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Available online 20 June 2019 2590-0862/© 2019 The Author. Published by Elsevi nd/4.0/). The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (Fourth Report) was published in 2004 [1]. Subsequent research on blood pressure (BP) in children led to many reports on the increasing prevalence of abnormal BP in children, and on factors associated with abnormal BP that contributed to heightened risk for cardiovascular disease in early adulthood. Based on an expanded body of knowledge, the American Academy of Pediatrics sponsored an update of the pediatric BP guidelines. The Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents (CPG) was published in 2017 [2], and provides comprehensive clinical guidance for detection, diagnosis, and management of abnormal BP in pediatric patients. The overall clinical approach in evaluation and management of hypertension in children and adolescents is similar to the previous Fourth Report. However, two key changes in the new CPG are likely to confer a change in detection and prevalence of abnormal BP and hypertension in youth. There is a consistent positive association of overweigh and obesity status with higher BP in childhood [3,4]. Removal of BP data on children with body mass index (BMI) > 85th percentile in the child normative BP database resulted in a somewhat lower BP level at each sex, age, and height adjusted BP percentile [5]. These BP tables, based on normal weight children were used in the 2017 CPG. In the new tables, the BP levels at the 90th and 95th percentile, used to define abnormal BP and hypertension, are 2–3 mmHg lower than the systolic and diastolic BP levels in the Fourth Report. The definition of hypertension in children <13 years of age remains unchanged as systolic and/or diastolic BP 95th percentile. BP levels in children previously termed “prehypertension” are now termed “elevated BP” and for children<13 years of age. Elevated BP is defined as BP 90th percentile and<95th percentile. Normal BP for children<13 is <90th on the sex, age, height adjusted BP tables. More significant changes were made in the definition of hypertension for adolescents 13 years of age. For both males and females from age 13 and above a numerical value is used to define BP status. Normal BP is < 120/80 mmHg. Elevated BP is 120–129/<80 mmHg. Hypertension stage 1 is 130–139/80–89 mmHg. Hypertension stage 2 is >140/90 mmHg. These numerical values for hypertension in adolescents are close to the 95th percentile, on the

Effects of the 2017 clinical practice guidelines on hypertension in children and adolescents: A commentary