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Children under pressure: an underestimated burden?
  1. Saverio Stranges,
  2. Francesco P Cappuccio
  1. Clinical Sciences Research Institute, Warwick Medical School, Coventry, UK
  1. Correspondence to:
    Professor F P Cappuccio
    Cardiovascular Medicine & Epidemiology, Clinical Sciences Research Institute, Warwick Medical School, CSB at UHCW Campus, Clifford Bridge Road, Coventry CV2 4DX, UK;cvme{at}

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Perspective on the paper by Jackson et al (see 298)

The study by Jackson et al1 represents a significant contribution to our knowledge in the area of hypertension research and related clinical practice. The definition of national blood pressure references for children and young adults, aged 4–23 years, living in Great Britain provides important, complementary information to the updated US guidelines on the management of high blood pressure in children and adolescents aged 1–17 years,2 as well as to earlier attempts to define normative blood pressure values from other countries.3–,7 In addition, these centiles will integrate existing charts in the UK regarding other important parameters (eg, body mass index), thereby allowing a more comprehensive characterisation of the health of children. Some distinctive aspects of the study by Jackson et al1 should be highlighted: the representative and large sample size of the seven surveys from which blood pressure data were drawn; the consistent method applied for blood pressure measurements; the use of a statistical technique such as the LMS method to construct blood pressure centiles, which accounts for the skewness (L), median (M), and coefficient of variation (S) of the blood pressure distribution.8 Indeed, this statistical tool had been previously used in a German study to derive normalised reference values for the 24-h ambulatory blood pressure in children and adolescents aged 5–20 years.7

In addition to the statistical value of their contribution, the study by Jackson et al is particularly relevant because it gives emphasis to a significant problem in the medical field: hypertension in childhood. In the past few decades, the definition of …

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