The 2017 American Academy of Pediatrics (AAP) clinical practice guidelines classify a greater proportion of children as having elevated blood pressure (BP), and in turn higher cardiovascular risk, compared with the 2004 fourth report from the National Heart, Lung, and Blood Institute, according to a new study.
For their study, the researchers evaluated 15,647 generally healthy, low-risk children aged 5 to 18 years from the 1999-2014 National Health and Nutrition Examination Surveys.
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The researchers applied both the 2004 and the new 2017 guidelines in classifying participants in order to compare the prevalence and severity of elevated BP in this cohort under both sets of guidelines.
Participants whose BP was “reclassified upwards” were matched for sex, height, and age with controls with normal BP. The researchers compared anthropometric and laboratory risk factors between groups, and calculated age- and sex-specific z scores for weight, waist circumference, and body mass index (BMI).
Results of the study showed that the estimated population prevalence of elevated BP had increased from 11.8% to 14.2% under the new 2017 AAP guidelines, indicating a significant increase in disease burden for the health care system.
A total of 905 of 15,584 children had newly diagnosed hypertension (n = 381) or a worsening in clinical stage (n = 524). Predictors of reclassification upwards included overweight and obesity, as reflected by higher z scores for weight, waist circumference, and body mass index.
Furthermore, the prevalence of abnormal laboratory test results also increased. Adverse lipid profiles and increased hemoglobin A1c levels (prediabetes) were detected more frequently under the new guidelines.
“Clustering of cardiovascular risk factors in otherwise healthy US children suggests that those whose BP was reclassified represent a high-risk population whose cardiovascular risk may previously have been underestimated,” the researchers concluded.
Sharma AK, Metzger DL, Rodd CJ, et al. Prevalence and severity of high blood pressure among children based on the 2017 American Academy of Pediatrics guidelines. JAMA Pediatr. 2018;172(6):557-565. doi:10.1001/jamapediatrics.2018.0223