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Updated Guidelines Identify More Children with High Blood Pressure

April 26, 2018

By Will Boggs MD

NEW YORK (Reuters Health) - Updated guidelines from the American Academy of Pediatrics (AAP) identify significantly more children with elevated blood pressure than previously, researchers report.

"Based on the new AAP guidelines, nearly 1 in 7 children in the general population have blood pressure (BP) levels consistent with a diagnosis of elevated BP or stages 1 and 2 hypertension," said Dr. Atul K. Sharma from the University of Manitoba in Winnipeg, Canada.

"Clustering of cardiovascular risk factors suggests that children whose blood pressure is reclassified under the new guidelines represent a particularly high-risk population whose cardiovascular risk may previously have been underestimated," he told Reuters Health by email.

The new AAP guidelines for children aged 1 to 13 years define elevated blood pressure as being at least the 90th up to <95th percentile or 120/80 mmHg to less than 95th percentile (whichever is lower); stage 1 hypertension as at least the 95th percentile to less than 95th percentile plus 12 mmHg or 130/80-139/89 mmHg (whichever is lower); and stage 2 hypertension as at least the 95th percentile plus 12 mmHg or at least 140/90 mmHg (whichever is lower).

For children 13 years and older, elevated blood pressure ranges from 120/<80 to 129/<80 mmHg; stage 1 hypertension ranges from 130/80 to 139/89 mmHg; and stage 2 hypertension includes blood pressures at least 140/90 mmHg.

Dr. Sharma and colleagues investigated the consequences of the new guidelines on the prevalence and severity of elevated blood pressure in a sample of U.S. children aged 5 to 18 years from the 1999-2014 National Health and Nutrition Examination Surveys (NHANES).

The prevalence of high blood pressure increased from 12.8% under the older definitions to 15.0% under the new AAP guidelines, the researchers report in JAMA Pediatrics, online April 23.

Overall, 5.8% of children studied were reclassified upward under the new guidelines. Few children regressed to a lower level.

Compared with children with normal blood pressure, those reclassified upward were more likely to be male, overweight, or obese. They were also much more likely to have additional cardiovascular risk factors, such as abnormal lipids or prediabetes.

"Since we studied blood-pressure at only a single time-point, long-term longitudinal follow-up is also needed to better understand risks of heart disease and stroke as these children grow to adulthood," Dr. Sharma said. "In addition, better preventative strategies need to be developed for both high BP and associated risk factors, particularly overweight and obesity. Treatment studies will also be needed to identify the optimal combination of life-style changes and medication to prevent complications in later life."

Dr. Stephen R. Daniels from the University of Colorado School of Medicine, in Aurora, who wrote a linked editorial, told Reuters Health by email, "These findings should provide further emphasis on the measurement of blood pressure and the detection of elevated blood pressure in children and adolescents in the primary care setting. I hope this paper will emphasize for pediatricians and family physicians the need to follow the new guidelines, which provide the clinical approaches needed for evaluation and treatment of high blood pressure."

"In addition," he said, "parents should be discussing blood pressure in their children, especially when there is a family history of hypertension, with their primary care provider."


JAMA Pediatr 2018.

(c) Copyright Thomson Reuters 2018. Click For Restrictions -

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