Newer guidelines raise rate of pediatric hypertension
Guidelines implemented by the American Academy of Pediatrics in 2017 identified more children with adverse metabolic profiles in childhood and elevated CV risk in adulthood compared with the 2004 guidelines, according to findings published in Hypertension.
The study, led by Tingting Du, MD, PhD, and colleagues, sought to evaluate the consequences of 2017 pediatric hypertension definitions compared with 2004 guidelines on pediatric hypertension and to assess the performance of the guidelines in predicting adult hypertension, metabolic syndrome and left ventricular hypertrophy.
“After reviewing years of information from the Bogalusa Heart Study, we concluded that compared with children with normal blood pressure, those reclassified as having elevated or high blood pressure were more likely to develop adult high blood pressure, thickening of the heart muscle well and the metabolic syndrome — all risk factors for heart disease,” Lydia A. Bazzano, MD, PhD, associate professor of epidemiology at the Tulane School of Public Health and Tropical Medicine, said in a press release.
Du and colleagues analyzed data from the Bogalusa Heart Study, which followed patients from childhood through a follow-up period of 36 years.
The researchers identified 3,940 children (aged 3 to 18 years, 47% boys, 35% black) from the longitudinal Bogalusa Heart Study.
The rate of discerned hypertension was higher based on the 2017 guidelines compared with 2014 (11% vs 7%), Du and colleagues wrote.
The proportion of children identified as having hypertension who developed adult LV hypertrophy was higher according to 2017 guidelines compared with 2004 (19% vs 12%), the researchers wrote.
Du and colleagues found that 329 children who were reclassified to higher BP categories by the 2017 guidelines were more likely than their propensity score–matched normotensive counterparts to develop hypertension, metabolic syndrome and LV hypertrophy later in life. Children who were classified to lower BP categories by 2017 guidelines (n = 38) had similar cardiometabolic outcomes to their propensity score–matched counterparts, the researchers wrote.
“For most children with high blood pressure that is not caused by a separate medical condition or a medication, lifestyle changes are the cornerstone of treatment,” Bazzano said in the release. “It’s important to maintain a normal weight, avoid excess salt and eat a healthy diet that is high in fruit, vegetables, legumes, nuts whole grains, lean protein and limited in salt, added sugars, saturated — and trans — fats to reduce blood pressure.” – by Earl Holland Jr.
Disclosures: The authors report no relevant financial disclosures.