Sharma AK, et al. - The consequences of the American Academy of Pediatrics clinical practice guidelines for the management of elevated blood pressure (BP) was comprehensively analyzed by experts in children with regard to the prevalence and severity of elevated BP among children. They also intended to characterize risk factors for children with new-onset hypertension or a worsening in clinical stage. In otherwise healthy US children, clustering of cardiovascular risk factors indicated that those whose BP was reclassified depicted a high-risk population whose cardiovascular risk could have been underestimated.

Methods

• Both sets of guidelines aided in classifying BP in 15,647 generally healthy, low-risk children aged 5 to 18 years from National Health and Nutrition Examination Surveys (from January 1, 1999, to December 31, 2014).
• Children whose BP was reclassified upward (cases) were matched for sex, age, and height with controls with normal BP in the case-control portion of the study.
• A comparison was carried out of the anthropometric and laboratory risk factors and age- and sex-specific z scores for weight, waist circumference, and body mass index were estimated.
• Blood pressure was measured by auscultation by trained personnel.
• After the child rested quietly for 5 minutes, 3 to 4 consecutive BP readings were recorded.
• Blood pressure percentiles and clinical classification based on either the 2017 American Academy of Pediatrics guidelines or the 2004 National, Heart, Lung, and Blood Institute report served as the primary outcome.

Results

• Out of the 15,647 children in the study (7,799 girls and 7,848 boys; mean [SD] age, 13.4 [2.8] years), based on the American Academy of Pediatrics guidelines, the estimated (weighted) population prevalence of elevated BP increased from 11.8% (95% CI, 11.1%-13.0%) to 14.2% (95% CI, 13.4%-15.0%).
• It was determined 905 of 15,584 children (5.8%) had newly diagnosed hypertension (n = 381) or a worsening in clinical stage (n = 524).
• It depicted a notable rise in disease burden for the health care system.
• As per the data, children whose BP was reclassified upward exhibited a greater tendency of being overweight or obese, with higher z scores for weight, waist circumference, and body mass index.
• Furthermore, an increase was reported the prevalence of abnormal laboratory test results, displayed adverse lipid profiles and increased hemoglobin A1c levels (prediabetes).