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OBJECTIVE. Children and adolescents with newly diagnosed hypertension undergo various tests to define the cause and target organ consequences of the elevated blood pressure. We tested the hypothesis that the diagnostic yield of individual components of the currently recommended assessment does not justify performance for all patients with mild-to-moderate hypertension. METHODS. A retrospective chart review was conducted of patients who were referred between July 2002 and June 2007 for mild-to-moderate hypertension, defined as maximum blood pressure at ≥95% + 20/10 mmHg. The assessment included history and physical examination, nutritional assessment, urinalysis, biochemical and fasting lipid profile, renal ultrasound, echocardiogram, and 24-hour ambulatory blood pressure monitoring. RESULTS. A total of 249 patients were identified, and charts for 220 (88%) were available for review. There were 156 boys and 64 girls aged 13.3 ± 4.4 years. BMI was 26.1 ± 6.7 kg/m2, and 143 (65%) had a BMI of ≥90%. Results of urinalysis and serum biochemical testing were clinically normal in all cases. Among those with a lipid profile, 59 (42%) had total cholesterol values of >170 mg/dL, and 26 (19%) had severe hypercholesterolemia (>200 mg/dL). Renal sonography revealed findings plausibly associated with hypertension in 14 (8%) patients; 4 (2%) had renovascular abnormalities. Yield of echocardiography was 17%. On ambulatory blood pressure monitoring, 47 (60%) children had systolic readings of >95% at least 20% of the time, and 28 (36%) had diastolic readings of >95% at least 20% of the time. CONCLUSIONS. For children and adolescents with mild-to-moderate hypertension, on the basis of a cutoff of 5% to 20% abnormal results to define a useful test, the initial evaluation can range from a serum cholesterol level and ambulatory blood pressure monitoring to a panel that consists of a fasting lipid profile, renal ultrasound, echocardiogram, and ambulatory blood pressure monitoring. Additional assessment should be guided by specific clinical features and the nature of the patient population.

This essay argues for the emergence of a cultural and epistemological divide between amateur savants and members of the Royal Academy of the Sciences in late Old Regime and revolutionary France and suggests that the amateur ideal rose in significance even as intellectual activity came to be increasingly centralized in the postrevolutionary era. At the crux of the tensions between the amateur ideal and the professionalizing reality in the immediate postrevolutionary period stood Aubin-Louis Millin and his journal, the Magasin Encyclopédique. The essay examines, in particular, the revival in the pages of the Magasin Encyclopédique of interest in Nicolas-Claude Fabri de Peiresc, the seventeenth-century icon of an amateur ideal in which investigations in the natural sciences and scholarship were private, decentralized, often provincial activities. Although the sciences in the revolutionary and Napoleonic eras were often perceived as forward looking and dismissive of the past, this essay finds that a sentimental and nostalgic attachment to the past-to a myth of Peiresc-continued to play an important role in the identity of postrevolutionary men of letters.