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March 2012, Volume 42 Number 3 , p 54 - 57


  • Valerie Gill MA, MEd, RN
  • MaryAnn Edelman MS, RN, CNS


MK, a 15-year-old male, is seen in the clinic for a routine annual physical exam. MK weighs 190 pounds (86.2 kg) and is 5 feet 6 inches tall (BMI 30.7).MK's BP is 150/90 sitting at rest. His mother confirms a family history of hypertension: She was diagnosed with hypertension at age 20. MK's father recently suffered a hemorrhagic stroke secondary to uncontrolled hypertension. MK states that when he's with friends he "smokes cigarettes and drinks beer, just to socialize."MK admits that he doesn't follow any special diet. For breakfast he has a bacon, egg, and cheddar cheese omelet and a can of soda; at lunch he eats whatever his friends have, usually a hot dog with barbeque sauce, and soda. Dinner is usually a burger or fried chicken with French fries. He eats chips at night while playing computer games.Children and adolescents rarely show signs and symptoms of hypertension, so the condition is usually detected during a routine health exam. The increasing rate of hypertension in children and adolescents is a major risk factor for heart disease and stroke during adulthood. The American Heart Association (AHA) recommends that all children and adolescents age 3 and older have yearly BP measurements.1The National Heart, Lung, and Blood Institute (NHLBI) classifies BP readings for children and adolescents according to developmental ages, gender, and height. These guidelines are used to determine normal and abnormal BP readings.2 In childhood, BP normally increases with age and body size. A child and adolescent's gender, age, and height are used to determine specific systolic and diastolic BP percentiles. This approach allows a more precise classification of BP according to body size as the child grows. For more information, see Defining and classifying hypertension in children and adolescents.Many patients, especially children and adolescents, may have what's known as "white coat hypertension." It's often seen in the medical setting, where the child's anxiety about seeing

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