Can Pediatric Hypertension Criteria Be Simplified?

Xi, Bo; Zhang, Tao; Li, Shengxu; Harville, Emily W.; Bazzano, Lydia; He, Jiang; Chen, Wei

doi:10.1161/hypertensionaha.116.08782

Cited by 55 publications

(34 citation statements)

References 38 publications

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“…The average of these measurements was calculated for both SBP and DBP [ 48 ]. For primary analyses, elevated BP at 11 years of age was defined as a SBP measure ≥110 mmHg and/or a DBP measure > 70 mmHg [ 49 ]. Xi et al have previously proposed this definition for elevated BP for children aged 6–11, because these static cutoffs are easier to implement in clinical settings [ 49 ].…”

Section: Methodsmentioning

confidence: 99%

“…For primary analyses, elevated BP at 11 years of age was defined as a SBP measure ≥110 mmHg and/or a DBP measure > 70 mmHg [ 49 ]. Xi et al have previously proposed this definition for elevated BP for children aged 6–11, because these static cutoffs are easier to implement in clinical settings [ 49 ]. This definition of elevated BP in childhood is similarly predictive of hypertension and preclinical CVD in adulthood as the American Academy of Pediatrics (AAP) definition, which uses percentile-based cutoffs [ 49 , 50 ].…”

Section: Methodsmentioning

confidence: 99%

“…Xi et al have previously proposed this definition for elevated BP for children aged 6–11, because these static cutoffs are easier to implement in clinical settings [ 49 ]. This definition of elevated BP in childhood is similarly predictive of hypertension and preclinical CVD in adulthood as the American Academy of Pediatrics (AAP) definition, which uses percentile-based cutoffs [ 49 , 50 ]. In sensitivity analyses, we also examined elevated BP at age 11 defined using the AAP guidelines (i.e., SBP and/or DBP greater than or equal to the 90th percentile for sex, age, and height) [ 51 ].…”

Section: Methodsmentioning

confidence: 99%

“…S2 ), and was therefore excluded from all models. In sensitivity analyses, we compared BKMR results when using the AAP percentile-based cutoffs [ 51 ] with the static cutoffs proposed by Xi et al [ 49 ] to define elevated BP at age 11.…”

Section: Methodsmentioning

confidence: 99%

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Prenatal metal mixtures and child blood pressure in the Rhea mother-child cohort in Greece

et al. 2021

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Background Child blood pressure (BP) is predictive of future cardiovascular risk. Prenatal exposure to metals has been associated with higher BP in childhood, but most studies have evaluated elements individually and measured BP at a single time point. We investigated impacts of prenatal metal mixture exposures on longitudinal changes in BP during childhood and elevated BP at 11 years of age. Methods The current study included 176 mother-child pairs from the Rhea Study in Heraklion, Greece and focused on eight elements (antimony, arsenic, cadmium, cobalt, lead, magnesium, molybdenum, selenium) measured in maternal urine samples collected during pregnancy (median gestational age at collection: 12 weeks). BP was measured at approximately 4, 6, and 11 years of age. Covariate-adjusted Bayesian Varying Coefficient Kernel Machine Regression and Bayesian Kernel Machine Regression (BKMR) were used to evaluate metal mixture impacts on baseline and longitudinal changes in BP (from ages 4 to 11) and the development of elevated BP at age 11, respectively. BKMR results were compared using static versus percentile-based cutoffs to define elevated BP. Results Molybdenum and lead were the mixture components most consistently associated with BP. J-shaped relationships were observed between molybdenum and both systolic and diastolic BP at age 4. Similar associations were identified for both molybdenum and lead in relation to elevated BP at age 11. For molybdenum concentrations above the inflection points (~ 40–80 μg/L), positive associations with BP at age 4 were stronger at high levels of lead. Lead was positively associated with BP measures at age 4, but only at high levels of molybdenum. Potential interactions between molybdenum and lead were also identified for BP at age 11, but were sensitive to the cutoffs used to define elevated BP. Conclusions Prenatal exposure to high levels of molybdenum and lead, particularly in combination, may contribute to higher BP at age 4. These early effects appear to persist throughout childhood, contributing to elevated BP in adolescence. Future studies are needed to identify the major sources of molybdenum and lead in this population.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Prenatal metal mixtures and child blood pressure in the Rhea mother-child cohort in Greece

