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High BP is consistently greater in boys (15%–19%) than in girls (7%–12%).

The prevalence of high BP is higher among Hispanic and non-Hispanic African American children compared with non-Hispanic white children, with higher rates among adolescents than among younger children.

The process used to conduct the systematic review was consistent with the recommendations of the Institute of Medicine for systematic reviews.

For the topics not researched by using the PICOT format, separate searches were conducted.

Of the topics covered in the outline, ∼80% were researched by using a Patient, Intervention/Indicator, Comparison, Outcome, and Time (PICOT) format to address the following key questions: To address these key questions, a systematic search and review of literature was performed.


Recognizing ongoing evidence gaps and the need for an updated, thorough review of the relevant literature, the American Academy of Pediatrics (AAP) and its Council on Quality Improvement and Patient Safety developed this practice guideline to provide an update on topics relevant to the diagnosis, evaluation, and management of pediatric HTN.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.(See Table 1 for a complete list of KASs.)A detailed description of the methodology used to conduct the literature search and systematic review for this clinical practice guideline will be included in the forthcoming technical report.

In brief, reference selection involved a multistep process.A detailed list of subcommittee members and affiliations can be found in the Consortium section at the end of this article.



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