Editorial International Differences in Secular Trends in Childhood Blood Pressure A Puzzle to be Solved

Hypertension is a potent independent risk factor forstroke, myocardial infarction, heart failure, renal failure, and mortality in adults.1 Although most of these adverse outcomes occur in adulthood, it has become clear that hypertension is a life course problem that can become evident in childhood and can be progressive throughout childhood into adolescence and adulthood.2 It has also become clear that elevated blood pressure in childhood is associated with early markers of cardiovascular abnormalities, including left ven-tricular hypertrophy3 and atherosclerosis.4 For these reasons, there has been an increasing focus on the identification and treatment of children and adolescents with hypertension and the prevention of the occurrence of hypertension in the first place.5 Article see p 397 There is still much to be learned about the mechanism