Impact of the 2017 American Academy of Pediatrics Guideline on Hypertension Prevalence Compared With the Fourth Report in an International Cohort

Author:

Yang Liu1,Kelishadi Roya2,Hong Young Mi3,Khadilkar Anuradha4,Nawarycz Tadeusz5,Krzywińska-Wiewiorowska Małgorzata6,Aounallah-Skhiri Hajer7,Motlagh Mohammad Esmaeil8,Kim Hae Soon3,Khadilkar Vaman4,Krzyżaniak Alicja6,Ben Romdhane Habiba9,Heshmat Ramin10,Chiplonkar Shashi4,Stawińska-Witoszyńska Barbara6,El Ati Jalila11,Qorbani Mostafa12,Kajale Neha4,Traissac Pierre13,Ostrowska-Nawarycz Lidia5,Ardalan Gelayol2,Ekbote Veena4,Zhao Min14,Heiland Emerald G.15,Liang Yajun16,Xi Bo1

Affiliation:

1. From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (L.Y., B.X.)

2. Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.)

3. Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.)

4. Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)

5. Department of Biophysics, Medical University of Lodz, Poland (T.N., L.O.-N.)

6. Department of Epidemiology and Hygiene, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W., A.K., B.S.-W.)

7. National Institute of Public Health, Nutrition Surveillance and Epidemiology in Tunisia Research Laboratory, Tunis, Tunisia (H.A.-S.)

8. Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.)

9. Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia (H.B.R.)

10. Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.)

11. Nutrition Surveillance and Epidemiology Unit, National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.)

12. Department of Epidemiology, Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran (M.Q.)

13. Institut de Recherche pour le Développement, UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.)

14. Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)

15. Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden (E.G.H.)

16. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden (Y.L.).

Abstract

In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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