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

Journal of Human Hypertension volume 35, pages 1038–1045 (2021)Cite this article

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Abstract

The European Society of Hypertension (ESH) and American Academy of Pediatrics (AAP) recently updated their childhood hypertension management guidelines. We aimed to compare the hypertension prevalence determined using the two aforementioned guidelines and Fourth Report in a national cohort study. This 4.6-year follow-up study included 4276 children who had participated in the China Health and Nutrition Study. At baseline and during a follow-up survey, hypertension was defined using the three guidelines. We calculated the pediatric hypertension prevalence in at least one survey and in both surveys as the number of participants identified as hypertensive in at least one survey or in both surveys divided by 4276, respectively. Using Mc Nemar’s test, we determined that the prevalence of pediatric hypertension differed significantly according to AAP vs. ESH guidelines and Fourth Report at the baseline (8.3% vs. 5.0% and 5.0%, respectively; reference, AAP; Ps < 0.001 for AAP vs. ESH guidelines and Fourth Report) and follow-up surveys (14.5% vs. 5.0% and 6.0%, respectively; reference, AAP; both Ps < 0.001), as well as among those detected with hypertension in at least one survey (21.0% vs. 9.4% and 10.4%, respectively; reference, AAP; both Ps < 0.001) and both surveys (1.8% vs. 0.5% and 0.6%, respectively; reference, AAP; both Ps < 0.001). We obtained similar results when using the three guidelines to define childhood elevated blood pressure. Our findings confirm the higher prevalence of pediatric hypertension using AAP guideline than those using ESH guideline and Fourth Report. Consequently, childhood hypertension management guidelines should be selected and used with caution.

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Acknowledgements

We thank the National Institute for Nutrition and Health, China Center for Disease Control and Prevention, Carolina Population Center, the University of North Carolina at Chapel Hill, the NIH, and the NIH Fogarty International Center for the support for the CHNS data collection and analysis files. This study was supported by the PhD Funding Program of North Sichuan Medical College (CBY18-QD02), the Key Subject Development Program of North Sichuan Medical College (NSMC-M-18-19), and Funding Program of Primary Health Development Research Center of Sichuan Province (SWFZ20-Q-045).

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Authors and Affiliations

  1. Department of Preventive Medicine, North Sichuan Medical College, Nanchong, Sichuan, China

    Hui Fan

  2. Applied Biostatistics Laboratory, University of Michigan School of Nursing, Ann Arbor, Michigan, USA

    Xingyu Zhang

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  1. Hui Fan
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HF conceptualized and designed the study, carried out the initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript. XZ critically reviewed and revised the manuscript. Both authors approved the final manuscript as submitted.

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Correspondence to Hui Fan.

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Fan, H., Zhang, X. Difference in hypertension prevalence applying three childhood hypertension management guidelines in a national cohort study. J Hum Hypertens 35, 1038–1045 (2021). https://doi.org/10.1038/s41371-020-00447-7

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