The prevalence of primary pediatric prehypertension and hypertension in a real-world managed care system

Abstract

To assess the burden associated with hypertension, reliable estimates for the prevalence of pediatric hypertension are vital. For this cross-sectional study of 237,248 youths aged 6 to 17 years without indication of secondary hypertension, blood pressure (BP) was classified according to age, sex, and height using standards from the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents as prehypertension with at least 1 BP ≥90th percentile and as hypertension with 3 BPs ≥95th percentile. The prevalence of prehypertension and hypertension were 31.4% and 2.1%, respectively. An additional 21.4% had either 1 (16.6%) or 2 (4.8%) BPs ≥95th percentile. Based on this large population-based study using routinely measured BP from clinical care, a remarkable proportion of youth (6.9%) has hypertension or nearly meets the definition of hypertension with 2 documented BPs in the hypertensive range.

Figure 1

Flow chart of the Kaiser Permanente Southern California (KPSC) Children's Health Study and further inclusions for the final analytical cohort in the present study. *Existing diagnoses of chronic conditions significantly affecting growth or blood pressure (n=2712), such as growth hormone deficiency (International Classification of Disease, Ninth Revision [ICD‐9] 253.3) or overproduction (ICD‐9 253.0), aortic coarctation (ICD‐9 747.10), chronic renal disease (ICD‐9 585.x), congenital adrenal hyperplasia (ICD‐9 255.2), Cushing syndrome (ICD‐9 255.0), hyperaldosteronism (ICD‐9 255.1), and/or hyperthyroidism (ICD‐9 242). #Except youth patients with a diagnosis of essential hypertension (ICD‐9 401 or 402) and at least one prescription of antihypertensive drugs (n=984) were classified as patients with hypertension if there was no information in the electronic health record to suggest a different diagnosis.

Figure 2

Crude and adjusted prevalence ratio (PR) for hypertension in youth aged 6 to 17 years by race and sex (P for interaction sex × race=.001) suggesting that racial disparities in hypertension are stronger in boys than in girls and are significantly attenuated after adjustment for other factors including body mass index for age. PI indicates Pacific Islander; CI, confidence interval.