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In Reply: In response to Drs van Schalkwyk and Turner, we recognize that blood pressure variability in children and adolescents with normotension, prehypertension, and hypertension is important and not well-studied. The current definition of pediatric (and adult) hypertension clearly defines only the minimum number of readings needed for the diagnosis.^1-2

For patients with hypertension in our study, the mean number of blood pressure measurements was 10.5 (range, 3-58; SD, 7.2), although the mean number of blood pressure measurements in the hypertensive range was 4.6 (range, 3-33; SD, 2.7). Therefore, for patients with hypertension, a mean of almost 50% of blood pressure readings were in the hypertensive range. The prevalence of hypertension in our population (3.6%) is in the middle of the range found in other studies (2%-5%).^3-5

One of the presumed implications of blood pressure variability on the underdiagnosis of children and adolescents with hypertension would be that clinicians are . . . [Full Text of this Article]

Matthew L. Hansen, MD; Paul W. Gunn, BS; David C. Kaelber, MD, PhD
dkaelber@partners.org
MetroHealth Medical Center
Case Western Reserve University
Cleveland, Ohio

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RELATED LETTER

Diagnosing Hypertension in Children and Adolescents
Johan M. van Schalkwyk and Martin J. Turner
JAMA. 2008;299(2):168.
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