AAP updates policy statement on athletic participation by children and adolescents with systemic hypertension.

The most common cardiovascular condition in competitive athletes is hypertension. The American Academy of Pediatrics (AAP) updated its policy statement using new recommendations made in the 2005 36th Bethesda Conference guidelines; the 2004 Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents; and the 2003 Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension guidelines include three categories: prehypertension, stage 1 hypertension, and stage 2 hypertension. Childhood hypertension is defined as blood pressure of at least the 95th percentile for sex, age, and height on at least three occasions. Prehypertension is defined as at least the 90th but less than the 95th percentile, or at least 120/80 mm Hg but less than the 95th percentile. Stage 1 hypertension is defined as the 95th percentile to 5 mm Hg higher than the 99th percentile. Stage 2 hypertension is defined as more than 5 mm Hg higher than the 99th percentile. Blood pressure tables for children can be found at http://www.nhlbi.nih.gov/guidelines/ hypertension/child_tbl.pdf. According to the Fourth Report, once hypertension is confirmed, an evaluation that includes echocardiography, retinal examination, and possible workup for sleep disorders should be performed in addition to a history, a physical examination, and laboratory studies.