{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:45:58Z","timestamp":1792791958214,"version":"4.5.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T00:00:00Z","timestamp":1617321600000},"content-version":"vor","delay-in-days":32,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["15SFRN23680000"],"award-info":[{"award-number":["15SFRN23680000"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Elevated blood pressure (BP) and hypertension commonly occur in children and adolescents and increase the risk of cardiovascular disease in adulthood. The purpose of this review is to summarize recent research in pediatric hypertension including changes in defining hypertension, BP measurement techniques, hypertension epidemiology, risk factors, treatment, and BP-related target organ damage. Defining pediatric hypertension using the 2017 American Academy of Pediatrics\u2019 updated Clinical Practice Guideline resulted in a larger proportion of children being classified as having elevated BP or hypertension compared with prior guidelines. Trends in the distribution of BP among US children and adolescents suggest that BP levels and the prevalence of hypertension may have increased from 2011\u20132014 to 2015\u20132018. Factors including a family history of hypertension, obesity, minority race\/ethnicity, physical inactivity, high dietary intake of sodium, and poor sleep quality are associated with an increased prevalence of elevated BP and hypertension. Evidence of a linear relationship between systolic BP and target organ damage indicates that BP levels currently considered normal could increase the risk of target organ damage in childhood. Lifestyle changes, such as adhering to the Dietary Approaches to Stop Hypertension diet, are a central component of effectively reducing BP and have been shown to reduce target organ damage. Pharmacologic treatment using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers is an effective and safe method for reducing BP among children with uncontrolled BP after implementing lifestyle changes. Research gaps in the prevention, detection, classification, and treatment of hypertension in children demonstrate opportunities for future study.<\/jats:p>","DOI":"10.1093\/ajh\/hpab004","type":"journal-article","created":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T16:54:03Z","timestamp":1609952043000},"page":"242-249","source":"Crossref","is-referenced-by-count":79,"title":["Blood Pressure in Childhood and Adolescence"],"prefix":"10.1093","volume":"34","author":[{"given":"Shakia T","family":"Hardy","sequence":"first","affiliation":[{"name":"Department of Epidemiology, University of Alabama at Birmingham , Birmingham, Alabama ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine M","family":"Urbina","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cincinnati Children\u2019s Hospital, and the University of Cincinnati , Cincinnati, Ohio ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,4,2]]},"reference":[{"key":"2026041420045159100_CIT0001","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1016\/S0140-6736(12)61766-8","article-title":"A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990\u20132010: a systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"Lim","year":"2012","journal-title":"Lancet"},{"key":"2026041420045159100_CIT0002","doi-asserted-by":"crossref","first-page":"e1000058","DOI":"10.1371\/journal.pmed.1000058","article-title":"The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors","volume":"6","author":"Danaei","year":"2009","journal-title":"PLoS Med"},{"key":"2026041420045159100_CIT0003","doi-asserted-by":"crossref","first-page":"2107","DOI":"10.1001\/jama.291.17.2107","article-title":"Trends in blood pressure among children and adolescents","volume":"291","author":"Muntner","year":"2004","journal-title":"JAMA"},{"key":"2026041420045159100_CIT0004","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1161\/HYPERTENSIONAHA.116.08312","article-title":"Blood pressure trajectories from childhood to young adulthood associated with cardiovascular risk: results from the 23-year longitudinal Georgia Stress and Heart Study","volume":"69","author":"Hao","year":"2017","journal-title":"Hypertension"},{"key":"2026041420045159100_CIT0005","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1161\/HYPERTENSIONAHA.117.09537","article-title":"Race and sex differences of long-term blood pressure profiles from childhood and adult hypertension: the Bogalusa Heart Study","volume":"70","author":"Shen","year":"2017","journal-title":"Hypertension"},{"key":"2026041420045159100_CIT0006","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1161\/CIRCULATIONAHA.113.001614","article-title":"Combined effects of child and adult elevated blood pressure on subclinical atherosclerosis: the International Childhood Cardiovascular Cohort