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We have read Dr Forrest Adams' note entitled "Blood Pressure of Children in the United States" (Pediatrics See Table in the PDF File 61:931, 1978) in which he comments on specific sections of a report of a Task Force on Blood Pressure Control in Children. Knowledge concerning the relationship between blood pressure in children and subsequent health in adult life should be of continuous interest to all pediatricians. Dr Adams states that it is misleading to present percentile graphs of US children's blood pressures for reference because US children's blood pressures increase with age while other cultures fail to show an increase from infancy to 50 years.

Sibling aggregation of blood pressure has been shown in children 2 to 14 years of age. To determine the earliest age at which this finding is detectable, blood pressures were evaluated in 98 siblings from 43 black families with newborns. Variances of blood pressure scores were significantly greater among families than within families for systolic (p less than .025) but not diastolic pressures. Sib-sib intraclass correlation coefficients were .26 (95% two-sided confidence limits .05 to .47) for systolic and .16 (-.06 to .38) for diastolic pressures. When 1-month-old infant pressures were added, significant aggregation was present for systolic (p less than .01) and diastolic (p less than .025) pressures. The intraclass correlation coefficients were .21 (.02 to .38) and .17 (.03 to .34), respectively. When newborn scores were substituted, aggregation was not demonstrable. These data demonstrate a familial influence on blood pressure in infancy by 1 month of age.

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During a two-year period we have seen six patients with malformations of the ventricular septum resulting in the shunting of blood between the left ventricle and the right atrium. Surgical closure of the defect has been successful in all. A history of bacterial endocarditis was established in two patients and strongly suspected in two others before operation. The surprisingly large number of patients with a malformation previously considered rare and the unusually high incidence of endocarditis as a complication prompted a review of the anatomical and clinical features of this anomaly.There have been 26 patients reported with left ventricular to right atrial shuntst on whom relatively complete clinical studies are available (Perry, Burchell, and Edwards, 1949;Stahlman et al., 1955;Kirby, Johnson, and Zinsser, 1957;Ferencz, 1957;Lynch et al., 1958;Gerbode et al., 1958;Kjellberg et al., 1959;Braunwald and Morrow, 1960;Levy and Lillehei, 1962). Symptoms were directly related to the amount of left-to-right shunting of blood with pulmonary vascular engorgement. These consisted of poor feeding in infancy and easy fatigue; tachypncea, pneumonia, and congestive heart failure were often noted. The usual findings on examination were a precordial thrill and loud systolic murmur along the lower left sternal border; a mid-diastolic apical rumble was heard in some patients.Chest radiography generally demonstrated cardiomegaly, pulmonary vascular engorgement, and in 15 of the 26 patients specific enlargement of the right atrium. The electrocardiogram was not diagnostic; an abnormal P wave was present in a few of the tracings. Except for one patient with a mean electrical axis of -90°, there were no reports of the axis being to the left or superiorly oriented. Cardiac catheterization demonstrated a left-to-right shunt at the level of the right atrium in all but 2 patients. The right atrial pressure was raised in 5 of the 9 patients in whom it was recorded.