New clinical practice guidelines for diagnosis and management of elevated blood pressure in children identify high-risk populations whose risk was previously underestimated, according to the results of a recent study published in JAMA Pediatrics.
Anthropometric and laboratory risk factors from generally healthy, low-risk children who participated in the National Health and Nutrition Examination Surveys were classified according to both the prior and recently updated clinical blood pressure guidelines. Children whose blood pressure was reclassified upward according to the new guideline were matched with normal blood pressure control patients, and blood pressure percentiles were compared between groups.
Among the 15,647 participants, the estimated population prevalence of elevated blood pressure increased from 11.8% to 14.2% as a result of the new guidelines. Furthermore, 905 (5.8%) were reclassified upward, with 368 considered to have elevated blood pressure, 13 to have stage 1 hypertension, and 54 to have stage 2 hypertension. When children who had been reclassified upward were compared with normotensive control patients, the reclassified children were more likely to be overweight or obese and have higher levels of low-density lipoprotein, triglycerides, total cholesterol, and hemoglobin A1c.
The study authors wrote, “These data suggest that we may previously have been underestimating cardiovascular risk in otherwise healthy US children.” They also noted the new challenges this entails, adding, “With more than 5% of generally healthy individuals reclassified upward under the new guidelines, the additional disease burden faced by caregivers, families, and patients is nontrivial…. [L]ong-term follow-up studies of cardiovascular morbidity and mortality will ultimately be needed to precisely define cardiovascular risk.”
Sharma A, Metzger D, Rodd C, et al; Prevalence and severity of high blood pressure among children based on the 2017 American Academy of Pediatrics Guidelines [published online April 23, 2018]. JAMA Pediatrics. doi: 10.1001/jamapediatrics.2018.0223