Adverse Outcomes in Pediatric Hypertension
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See related article, pp 1142–1147
It has been clear for decades that elevated blood pressure in adults is strongly associated with adverse cardiovascular disease outcomes,1 including myocardial infarction, cerebrovascular disease, and congestive heart failure. It has been harder to establish a direct association between elevated blood pressure in children and adolescents and cardiovascular disease in adulthood. This has, in part, led the United States Preventive Services Task Force to report an I statement,2 indicating that there is insufficient evidence for or against blood pressure screening in pediatric patients. Such direct evidence would be valuable to have in hand; however, because these relationships develop longitudinally, this evidence is difficult, if not impossible, to obtain. To evaluate the direct link between childhood risk factors such as hypertension and adult cardiovascular outcomes requires studies with a high level of follow-up that take place over many decades.
Despite this lack of direct long-term evidence, there are many important other lines of evidence that contribute to our understanding of how elevated blood pressure may adversely affect the cardiovascular system in the short term for children and adolescents. First, it has been shown that while blood pressure levels are variable over time, in general, blood pressure levels track. This means that individuals who have high blood pressure at one time are more likely to have elevated blood pressure at subsequent …