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Study: Kids’ Hypertension Guideline Update ‘Justified’

Pediatric blood pressure cutoffs updated in 2017 don’t appear to have improved cardiometabolic risk prediction except in children up-classified compared with the 2004 guidelines, researchers found.

Whether defined by the 2004 Fourth Report from the National Heart, Lung, and Blood Institute and others or the 2017 American Academy of Pediatrics (AAP) guidelines, high blood pressure in childhood led to the same rates of hypertension, metabolic syndrome, and left ventricular (LV) hypertrophy in adulthood.

The updated thresholds only improved prediction of later LV hypertrophy, Lydia Bazzano, MD, PhD, of Tulane University School of Public Health and Tropical Medicine in New Orleans, and colleagues reported in the May 2019 issue of Hypertension.

However, the 8% of children who were reclassified to higher blood pressure (BP) categories had significantly higher adult risk compared with normotensive peers on propensity score-matched analysis for the following:

  • Hypertension (OR 2.50)
  • Metabolic syndrome (OR 1.51)
  • LV hypertrophy (OR 1.06)

On the other hand, the 1% of those reclassified downward showed no difference in cardiometabolic outcomes in later life.

“These findings have important health implications and support that the new BP thresholds are justifiable” despite the “similar strengths of associations and overall predictive performance” from the 2004 and 2017 guideline definitions, Bazzano’s group concluded.

The AAP’s revamped guidelines were endorsed by the American Heart Association as the groups sought to unify thresholds for pediatric and adult hypertension.

Bazzano and colleagues based the study on the nearly 4,000 children who entered the Bogalusa Heart Study via the semi-rural school system in Bogalusa, Louisiana, and were followed for 36 years. A subset of 1,760 had adult echocardiography to measure LV hypertrophy.

Pediatric hypertension would have been diagnosed in 7% and 11% of the cohort by the old and new definitions, respectively.

“An impressive strength of the study is that it provides over 20 years of longitudinal data from childhood into adulthood, a feat which would be difficult to achieve in a prospective manner,” commented Marc Lande, MD, MPH, of the University of Rochester Medical Center, New York. He was not involved with the study but does collaborate on research with one of the authors.

“A main reason that we measure a child’s blood pressure at their annual routine physical examination at the primary care office is to identify those children who may be more likely to develop early cardiovascular problems, such as hypertension and cardiac hypertrophy as adults,” he told MedPage Today. “Our hope is that early intervention, as with a healthful diet and regular exercise, will lead to improved cardiovascular outcomes in adulthood in these higher-risk children.”

Adults with hypertension and those with cardiac hypertrophy are more prone to go on to have cardiovascular events, Lande noted.

Bazzano and colleagues acknowledged limitations of the study including a relatively small and community-based sample with limited national generalizability. In addition, they had no data on coronary heart disease or stroke rates in their study population.

“Longitudinal studies of CVD [cardiovascular disease] morbidity and mortality will ultimately be needed to precisely evaluate the effect of the 2017 guidelines on CVD outcomes, which will further refine the BP guidelines for children,” the authors said.

The study was supported by NIH grants.

Bazzano disclosed no relevant conflicts of interest.