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Isolated diastolic high blood pressure: a distinct clinical phenotype in US children
Habeeb Alsaeed1, Daniel L Metzger2, Tom D Blydt-Hansen3
1Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
Insights
Isolated diastolic hypertension (iDH) affects 1.9% of US children and is characterized by distinct clinical features. These children are younger, leaner, more often female, and have higher resting heart rates, suggesting unique pathophysiology.
Area of Science:
- Pediatric Cardiology
- Public Health
- Clinical Phenotyping
Background:
- Isolated diastolic hypertension (iDH) is identified in 0.7-4.5% of healthy children.
- Current guidelines define elevated and hypertensive diastolic blood pressure ranges in children.
- The National Health and Nutrition Examination Survey (NHANES) provides data for US children's health trends.
Purpose of the Study:
- To characterize children with isolated diastolic high blood pressure (iDH).
- To compare the clinical features of iDH with isolated systolic hypertension (iSH).
- To investigate potential underlying pathophysiological differences in iDH.
Main Methods:
- Analysis of 17,362 children aged 8-18 years from NHANES (1999-2016).
- Blood pressure measured using sphygmomanometry according to 2017 guidelines.
- Categorization of high blood pressure into isolated systolic (iSH), isolated diastolic (iDH), and Mixed.
Main Results:
- 1.9% of children had iDH, 11.1% had iSH, and 1.0% had Mixed high blood pressure.
- Children with iDH were more likely to be female, younger, white, and leaner than those with iSH.
- Resting heart rate was significantly higher in iDH, even after adjusting for covariates.
Conclusions:
- Children with iDH exhibit a distinct clinical profile compared to those with iSH.
- A leaner physique and elevated resting heart rate in iDH may indicate different underlying mechanisms.
- Further longitudinal studies are required to understand the pathogenesis, progression, and prognosis of iDH.
Background:
Screening studies have shown that 0.7-4.5% of generally healthy children have isolated diastolic high BP. We therefore studied the characteristics of children with diastolic BP in the elevated and hypertensive ranges according to current guidelines in US children from the National Health and Nutrition Examination Survey (NHANES, 1999-2016).
Methods:
We studied 17,362 children (8-18 years) with BP measured by sphygmomanometry. High BP was categorized as isolated systolic (iSH), isolated diastolic (iDH), or Mixed.
Results:
Overall, 86.0% (95% CI = 85.0-87.0) of the population had normal BP, 8.7% (8.0-9.3) elevated BP, 4.9% (4.4-5.5) Stage 1, and 0.4% (0.4-0.6) Stage 2. Moreover, 11.1% (10.3-12.0) had iSH, 1.9% (1.5-2.2) iDH, and 1.0% (0.8-1.2) Mixed. Children with iDH were more likely to be female, younger, white, and leaner than those with iSH, with lower rates of overweight/obesity. iDH was generally between normals and iSH. Resting heart rate was significantly higher in iDH even after adjustment for known covariates.
Conclusions:
Children with iDH may have a distinct clinical picture. A leaner habitus and higher resting heart rate may reflect differences in underlying pathophysiology. Longitudinal follow-up studies are needed to better define the pathogenesis, progression, and long-term prognosis in iDH.
Impact:
Using gold-standard auscultation and 2017 guidelines, isolated diastolic high BP (iDH) is found in 1.9% (95% CI 1.5-2.2) of American children; these children are younger, leaner, more female, and have fewer cardiometabolic risks. Resting heart rate is significantly higher in iDH compared to both normals and iSH even after adjustments for known covariates. Autonomic hyperactivity in iDH may speak to both etiology and therapeutic approaches. iDH appears to be a distinct clinical phenotype characterized by differences in anthropometric measures, sex, age, and resting heart rate. Follow-up studies are clearly needed to clarify its pathogenesis, progression, and prognosis.
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