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Impact of the 2017 American Academy of Pediatrics Guideline on Hypertension Prevalence Compared With the Fourth Report in an International Cohort Publisher Pubmed



Yang L1 ; Kelishadi R2 ; Hong YM3 ; Khadilkar A4 ; Nawarycz T5 ; Krzywinskawiewiorowska M6 ; Aounallahskhiri H7 ; Motlagh ME8 ; Kim HS3 ; Khadilkar V4 ; Krzyzaniak A6 ; Romdhane HB9 ; Heshmat R10 ; Chiplonkar S4 Show All Authors
Authors
  1. Yang L1
  2. Kelishadi R2
  3. Hong YM3
  4. Khadilkar A4
  5. Nawarycz T5
  6. Krzywinskawiewiorowska M6
  7. Aounallahskhiri H7
  8. Motlagh ME8
  9. Kim HS3
  10. Khadilkar V4
  11. Krzyzaniak A6
  12. Romdhane HB9
  13. Heshmat R10
  14. Chiplonkar S4
  15. Stawinskawitoszynska B6
  16. El Ati J11
  17. Qorbani M12
  18. Kajale N4
  19. Traissac P13
  20. Ostrowskanawarycz L5
  21. Ardalan G2
  22. Ekbote V4
  23. Zhao M14
  24. Heiland EG15
  25. Liang Y16
  26. Xi B1
Show Affiliations
Authors Affiliations
  1. 1. Department of Epidemiology, School of Public Health, Shandong University, 44 Wenhuaxi Rd, Jinan, Shandong, 250012, China
  2. 2. Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
  3. 3. Department of Pediatrics, Ewha Womans University, School of Medicine, Seoul, South Korea
  4. 4. Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
  5. 5. Department of Biophysics, Medical University of Lodz, Lodz, Poland
  6. 6. Department of Epidemiology and Hygiene, Poznan University of Medical Sciences, Poznan, Poland
  7. 7. National Institute of Public Health, Nutrition Surveillance and Epidemiology in Tunisia Research Laboratory, Tunis, Tunisia
  8. 8. Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran
  9. 9. Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
  10. 10. Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran
  11. 11. Nutrition Surveillance and Epidemiology Unit, National Institute of Nutrition and Food Technology, Tunis, Tunisia
  12. 12. Department of Epidemiology, Non- Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
  13. 13. Institut de Recherche Pour le Developpement, UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France
  14. 14. Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China
  15. 15. Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden
  16. 16. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

Source: Hypertension Published:2019


Abstract

In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk. © 2019 American Heart Association, Inc.
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