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Under new AAP guideline, more US youths classified as having hypertension
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Although the prevalence of hypertension among U.S. youths aged 12 to 19 years decreased between 2001 and 2016, there was an increase in the number of youths reclassified as having hypertension when a new AAP guideline was applied, according to a study from the CDC.
“A new CDC study examined the impact of the 2017 AAP Clinical Practice Guideline on hypertension prevalence among youth in the United States,” Jennifer Wiltz, MD, MPH, senior pediatric medical officer at the CDC, told Infectious Diseases in Children. “Using the new guideline, approximately 800,000, or 2.6%, additional youth aged 12 to 19 years are reclassified as having hypertension, for a total of 1.3 million youth now with hypertension.”
Wiltz and colleagues analyzed data from the 2001-2016 National Health and Nutrition Examination Survey (NHANES), which included 12,004 youths aged 12 to 19 years. They calculated the prevalence of hypertension in this population based on the new AAP guideline and 2004 hypertension guidance for comparison. The 2017 guideline included new thresholds and percentile references based on a healthy-weight population.
Wiltz and colleagues used age-specific thresholds (12-17 years, 18-19 years) in both the former and new guidelines to define elevated blood pressure and hypertension.
The researchers found that the prevalence of hypertension had declined when using the new guideline (7.7% to 4.2%; P < .001) and the former AAP guideline (3.2% to 1.5%, P < .001). All weight status categories saw prevalence declines.
However, applying the new threshold for hypertension and new percentage tables in the 2017 AAP guideline resulted in a weighted net estimated increase of 795,000 youths being reclassified as having hypertension when 2013-2016 NHANES data were used.
Older youths, males and those with obesity were more likely to be reclassified as having hypertension. Hypertension prevalence ranged from 2% in healthy-weight youths to almost 14% in youths with severe obesity, according to the researchers.
“Too many youths have high blood pressure,” Wiltz said. “Pediatricians can support patients and families by routinely conducting blood pressure screenings for youth, being prepared to recommend lifestyle interventions and medication as appropriate, and leading cardiovascular health efforts in their community.” – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.
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