Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

Flynn, Joseph T.; Kaelber, David C.; Baker‐Smith, Carissa M.; Blowey, Douglas L.; Carroll, Aaron E.; Daniels, Stephen R.; Ferranti, Sarah D. de; Dionne, Janis M.; Falkner, Bonita; Flinn, Susan K.; Gidding, Samuel S.; Goodwin, Celeste; Leu, Michael G.; Powers, Makia; Rea, Corinna J.; Samuels, Joshua; Simasek, Madeline; Thaker, Vidhu; Urbina, Elaine M.

doi:10.1542/9781610024310-part03-ch13

Cited by 6 publications

(8 citation statements)

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“…Notable differences include the AAP's utilization of a lower BP reference value, excluding obese children, and applying a static cutoff BP value at a younger age (13 years) than the ESH (16 years), with lower static cutoff values. 23,24 Previous studies have consistently shown a higher prevalence of high BP in the AAP compared to that in the ESH, [32][33][34][35][36][37] consistent with the findings in our study. There was a concern regarding a potential underdiagnosis of HTN in the AAP for youths older than 13 years, as a static cutoff BP value derived from adulthood HTN definitions was applied.…”

supporting

confidence: 92%

Assessment of Cardiovascular Disease Risk Factors in Korean Children: Impact of Various Pediatric Hypertension Guidelines and Application of the Korean Blood Pressure Reference

Kim,

Park,

Cho

2024

Preprint

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Background: The global prevalence of pediatric hypertension (HTN) is increasing and is a significant precursor of cardiovascular disease (CVD). We performed a comparative analysis of two guidelines for pediatric HTN: the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH); the Korean blood pressure (BP) reference was applied to the Korean pediatric population. Methods: Data from 2,060 children and adolescents aged 10-18 years from the Korean National Health and Nutrition Examination Survey (2016-2018) were analyzed. BP was classified according to the AAP, ESH, and Korea Regional BP Classification (KRC). High BP was defined as BP exceeding the normotensive range. Results: The prevalence of high BP in Korean youth was notably higher in the AAP group than that in the ESH group (19.5% vs. 10.6%, p<0.0001). There were variations in the prevalence based on age, sex, and obesity. No significant disparities were observed between the AAP and KRC groups in terms of high BP prevalence. The application of the AAP and KRC demonstrated a more comprehensive reflection of CVD risk factors, including obesity and metabolic profiles, compared to the ESH. The KRC showed a tendency for more non-obese individuals to be categorized as having elevated BP, although this difference was not statistically significant. Conclusions: This study advocates the adoption of the KRC for defining pediatric HTN in Korea. The KRC identified individuals with CVD risk as having a high BP, which raises the potential of the KRC for early intervention in CVD risk control.

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supporting

confidence: 92%

Assessment of Cardiovascular Disease Risk Factors in Korean Children: Impact of Various Pediatric Hypertension Guidelines and Application of the Korean Blood Pressure Reference

Kim,

Park,

Cho

2024

Preprint

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“…Otherwise, a third reading was performed [ 25 ]. Average values were calculated for the final SBP and DBP, which were adjusted by age, sex, and height to obtain percentile and z-score values [ 32 ]. Biochemical blood analysis was performed by trained nurses using samples taken early in the morning after overnight fasting.…”

Section: Methodsmentioning

confidence: 99%

Urinary Nitric Oxide Levels Are Associated with Blood Pressure, Fruit and Vegetable Intake and Total Polyphenol Excretion in Adolescents from the SI! Program

