Impact of updated pediatric hypertension criteria on prevalence estimates of hypertension among Chinese children

Difference in hypertension prevalence applying three childhood hypertension management guidelines in a national cohort study

The European Society of Hypertension (ESH) and American Academy of Pediatrics (AAP) recently updated their childhood hypertension management guidelines. We aimed to compare the hypertension prevalence determined using the two aforementioned guidelines and Fourth Report in a national cohort study. This 4.6-year follow-up study included 4276 children who had participated in the China Health and Nutrition Study. At baseline and during a follow-up survey, hypertension was defined using the three guidelines. We calculated the pediatric hypertension prevalence in at least one survey and in both surveys as the number of participants identified as hypertensive in at least one survey or in both surveys divided by 4276, respectively. Using Mc Nemar's test, we determined that the prevalence of pediatric hypertension differed significantly according to AAP vs. ESH guidelines and Fourth Report at the baseline (8.3% vs. 5.0% and 5.0%, respectively; reference, AAP; P_s < 0.001 for AAP vs. ESH guidelines and Fourth Report) and follow-up surveys (14.5% vs. 5.0% and 6.0%, respectively; reference, AAP; both P_s < 0.001), as well as among those detected with hypertension in at least one survey (21.0% vs. 9.4% and 10.4%, respectively; reference, AAP; both P_s < 0.001) and both surveys (1.8% vs. 0.5% and 0.6%, respectively; reference, AAP; both P_s < 0.001). We obtained similar results when using the three guidelines to define childhood elevated blood pressure. Our findings confirm the higher prevalence of pediatric hypertension using AAP guideline than those using ESH guideline and Fourth Report. Consequently, childhood hypertension management guidelines should be selected and used with caution.

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

2017 pediatric blood pressure (BP) guidelines applied adult BP norms to define clinic hypertension (HTN) in patients ≥ 13 years. 2014 pediatric ambulatory BP monitor (ABPM) guidelines recommend age‐ and sex‐specific percentile norms for patients < 18 years. The authors evaluated reclassification of HTN when applying adult ABPM norms in patients ≥ 13 years and assessed the association of left ventricular hypertrophy (LVH) with HTN. Charts of patients 13–17 years with ABPM 9/2018–5/2019 were reviewed for sex, age, height, weight, BP medication, ABPM results, and left ventricular mass index (LVMI). American Heart Association 2005 (AHA 2005), AHA 2017 (AHA 2017), and European Society of Hypertension 2018 (ESH 2018) guidelines for adult ABPM were compared with 2014 AHA pediatric norms (pABPM). HTN was defined by each guideline using only ABPM. ABPM and clinic BP were used to classify white coat hypertension (WCH) and masked hypertension (MH). LVH was defined as LVMI > 51 g/m^2.7. 272 patients had adequate ABPM. 124 patients also had echocardiogram. All adult norms resulted in significant reclassification of HTN. LVMI correlated significantly with systolic BP only. The odds of a patient with HTN having LVH was significant using AHA 2005 (OR: 8.75 [2.1, 36.4], p = .03) and ESH 2018 (OR: 4.94 [1, 24.3], p = .002). Significant reclassification of HTN occurs with all adult norms. HTN is significantly associated with LVH using AHA 2005 and ESH 2018. Applying pediatric norms for ABPM while using adult norms for clinic BP causes confusion. Guideline selection should balance misdiagnosis with over‐diagnosis.