 4.5 mm Hg; p <.001) higher in the most recent survey. In 1988 to 1994, 11.7% of the children were overweight (body-mass index [BMI] >=95th percentile for age and sex); in 1999 to 2000, 16.3% were overweight. With additional adjustment for differences in BMI distribution in 1988 to 1994 and the most recent survey, the increase in systolic and diastolic blood pressures were reduced by 29% and 12%, respectively. These results suggest that the increase in blood pressure observed over the past decade in children and youth is partially attributable to the increased prevalence of overweight as well as other lifestyle factors such as patterns of physical activity and dietary intake. Taken together and combined with national prevalence and trend data for other risk factors for cardiovascular disease (CVD), these results prompted the recent revision of the clinical practice guidelines for diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatric healthcare providers are encouraged to implement these new evidence-based guidelines that emphasize early identification of children at risk for elevated blood pressure and therapeutic lifestyle changes designed to reduce the risk and CVD-related burden of hypertension.


Comment by Laura L. Hayman




National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. (2004). The Fourth Report on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics, 114 (2, Suppl.),555 - 579.