Consortium","volume":"128","author":"Juhola","year":"2013","journal-title":"Circulation"},{"key":"2026041420045159100_CIT0007","doi-asserted-by":"crossref","first-page":"758","DOI":"10.15585\/mmwr.mm6727a2","article-title":"Hypertension among youths\u2014United States, 2001\u20132016","volume":"67","author":"Jackson","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026041420045159100_CIT0008","doi-asserted-by":"crossref","first-page":"e20173459","DOI":"10.1542\/peds.2017-3459","article-title":"Prevalence of obesity and severe obesity in US children, 1999\u20132016","volume":"141","author":"Skinner","year":"2018","journal-title":"Pediatrics"},{"key":"2026041420045159100_CIT0009","doi-asserted-by":"crossref","first-page":"e20171904","DOI":"10.1542\/peds.2017-1904","article-title":"Clinical practice guideline for screening and management of high blood pressure in children and adolescents","volume":"140","author":"Flynn","year":"2017","journal-title":"Pediatrics"},{"key":"2026041420045159100_CIT0010","doi-asserted-by":"crossref","DOI":"10.5888\/pcd16.180528","article-title":"Estimated change in prevalence and trends of childhood blood pressure levels in the United States after application of the 2017 AAP Guideline","volume":"16","author":"Kibria","year":"2019","journal-title":"Prev Chronic Dis"},{"key":"2026041420045159100_CIT0011","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1097\/HJH.0000000000001903","article-title":"Updates to pediatric hypertension guidelines: influence on classification of high blood pressure in children and adolescents","volume":"37","author":"Dong","year":"2019","journal-title":"J Hypertens"},{"key":"2026041420045159100_CIT0012","first-page":"e13","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"key":"2026041420045159100_CIT0013","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1001\/jamapediatrics.2019.3310","article-title":"Global prevalence of hypertension in children: a systematic review and meta-analysis","volume":"173","author":"Song","year":"2019","journal-title":"JAMA Pediatr"},{"key":"2026041420045159100_CIT0014","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.3917","article-title":"Trends in blood pressure and hypertension among US children and adolescents, 1999\u20132018","author":"Hardy","year":"2021"},{"key":"2026041420045159100_CIT0015","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1161\/HYPERTENSIONAHA.118.12292","article-title":"Influence of Dietary Approaches to Stop Hypertension-type diet, known genetic variants and their interplay on blood pressure in early childhood: ABCD study","volume":"75","author":"Zafarmand","year":"2020","journal-title":"Hypertension"},{"key":"2026041420045159100_CIT0016","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1161\/HYPERTENSIONAHA.117.10944","article-title":"Maternal exposure to ambient particulate matter \u22642.5 \u00b5m during pregnancy and the risk for high blood pressure in childhood","volume":"72","author":"Zhang","year":"2018","journal-title":"Hypertension"},{"key":"2026041420045159100_CIT0017","doi-asserted-by":"crossref","first-page":"51","DOI":"10.4274\/jcrpe.4557","article-title":"The relationship between blood pressure and sleep duration in Turkish children: a cross-sectional study","volume":"10","author":"Bal","year":"2018","journal-title":"J Clin Res Pediatr Endocrinol"},{"key":"2026041420045159100_CIT0018","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1111\/jch.13520","article-title":"Sleep duration and blood pressure in children: analysis of the pan-European IDEFICS cohort","volume":"21","author":"Sparano","year":"2019","journal-title":"J Clin Hypertens"},{"key":"2026041420045159100_CIT0019","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1186\/s12887-019-1699-9","article-title":"Smartphone addiction may be associated with adolescent hypertension: a cross-sectional study among junior school students in China","volume":"19","author":"Zou","year":"2019","journal-title":"BMC Pediatr"},{"key":"2026041420045159100_CIT0020","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1161\/CIRCULATIONAHA.114.013104","article-title":"Adverse childhood experiences and blood pressure trajectories from childhood to young adulthood: the Georgia stress and Heart study","volume":"131","author":"Su","year":"2015","journal-title":"Circulation"},{"key":"2026041420045159100_CIT0021","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.amjmed.2018.12.022","article-title":"Young adults and adverse childhood events: a potent measure of cardiovascular risk","volume":"132","author":"Kreatsoulas","year":"2019","journal-title":"Am J Med"},{"key":"2026041420045159100_CIT0022","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1161\/HYP.0000000000000007","article-title":"Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association","volume":"63","author":"Flynn","year":"2014","journal-title":"Hypertension"},{"key":"2026041420045159100_CIT0023","doi-asserted-by":"crossref","first-page":"2414","DOI":"10.1097\/HJH.0000000000002229","article-title":"Impact of ESH and AAP hypertension guidelines