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More children diagnosed with high BP under updated guidelines
CV risk may have been previously underestimated, as more children in the United States had reclassified BPs based on the 2017 American Academy of Pediatrics/American Heart Association guidelines for elevated BP management in children, according to a study published in JAMA Pediatrics.
Atul K. Sharma, MD, MSc, FRCPC, researcher at Children’s Hospital Research Institute of Manitoba in Canada and assistant professor in the department of pediatrics and child health at University of Manitoba, and colleagues analyzed data from 15,647 children (mean age, 13 years; 7,848 boys) from 1999-2014 National Health and Nutrition Examination Survey who were generally healthy and low risk.
Data included information on diet, demographics, laboratory values, physical examinations and survey data sets. During examinations, measurements were taken such as weight, BMI, waist circumference and BP. CV risk was assessed with laboratory data, which included HDL, LDL, triglycerides and HbA1c.
The American Academy of Pediatrics guidelines were used to assess children for hypertension.
The estimated population prevalence of high BP increased from 11.8% in 2006 (95% CI, 11.1-13) to 14.2% (95% CI, 13.4-15) after the new guidelines were established.
Compared with the 2004 NIH/NHLBI report, 5.8% of children had newly diagnosed hypertension (n = 381) or a worse clinical stage (n = 524) under the new guidelines. Children with BP that was reclassified upward were more likely to have overweight or obesity, which was shown by higher z scores for waist circumference, weight and BMI. Compared with children who were not reclassified upward, those who were had higher total cholesterol (12.4% vs. 9.3%; P = .06), triglycerides (22.6% vs. 10.7%; P < .001), LDL (12.2% vs. 3.9%; P = .002) and HbA1c (3.4% vs. 0.6%; P = .02).
“These data suggest that we may previously have been underestimating cardiovascular risk in otherwise healthy U.S. children,” Sharma and colleagues wrote. “Clustering of risk factors suggests that reclassified children represent a high-risk population, which serves to validate the new, more stringent 2017 guidelines.”
In a related editorial, Stephen R. Daniels, MD, PhD, professor of pediatrics and chairman of the department of pediatrics at University of Colorado School of Medicine in Aurora and pediatrician-in-chief and L. Joseph Butterfield chair in pediatrics at Children’s Hospital Colorado in Aurora, wrote: “What we really want to know is how best to identify children and adolescents who are at highest lifetime risk of developing clinically meaningful CVD. Unfortunately, at present, we are left with using the best evidence available, which does not allow clear identification of lifetime risk of CVD. It is somewhat reassuring that the individuals identified in the new classification system have other risk factors, such as obesity as well as blood pressure elevation.” – by Darlene Dobkowski
Disclosures: The authors and Daniels report no relevant financial disclosures.