Blood pressure nomograms for children and adolescents, by height, sex, and age, in the United States.

Because height is a more appropriate index of maturation than weight for use with normative blood pressure (BP) data, we developed normative BP levels for children, by sex, while accounting for age and height simultaneously. Eight U.S. studies used in the Report of the Second Task Force on Blood Pressure Control in Children and one additional study of BP in U.S. children were reanalyzed to develop age-sex-height-specific values for normative BP values among 56,108 children, aged 1 to 17 years, seen at 76,018 visits. Height percentiles were computed on the basis of standard National Center for Health Statistics growth charts. When height is taken into account, more short children (10th age-sex-specific height percentile) and fewer tall children (90th age-sex-specific height percentile) are likely to be classified as hypertensive than when the current age-sex-specific percentiles of BP alone are used. Tables are provided for boys and girls separately, by single year of age (1 to 17 years) and by the 90th and 95th percentiles of systolic blood pressure and diastolic blood pressure (fifth phase of Korotkoff sounds) for selected age-sex-specific height percentiles based on standard U.S. growth charts.

Distribution and correlates of creatinine clearance in children and adolescents with blood pressure elevation.

The kidney has been implicated as both an etiologic factor and as a target organ in patients with essential hypertension. Renal function has not been studied extensively in children and adolescents with essential hypertension. Eighty-eight subjects, aged 6 to 23 years, with blood pressure persistently above the 90th percentile for age were studied. Creatinine clearance was determined from a single 24-hour urine collection. The mean creatinine clearance was 129.3 +/- 55.3 ml/min per 1.73 m2. Multiple regression analysis was used to investigate potential correlates of creatinine clearance. Because creatinine clearance was not normally distributed, the logarithm of creatinine clearance was used as the dependent variable. Body mass index, resting heart rate, and basal supine plasma renin activity were significant direct independent correlates. Peripheral vascular resistance at maximal exercise was an inverse correlate of the logarithm of creatinine clearance. These findings are consistent with previous studies of adults and may provide the basis for strategies to identify young patients with essential hypertension who are at risk for the development of renal dysfunction.

Juvenile hypertension: highlights of a workshop.

The workshop was successful in achieving its two major goals: (1) the scientific updating of research issues in pediatric blood pressure determinants and in pediatric hypertension, and (2) the delineation of future research objectives. These objectives are itemized at the end of the workshop proceedings and, in brief, center around the need for better definitions of normal and abnormal blood pressures in youth, the identification of variables in childhood capable of indicating which children are at risk for developing hypertension as adults, and finally, a thoughtful list of additional research issues germane to the explanation of primary and secondary forms of hypertension.