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Prevalence implications of the 2017 American Academy of Pediatrics hypertension guideline and associations with adult hypertension


Khoury, M and Khoury, P and Bazzano, L and Burns, TL and Daniels, S and Dwyer, T and Ikonen, J and Jacobs, DR and Juonala, M and Kahonen, M and Prineas, R and Raitakari, OT and Steinberger, J and Venn, A and Viikari, J and Woo, JG and Sinaiko, A and Urbina, EM, Prevalence implications of the 2017 American Academy of Pediatrics hypertension guideline and associations with adult hypertension, Journal of Pediatrics, 241 pp. 22-28.e4. ISSN 0022-3476 (2022) [Refereed Article]

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Copyright 2021 Elsevier Inc. All rights reserved.

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DOI: doi:10.1016/j.jpeds.2021.09.056


Objective: To evaluate the impact of the 2017 American Academy of Pediatrics hypertension Clinical Practice Guideline (CPG), compared with the previous guideline ("Fourth Report"), on the frequency of hypertensive blood pressure (BP) measurements in childhood and associations with hypertension in adulthood using data from the International Childhood Cardiovascular Cohort Consortium.

Study design: Childhood BPs were categorized in normal, prehypertensive/elevated, and hypertensive (stage 1 and 2) ranges using the Fourth Report and the CPG. Participants were contacted in adulthood to assess self-reported hypertension. The associations between childhood hypertensive range BPs and self-reported adult hypertension were evaluated.

Results: Data were available for 34 014 youth (10.4 3.1 years, 50.6% female) with 92 751 BP assessments. Compared with the Fourth Report, the CPG increased hypertensive readings from 7.6% to 13.5% and from 1.3% to 2.5% for stage 1 and 2 hypertensive range, respectively (P< .0001). Of 12 761 adults (48.8 7.9 years, 43% male), 3839 (30.1%) had self-reported hypertension. The sensitivity for predicting adult hypertension among those with hypertensive range BPs at any point in childhood, as defined by the Fourth Report and the CPG, respectively, was 13.4% and 22.4% (specificity 92.3% and 85.9%, P< .001), with no significant impact on positive and negative predictive values. Associations with self-reported adult hypertension were similar and weak (c-statistic range 0.61-0.68) for hypertensive range BPs as defined by the Fourth Report and CPG.

Conclusions: The CPG significantly increased the prevalence of childhood BPs in hypertensive ranges and improved the sensitivity, without an overall strengthened association, of predicting self-reported adult hypertension.

Item Details

Item Type:Refereed Article
Keywords:pediatric, hypertension, sensitivity, specificity, guideline
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiovascular medicine and haematology not elsewhere classified
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Public health (excl. specific population health) not elsewhere classified
UTAS Author:Venn, A (Professor Alison Venn)
ID Code:150917
Year Published:2022
Web of Science® Times Cited:2
Deposited By:Menzies Institute for Medical Research
Deposited On:2022-07-05
Last Modified:2022-10-10

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