In the Journals

New estimate finds 4% of children have hypertension

Globally, the overall prevalence of hypertension in children and adolescents aged 19 years or younger is 4%, according to a systematic review and meta-analysis published in JAMA Pediatrics.

“From the public health perspective, reliable estimates of the prevalence of childhood hypertension serve as the basis for adequate prevention and treatment, as well as evidence-based health resource allocation and policymaking,” Peige Song, PhD, a former PhD student at the Centre for Global Health Research in the University of Edinburgh’s Usher Institute of Population Health Sciences and Informatics, and colleagues wrote. “Despite the existence of a large volume of studies that have assessed the prevalence of hypertension in children and adolescents, to our knowledge, the prevalence estimates of childhood hypertension have rarely been synthesized at the global level.”

Identifying and treating patients

In a related editorial, Stephen R. Daniels, MD, PhD, professor of pediatrics at the University of Colorado Anschutz Medical Campus, said defining pediatric and adolescent hypertension is difficult for a multitude of reasons, including natural changes with increasing age and body size. The study by Song and colleagues “is especially useful because the authors used a strict definition of hypertension, including persistence of elevated blood pressure over time, and were still able to identify 47 studies that met their inclusion criteria,” he wrote.

The AAP recommends that the definition of hypertension include persistence of systolic or diastolic blood pressure in the 95th percentile or higher on three occasions. A CDC study suggested that along with the release of these guidelines, approximately 800,000 additional children were classified as having hypertension.

“The results of the study by Song and colleagues, even with the limitations imposed by the available published studies, are important for pediatricians to consider as they follow up children and adolescents in primary care,” Daniels wrote. “Blood pressure should be measured at routine health maintenance visits, and when elevated blood pressure is found, it is important for additional measurements to be made to determine whether hypertension is present. It is only with appropriate attention to these issues that children and adolescents with hypertension can be appropriately identified and treated.”

Prevalence lower than previous estimate

Song and colleagues analyzed 47 studies from several databases. All included pediatric patients aged 19 years and younger, quantified the prevalence of hypertension in this population and measured blood pressure at least three times.

According to the findings, the pooled prevalence of hypertension among children was 4% (95% CI, 3.29%-4.78%), and the prevalence of prehypertension was 9.67% (95% CI, 7.26%-12.38%).

The researchers observed an increasing prevalence of childhood hypertension over the past 2 decades, with a relative increasing rate of 75% to 79% between 2000 and 2015.

According to the study, the prevalence of hypertension varied among age groups in 2015, with children aged 6 years having a prevalence of 4.32% (95% CI, 2.79%-6.63%) and 3.28% (95% CI, 2.25%-4.77%) among adolescents aged 19 years. Children aged 14 years had the highest prevalence of all ages in 2015 at 7.89% (95% CI, 5.75%-10.75%).

When categorized by severity for the entire study period, 4% of children had stage 1 hypertension (95% CI, 2.1%-6.48%), and 0.95% had stage 2 hypertension (95% CI, 0.48%-1.57%).

According to the researchers, the prevalence of hypertension was higher among children with overweight or obesity — 15.27% and 4.99%, respectively — compared with children with normal weight (1.9%). The overall prevalence of hypertension also was higher when measured with aneroid sphygmomanometer (7.23%) compared with other measuring devices, including mercury sphygmomanometer (4.59%) and oscillometric sphygmomanometer (2.94%).

Song and colleagues acknowledged that their pooled estimate of pediatric hypertension is lower than the pooled estimate reported in a previously conducted systematic review (4% vs. 11.2%).

“The large disparity might be explained mainly by the different numbers of visits for blood pressure measurements in these two systematic reviews,” they wrote. “In their study, the pooled prevalence of childhood hypertension was based on individual studies that had measured blood pressure on a single occasion or on two occasions or more, which could lead to a higher prevalence estimate given that the prevalence of childhood hypertension could decrease with the increase of visit numbers.” – by Katherine Bortz

Disclosures: Daniels and Song report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Globally, the overall prevalence of hypertension in children and adolescents aged 19 years or younger is 4%, according to a systematic review and meta-analysis published in JAMA Pediatrics.

