Updated Pediatric Hypertension Guidelines Improve Prediction of Future CV Outcomes

The 2017 guideline for the diagnosis and treatment of high blood pressure (BP) in children published by the American Academy of Pediatrics (AAP) may be more effective at identifying children with adverse metabolic profiles and cardiovascular outcomes compared with the 2004 guideline report by the National Institutes of Health’s National Heart, Lung, and Blood Institute (NIH/NHLBI), according to a longitudinal analysis published in Hypertension.

A total of 3940 children (age range, 3-18 years) enrolled in the Bogalusa Heart Study were included in the longitudinal study. Researchers evaluated data from each patient, including ≥1 BP measurement in childhood (baseline) and ≥1 BP measurement in adulthood (follow-up), over a 36-year follow-up period.

The researchers compared the AAP’s 2017 pediatric hypertension definitions with the NIH/NHLBI 2004 pediatric hypertension definitions on the prevalence of hypertension with regard to how well either guideline worked in predicting progression to adulthood hypertension.

A greater proportion of hypertension cases were identified with the 2017 vs the 2004 guidelines (11% vs 7%, respectively). The 2017 guideline was also able to identify a higher proportion of children with hypertension who developed adult left ventricular hypertrophy (LVH) compared with the 2004 guidelines (19% vs 12%, respectively).

Compared with propensity score-matched normotensive patients, children who were identified by the 2017 guidelines to have higher BP categories (8%) were more likely to subsequently develop metabolic syndrome, hypertension, and LVH later in life. Only 1% of children reclassified by the 2017 guidelines to lower BP categories had similar outcomes as the normotensive group.

Limitations of the study include the lack of data on major cardiovascular disease events in adulthood as well as the inclusion of a community-based sample, which may reduce the generalizability of the findings.

“Although the 2004 and 2017 guidelines were similar in overall ability to predict adult hypertension, metabolic syndrome, and LVH, using the 2017 guidelines improved the sensitivity of childhood hypertension in predicting future development of LVH in adulthood,” the researchers wrote.

“Implementing the 2017 guidelines would identify a group of children who were reclassified upward with newly diagnosed elevated BP or a worsening stage of hypertension with adverse metabolic profile and increased risks of progression to adult hypertension, metabolic syndrome, and LVH.”

Reference

Du T, Fernandez C, Barshop R, et al. 2017 Pediatric hypertension guidelines improve prediction of adult cardiovascular outcomes. Hypertension. 2019;73:00-00.