et al. 2022

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Nitric oxide (NO) is important to cardiovascular health (CVH), and its bioavailability could be regulated by the antioxidant effect of polyphenols, improving endothelial function and consequently blood pressure (BP). However, scant research has been carried out on NO and CVH correlates in adolescent populations. Therefore, our aim was to investigate the association between NO and the CVH status and other health factors in adolescents. NO, total polyphenol excretion (TPE), anthropometric measurements, BP, blood lipid profile, blood glucose, diet, physical activity, and smoking status were recorded, while CVH score was classified as ideal, intermediate, and poor. Negative associations were observed between NO and body mass index, body fat percentage, BP, and triglycerides; and positive associations between NO and skeletal muscle percentage, HDL-cholesterol, fruit and vegetable intake, and TPE was observed. To capture more complex interactions among different factors, multiple linear regression was performed, obtaining a significant association between NO and fruit and vegetable intake (β = 0.175), TPE (β = 0.225), and systolic BP (β = −0.235). We conclude that urinary NO levels are positively associated with the consumption of fruits and vegetables rich in antioxidants such as polyphenols and negatively associated with systolic BP.

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“…(1) Normal BP: mean systolic BP (SBP) and diastolic BP (DBP) <120/80 AND <90 th percentile for age, height, and sex at first screening, (2) Elevated BP: Mean SBP or DBP ≥ 90th percentile, but ≤ 95 th percentile (or 120-129/80 mm Hg for subjects ≥13 years), or (3) Hypertension: Mean SBP or DBP ≥95th percentile (or ≥130/80 mm Hg for subjects' ≥13 years) according to the 2017 American Academy of Pediatrics Clinical Practice Guidelines. 31 Students with abnormal BP measurements on the initial screening day had repeated BP measurements on up to two additional occasions to confirm the presence of sustained hypertension per AAP clinical practice guidelines. Subsequent BP measurements were performed within two months of the initial reading to reduce potential confounders from changes in body habitus.…”

Section: Outcomementioning

confidence: 99%

School Neighborhood Deprivation is Associated with a Higher Prevalence of Hypertension

Onugha,

Banerjee,

Nobleza

et al. 2024

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Hypertension, a major modifiable risk factor for cardiovascular disease, is increasing among adolescents. While socioeconomic factors contribute to hypertension risk in adults, similar data in children is lacking. We examined the association between socioeconomic characteristics of school neighborhoods and the prevalence of hypertension in adolescents. School neighborhood socioeconomic status (SES) was assessed via the area deprivation index (ADI), a composite measure of area-level socioeconomic deprivation. Using data from a school BP surveillance program implemented in the Houston metropolitan area, we performed a cross-sectional analysis using both univariate and multivariable regression analyses. Among 21,392 students aged 10 to 19 years during the 2000 through 2017 academic years, the prevalence of sustained hypertension was 2.6%. Although 85% of students attended schools located in neighborhoods in quartiles 1 (Q1) and 2 (Q2) (higher ADI represents more deprivation), Hispanics and African Americans were overrepresented in the schools located inside more deprived neighborhoods. The highest sustained hypertension rate (4.6%) was observed among students attending Q 3 and Q4 schools compared to 2.3% in Q 1 and Q2 schools (p < 0.001). Multivariable regression analysis showed that being male, obese, and attending school in a disadvantaged neighborhood were significantly associated with an increased prevalence of hypertension. Attending school in neighborhoods with lower SES may account for the increased hypertension prevalence in minority adolescents. Characteristics of school neighborhoods play an important role in disparities observed in hypertension prevalence, providing direct opportunities to encourage improved dietary intake and physical activity, both of which are important determinants of hypertension.

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Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

Cited by 6 publications

References 0 publications

Assessment of Cardiovascular Disease Risk Factors in Korean Children: Impact of Various Pediatric Hypertension Guidelines and Application of the Korean Blood Pressure Reference

Assessment of Cardiovascular Disease Risk Factors in Korean Children: Impact of Various Pediatric Hypertension Guidelines and Application of the Korean Blood Pressure Reference

Urinary Nitric Oxide Levels Are Associated with Blood Pressure, Fruit and Vegetable Intake and Total Polyphenol Excretion in Adolescents from the SI! Program

School Neighborhood Deprivation is Associated with a Higher Prevalence of Hypertension

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