for children and adolescents on office and ambulatory blood pressure-based classifications","volume":"37","author":"Lurbe","year":"2019","journal-title":"J Hypertens"},{"key":"2026041420045159100_CIT0024","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/MBP.0000000000000354","article-title":"Ambulatory blood pressure monitoring tolerability and blood pressure status in adolescents: the SHIP AHOY study","volume":"24","author":"Hamdani","year":"2019","journal-title":"Blood Press Monit"},{"key":"2026041420045159100_CIT0025","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2017.00153","article-title":"The use of ambulatory blood pressure monitoring as standard of care in pediatrics","volume":"5","author":"Peterson","year":"2017","journal-title":"Front Pediatr"},{"key":"2026041420045159100_CIT0026","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.jpeds.2020.06.059","article-title":"Use of automated office blood pressure measurement in the evaluation of elevated blood pressures in children and adolescents","volume":"227","author":"Hanevold","year":"2020","journal-title":"J Pediatr"},{"key":"2026041420045159100_CIT0027","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1007\/s00467-019-04368-7","article-title":"Multiple office blood pressure measurement: a novel approach to overcome the weak cornerstone of blood pressure measurement in children. Data from the SPA project","volume":"35","author":"Ardissino","year":"2020","journal-title":"Pediatr Nephrol"},{"key":"2026041420045159100_CIT0028","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1097\/HJH.0000000000002396","article-title":"Home and ambulatory blood pressure monitoring in children, adolescents and young adults: comparison, diagnostic agreement and association with preclinical organ damage","volume":"38","author":"Zeniodi","year":"2020","journal-title":"J Hypertens"},{"key":"2026041420045159100_CIT0029","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1038\/hr.2009.9","article-title":"Long-term reproducibility of home vs. office blood pressure in children and adolescents: the Arsakeion school study","volume":"32","author":"Stergiou","year":"2009","journal-title":"Hypertens Res"},{"key":"2026041420045159100_CIT0030","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1111\/jch.13860","article-title":"Performance of modified blood pressure-to-height ratio for diagnosis of hypertension in children: the CASPIAN-V study","volume":"22","author":"Yazdi","year":"2020","journal-title":"J Clin Hypertens"},{"key":"2026041420045159100_CIT0031","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1038\/jhh.2016.12","article-title":"Performance of blood pressure-to-height ratio as a screening tool for elevated blood pressure in pediatric population: a systematic meta-analysis","volume":"30","author":"Yin","year":"2016","journal-title":"J Hum Hypertens"},{"key":"2026041420045159100_CIT0032","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1093\/ajh\/hpy028","article-title":"Height-based equations can improve the diagnosis of elevated blood pressure in children","volume":"31","author":"Mourato","year":"2018","journal-title":"Am J Hypertens"},{"key":"2026041420045159100_CIT0033","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1161\/HYPERTENSIONAHA.115.05831","article-title":"Childhood to early-midlife systolic blood pressure trajectories: early-life predictors, effect modifiers, and adult cardiovascular outcomes","volume":"66","author":"Theodore","year":"2015","journal-title":"Hypertension"},{"key":"2026041420045159100_CIT0034","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1161\/HYPERTENSIONAHA.119.13027","article-title":"Association of blood pressure level with left ventricular mass in adolescents","volume":"74","author":"Urbina","year":"2019","journal-title":"Hypertension"},{"key":"2026041420045159100_CIT0035","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1161\/HYPERTENSIONAHA.119.14168","article-title":"Elevated blood pressure in childhood or adolescence and cardiovascular outcomes in adulthood: a systematic review","volume":"75","author":"Yang","year":"2020","journal-title":"Hypertension"},{"key":"2026041420045159100_CIT0036","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1001\/jamacardio.2020.1731","article-title":"Association of normal systolic blood pressure level with cardiovascular disease in the absence of risk factors","volume":"5","author":"Whelton","year":"2020","journal-title":"JAMA Cardiol"},{"key":"2026041420045159100_CIT0037","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1161\/HYPERTENSIONAHA.119.14682","article-title":"Subclinical systolic and diastolic dysfunction is evident in youth with elevated blood pressure","volume":"75","author":"Tran","year":"2020","journal-title":"Hypertension"},{"key":"2026041420045159100_CIT0038","doi-asserted-by":"crossref","first-page":"2346","DOI":"10.1097\/HJH.0000000000002550","article-title":"Elevated blood pressure in childhood and