et al. 2021

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“…Health workers need to compute the age-, height-and sex-specific centiles in the clinic setting to ascertain the BP classification of a paediatric patient before discharging them, and to confirm elevated BP on three separate visits. There is emerging evidence to suggest that simplified cut-offs may be sufficient for hypertension screening in children, [17] but this is not current guideline practice. In addition, the risk-benefit analyses of screening and the cost-effectiveness of therapeutic interventions in children still need to be clarified and evaluated in sub-Saharan Africa to inform policy recommendations.…”

Section: Editorialmentioning

confidence: 99%

Paediatric hypertension in South Africa: An underestimated problem calling for action

et al. 2018

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Screening for Hypertension in Children and Adolescents

Gartlehner

Schaaf

Orr

et al. 2020

JAMA

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ImportanceChildhood hypertension can result in adverse outcomes during adulthood; identifying and treating primary and secondary childhood hypertension may reduce such risks.ObjectiveTo update the evidence on screening and treatment of hypertension in childhood and adolescence for the US Preventive Services Task Force.Data SourcesPubMed, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, and trial registries through September 3, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through October 6, 2020.Study SelectionFair- or good-quality English-language studies evaluating diagnostic accuracy of blood pressure screening; cohort studies assessing the association of hypertension in childhood and adolescence with blood pressure or other intermediate outcomes in adulthood; randomized clinical trials (RCTs) or meta-analyses of pharmacological and lifestyle interventions.Data Extraction and SynthesisTwo reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; the evidence was synthesized qualitatively.Main Outcomes and MeasuresSensitivity, specificity, and measures of association between childhood and adulthood blood pressure; reduction of childhood blood pressure; adverse effects of treatments.ResultsForty-two studies from 43 publications were included (N>12 400). No studies evaluated the benefits or harms of screening and the effect of treating childhood hypertension on outcomes in adulthood. One study reported a sensitivity of 0.82 and a specificity of 0.70 for 2 office-based blood pressure measurements. Twenty observational studies suggested a significant association between childhood hypertension and abnormal blood pressure in adulthood (odds ratios, 1.1-4.5; risk ratios, 1.45-3.60; hazard ratios, 2.8-3.2). Thirteen placebo-controlled RCTs and 1 meta-analysis assessed reductions in systolic (SBP) and diastolic blood pressure from pharmacological treatments. Pooled reductions of SBP were −4.38 mm Hg (95% CI, −7.27 to −2.16) for angiotensin-converting enzyme inhibitors and −3.07 mm Hg (95% CI, −4.99 to −1.44) for angiotensin receptor blockers. Candesartan reduced SBP by −6.56 mm Hg (P < .001; n = 240). β-Blockers, calcium channel blockers, and mineralocorticoid receptor antagonists did not achieve significant reductions over 2 to 4 weeks. SBP was significantly reduced by exercise over 8 months (−4.9 mm Hg, P ≤ .05; n = 69), by dietary approaches to stop hypertension over 3 months (−2.2 mm Hg, P < .01; n = 57), and by a combination of drug treatment and lifestyle interventions over 6 months (−7.6 mm Hg; P < .001; n = 95). Low-salt diet did not achieve reductions of blood pressure.Conclusions and RelevanceObservational studies indicate an association between hypertension in childhood and hypertension in adulthood. However, the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care.

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Can Pediatric Hypertension Criteria Be Simplified?

Cited by 55 publications

References 38 publications

Prenatal metal mixtures and child blood pressure in the Rhea mother-child cohort in Greece

Prenatal metal mixtures and child blood pressure in the Rhea mother-child cohort in Greece

Paediatric hypertension in South Africa: An underestimated problem calling for action

Screening for Hypertension in Children and Adolescents

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