“From the public health perspective, reliable estimates of the prevalence of childhood hypertension serve as the basis for adequate prevention and treatment, as well as evidence-based health resource allocation and policymaking,” Peige Song, PhD, a former PhD student at the Centre for Global Health Research in the University of Edinburgh’s Usher Institute of Population Health Sciences and Informatics, and colleagues wrote. “Despite the existence of a large volume of studies that have assessed the prevalence of hypertension in children and adolescents, to our knowledge, the prevalence estimates of childhood hypertension have rarely been synthesized at the global level.”

Identifying and treating patients

In a related editorial, Stephen R. Daniels, MD, PhD, professor of pediatrics at the University of Colorado Anschutz Medical Campus, said defining pediatric and adolescent hypertension is difficult for a multitude of reasons, including natural changes with increasing age and body size. The study by Song and colleagues “is especially useful because the authors used a strict definition of hypertension, including persistence of elevated blood pressure over time, and were still able to identify 47 studies that met their inclusion criteria,” he wrote.

The AAP recommends that the definition of hypertension include persistence of systolic or diastolic blood pressure in the 95th percentile or higher on three occasions. A CDC study suggested that along with the release of these guidelines, approximately 800,000 additional children were classified as having hypertension.

“The results of the study by Song and colleagues, even with the limitations imposed by the available published studies, are important for pediatricians to consider as they follow up children and adolescents in primary care,” Daniels wrote. “Blood pressure should be measured at routine health maintenance visits, and when elevated blood pressure is found, it is important for additional measurements to be made to determine whether hypertension is present. It is only with appropriate attention to these issues that children and adolescents with hypertension can be appropriately identified and treated.”

Prevalence lower than previous estimate

Song and colleagues analyzed 47 studies from several databases. All included pediatric patients aged 19 years and younger, quantified the prevalence of hypertension in this population and measured blood pressure at least three times.

According to the findings, the pooled prevalence of hypertension among children was 4% (95% CI, 3.29%-4.78%), and the prevalence of prehypertension was 9.67% (95% CI, 7.26%-12.38%).

The researchers observed an increasing prevalence of childhood hypertension over the past 2 decades, with a relative increasing rate of 75% to 79% between 2000 and 2015.

According to the study, the prevalence of hypertension varied among age groups in 2015, with children aged 6 years having a prevalence of 4.32% (95% CI, 2.79%-6.63%) and 3.28% (95% CI, 2.25%-4.77%) among adolescents aged 19 years. Children aged 14 years had the highest prevalence of all ages in 2015 at 7.89% (95% CI, 5.75%-10.75%).

When categorized by severity for the entire study period, 4% of children had stage 1 hypertension (95% CI, 2.1%-6.48%), and 0.95% had stage 2 hypertension (95% CI, 0.48%-1.57%).

According to the researchers, the prevalence of hypertension was higher among children with overweight or obesity — 15.27% and 4.99%, respectively — compared with children with normal weight (1.9%). The overall prevalence of hypertension also was higher when measured with aneroid sphygmomanometer (7.23%) compared with other measuring devices, including mercury sphygmomanometer (4.59%) and oscillometric sphygmomanometer (2.94%).

Song and colleagues acknowledged that their pooled estimate of pediatric hypertension is lower than the pooled estimate reported in a previously conducted systematic review (4% vs. 11.2%).

“The large disparity might be explained mainly by the different numbers of visits for blood pressure measurements in these two systematic reviews,” they wrote. “In their study, the pooled prevalence of childhood hypertension was based on individual studies that had measured blood pressure on a single occasion or on two occasions or more, which could lead to a higher prevalence estimate given that the prevalence of childhood hypertension could decrease with the increase of visit numbers.” – by Katherine Bortz

Disclosures: Daniels and Song report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.