hypertension risk in adulthood: a systematic review and meta-analysis","volume":"38","author":"Yang","year":"2020","journal-title":"J Hypertens"},{"key":"2026041420045159100_CIT0039","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1161\/HYPERTENSIONAHA.118.12334","article-title":"Relation of blood pressure in childhood to self-reported hypertension in adulthood","volume":"73","author":"Urbina","year":"2019","journal-title":"Hypertension"},{"key":"2026041420045159100_CIT0040","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1161\/HYPERTENSIONAHA.120.16156","article-title":"Dietary approaches to stop hypertension dietary intervention improves blood pressure and vascular health in youth with elevated blood pressure","volume":"77","author":"Couch","year":"2021","journal-title":"Hypertension"},{"key":"2026041420045159100_CIT0041","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clnesp.2018.09.003","article-title":"Effects of the Dietary Approach to Stop Hypertension (DASH) diet on blood pressure, overweight and obesity in adolescents: a systematic review","volume":"28","author":"Paula Bricarello","year":"2018","journal-title":"Clin Nutr ESPEN"},{"key":"2026041420045159100_CIT0042","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.1007\/s40279-017-0753-8","article-title":"High-intensity interval training interventions in children and adolescents: a systematic review","volume":"47","author":"Eddolls","year":"2017","journal-title":"Sports Med"},{"key":"2026041420045159100_CIT0043","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1055\/a-1068-9331","article-title":"Effectiveness of multi-activity, high-intensity interval training in school-aged children","volume":"41","author":"Ketelhut","year":"2020","journal-title":"Int J Sports Med"},{"key":"2026041420045159100_CIT0044","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1080\/10641963.2017.1288742","article-title":"Combined exercise training reduces blood pressure, arterial stiffness, and insulin resistance in obese prehypertensive adolescent girls","volume":"39","author":"Son","year":"2017","journal-title":"Clin Exp Hypertens"},{"key":"2026041420045159100_CIT0045","doi-asserted-by":"crossref","DOI":"10.3390\/nu11010137","article-title":"The effect of a multidisciplinary lifestyle intervention on obesity status, body composition, physical fitness, and cardiometabolic risk markers in children and adolescents with obesity","volume":"11","author":"Seo","year":"2019","journal-title":"Nutrients"},{"key":"2026041420045159100_CIT0046","doi-asserted-by":"crossref","first-page":"1988","DOI":"10.1038\/s41366-019-0384-2","article-title":"The effect of weight loss and weight gain on blood pressure in children and adolescents with obesity","volume":"43","author":"Hagman","year":"2019","journal-title":"Int J Obes"},{"key":"2026041420045159100_CIT0047","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1161\/HYPERTENSIONAHA.118.10862","article-title":"Pharmacological treatment of arterial hypertension in children and adolescents: a network meta-analysis","volume":"72","author":"Burrello","year":"2018","journal-title":"Hypertension"},{"key":"2026041420045159100_CIT0048","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1161\/HYPERTENSIONAHA.112.196352","article-title":"Pregnancy outcome following exposure to angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists: a systematic review","volume":"60","author":"Bullo","year":"2012","journal-title":"Hypertension"},{"key":"2026041420045159100_CIT0049","doi-asserted-by":"crossref","first-page":"e20181818","DOI":"10.1542\/peds.2018-1818","article-title":"Treating hypertension in children with n-of-1 trials","volume":"143","author":"Samuel","year":"2019","journal-title":"Pediatrics"},{"key":"2026041420045159100_CIT0050","doi-asserted-by":"crossref","first-page":"A6","DOI":"10.1161\/hyp.76.suppl_1.6","article-title":"Abstract 6: comparison between ambulatory BP percentile and load as predictors of target organ damage in youth","volume":"76","author":"Hamdani","year":"2020","journal-title":"Hypertension"}],"container-title":["American Journal of Hypertension"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajh\/article-pdf\/34\/3\/242\/46285135\/hpab004.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajh\/article-pdf\/34\/3\/242\/46285135\/hpab004.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:07:53Z","timestamp":1776211673000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajh\/article\/34\/3\/242\/6208802"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,1]]},"references-count":50,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,4,2]]},"published-print":{"date-parts":[[2021,4,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ajh\/hpab004","relation":{},"ISSN":["0895-7061","1941-7225"],"issn-type":[{"value":"0895-7061","type":"print"},{"value":"1941-7225","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,3,1]]},"published":{"date-parts":[[2021,3,1]]}}}