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

Hui Fan1, Xingyu Zhang2

  • 1Department of Preventive Medicine, North Sichuan Medical College, Nanchong, Sichuan, China. 1577371399@qq.com.

Journal of Human Hypertension
|November 26, 2020
PubMed

Insights

The American Academy of Pediatrics (AAP) guideline identifies more children with hypertension than European Society of Hypertension (ESH) or Fourth Report guidelines. Careful selection of pediatric hypertension management guidelines is crucial.

Area of Science:

  • Pediatrics
  • Cardiology
  • Public Health

Background:

  • Recent updates to childhood hypertension management guidelines by the European Society of Hypertension (ESH) and American Academy of Pediatrics (AAP).
  • The need to compare prevalence estimates derived from different guidelines in a national context.

Purpose of the Study:

  • To compare the prevalence of pediatric hypertension using the updated AAP and ESH guidelines versus the Fourth Report criteria.
  • To assess the impact of guideline selection on hypertension prevalence in Chinese children.

Main Methods:

  • A 4.6-year follow-up cohort study of 4276 children from the China Health and Nutrition Study.
  • Hypertension defined using AAP, ESH, and Fourth Report guidelines at baseline and follow-up.
  • Statistical comparison using Mc Nemar's test to evaluate differences in prevalence.

Main Results:

  • The AAP guideline identified significantly higher hypertension prevalence at baseline (8.3% vs. 5.0% for ESH/Fourth Report) and follow-up (14.5% vs. 5.0%/6.0%).
  • Prevalence was also higher with AAP for children identified in at least one survey (21.0% vs. 9.4%/10.4%) and both surveys (1.8% vs. 0.5%/0.6%).
  • Elevated blood pressure definitions yielded similar comparative results across guidelines.

Conclusions:

  • The AAP guideline results in a substantially higher prevalence of pediatric hypertension compared to ESH and Fourth Report guidelines.
  • Clinical practice and public health strategies require careful consideration and selection of appropriate childhood hypertension management guidelines.

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