Impact of the 2017 American Academy of Pediatrics Guideline on Hypertension Prevalence Compared With the Fourth Report in an International Cohort

Abstract

In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk.

Reclassification of adolescent hypertension by ambulatory blood pressure monitoring using adult norms and association with left ventricular hypertrophy

“…15 We found significant misclassification or rather reclassification (since pediatric standards are not necessarily evidence-based) regardless of which adult norms were applied. This is similar to previous studies 16,17 Previous studies have evaluated the impact of reclassification of clinic BP when applying various normative data to a pediatric population, 5,6 but few have evaluated the impact on ABPM classification. 16,17 Two previous studies evaluated the impact of ABPM reclassification using pediatric norms and ESH norms.…”

Paediatric Hypertension in Africa: A Systematic Review and Meta-Analysis

“…However, the prevalence of both stage one (7·9 % increase) and stage two (1·3% increase) hypertension increased [87] . Additionally, a case control sub-study of 1606 subjects from the above mentioned cohort showed that, compared to normotensive children, those reclassified upwards were more likely to have a higher fasting blood glucose and advance lipid profile [87] . This highlights the potential clinical significance of appropriately classifying paediatric hypertension.…”

“…While the two most prevalent classification standards used in this review are internationally accepted, their suitability for an African child and adolescent populations remains unknown. A study comparing the 2017 AAP guidelines to that of the 2004 4 th report, in 47200 paediatric subjects from an international cohort (China, India, Iran, Korea, Poland, and Tunisia), found that making use of the 2017 AAP guidelines resulted in a 6·3% reduction in elevated BP [87] . However, the prevalence of both stage one (7·9 % increase) and stage two (1·3% increase) hypertension increased [87] .…”

“…A study comparing the 2017 AAP guidelines to that of the 2004 4 th report, in 47200 paediatric subjects from an international cohort (China, India, Iran, Korea, Poland, and Tunisia), found that making use of the 2017 AAP guidelines resulted in a 6·3% reduction in elevated BP [87] . However, the prevalence of both stage one (7·9 % increase) and stage two (1·3% increase) hypertension increased [87] . Additionally, a case control sub-study of 1606 subjects from the above mentioned cohort showed that, compared to normotensive children, those reclassified upwards were more likely to have a higher fasting blood glucose and advance lipid profile [87] .…”

Lifestyle Clusters and Cardiometabolic Risks in Adolescents: A Chinese School-Based Study Using a Latent Class Analysis Approach

“…The incidence of metabolic syndrome in children and adolescents with obesity ranges from 6 to 39%, depending on the definition applied ( 7 , 8 ). When defined according to the American Academy of Pediatrics (AAP) guidelines, EBP is prevalent in 8.6% of the pediatric population in 2017 ( 9 ). In China, the prevalence of pediatrics EBP is 9.8% ( 10 ), indicating the importance and urgency of addressing cardiometabolic abnormalities in adolescents.…”