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2017 Pediatric Hypertension Guidelines Improve Prediction of Adult Cardiovascular Outcomes
Tingting Du1,2, Camilo Fernandez2, Rupert Barshop2
1From the Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan China (D.T.).
Insights
The 2017 pediatric hypertension guidelines identified more children with hypertension than the 2004 guidelines. Children reclassified to higher blood pressure categories by the 2017 guidelines showed increased risks for adult hypertension, metabolic syndrome, and left ventricular hypertrophy (LVH).
Area of Science:
- Cardiology
- Pediatrics
- Public Health
Background:
- Pediatric hypertension definitions have evolved, with new guidelines published in 2017.
- Previous guidelines (2004) may have underestimated cardiovascular risk in some children.
- Longitudinal data is crucial for understanding the long-term impact of hypertension definitions.
Purpose of the Study:
- Compare the prevalence of pediatric hypertension using 2004 versus 2017 guidelines.
- Assess the predictive performance of both guideline sets for adult hypertension, metabolic syndrome, and left ventricular hypertrophy (LVH).
- Identify children at increased risk for adverse cardiometabolic outcomes based on updated definitions.
Main Methods:
- Longitudinal study of 3940 children (ages 3-18) from the Bogalusa Heart Study with 36-year follow-up.
- Hypertension prevalence calculated using 2004 and 2017 pediatric hypertension guidelines.
- Association analysis between childhood hypertension definitions and adult outcomes (hypertension, metabolic syndrome, LVH).
- Propensity score matching used to compare outcomes for reclassified children.
Main Results:
- Hypertension prevalence was 7% (2004 guidelines) and 11% (2017 guidelines).
- Both guideline sets showed similar associations with adult hypertension and metabolic syndrome.
- The 2017 guidelines identified a group of children with increased risk of developing adult LVH (19% vs. 12% with 2004 guidelines).
- Children reclassified to higher blood pressure categories by 2017 guidelines had significantly higher risks of future hypertension, metabolic syndrome, and LVH.
Conclusions:
- The 2017 pediatric hypertension guidelines identify a greater proportion of children with hypertension, including those at higher risk for adverse cardiometabolic outcomes.
- Updated definitions better capture cardiovascular risk, particularly for left ventricular hypertrophy, which was underestimated by the 2004 guidelines.
- The 2017 guidelines are essential for identifying children needing early intervention to prevent long-term cardiovascular complications.
Abstract:
We aimed to evaluate the consequences of the 2017 pediatric hypertension definitions, compared with the 2004 pediatric hypertension definitions on the prevalence of hypertension and to assess the performance of these 2 sets of guidelines in predicting adult hypertension, metabolic syndrome, and left ventricular hypertrophy (LVH). This longitudinal study consisted of 3940 children (47% male; ages 3-18 years) who came from the Bogalusa Heart Study with 36-year follow-up since childhood. Hypertension was identified in 7% and 11% as defined in the 2004 and 2017 guidelines, respectively. The 2004 and 2017 guidelines demonstrated similar associations with adulthood hypertension, metabolic syndrome, and LVH. However, the proportion of children identified as having hypertension who developed adult LVH increased from 12% when defined by the 2004 guidelines to 19% when defined by the 2017 guidelines. Overall, the 329 (8%) children who were reclassified to higher blood pressure categories by the 2017 guidelines were more likely than their propensity score-matched normotensive counterparts to develop hypertension, metabolic syndrome, and LVH in later life, whereas 38 (1%) children who were reclassified to lower blood pressure categories by the 2017 guidelines had similar cardiometabolic outcomes to their propensity score-matched normotensive counterparts. Hence, children who were reclassified to higher blood pressure categories based on 2017 guidelines were at increased risk of developing hypertension, metabolic syndrome, and LVH in later life. The 2017 guidelines identified a group of children with adverse metabolic profile and cardiometabolic outcomes, whose cardiovascular risk seemed to be underestimated using the 2004 guidelines.
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