To determine whether there are clinical differences between children referred for hypertension evaluation from a primary care practice and children with hypertension detected through school-based screening.

Referral patients (n=58) were compared with 44 screening patients with hypertension from school-based screening of 5102 students. All subjects underwent 24-hour ambulatory blood pressure (BP) monitoring. White coat hypertension was defined as 24-hour mean BP <95th percentile and BP load <25%.

Referral subjects were more likely to be male and had higher body mass index than screening subjects but did not differ by age or ethnic distribution. Average clinic BP values tended to be higher among referral patients (140/79 vs 135/76 mm Hg, P=.07); however, the hypertension severity was closely matched when clinic BP was indexed to the subject-specific 95th percentile. Ambulatory mean BP, BP indices, and BP loads showed no differences by subject source for 24-hour, wake, or sleep periods. White coat hypertension prevalence did not differ between referral and screening subjects (28% vs 30%, P=.83).

These findings suggest that hypertensive children identified by subspecialty referral are representative of the overall population of hypertensive children in the community, thereby supporting the generalizability of clinic-based research in pediatric hypertension.