Estimated Change in Prevalence and Trends of Childhood Blood Pressure Levels in the United States After Application of the 2017 AAP Guideline

Abstract

Introduction: Childhood hypertension is associated with higher risks of cardiovascular disease during adulthood. This study estimated the prevalence of hypertension and high blood pressure among children aged 8 to 17 years in the United States per the 2017 American Academy of Pediatrics (AAP) guideline and compared that with the 2004 National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI) guideline's prevalence estimate during 2005-2008 and 2013-2016.

Methods: This cross-sectional study analyzed the National Health and Nutrition Examination Survey data. High blood pressure included hypertension and elevated blood pressure (per the 2017 AAP guideline)/prehypertension (per the 2004 NIH/NHLBI guideline).

Results: The analysis included 3,633 children in 2005-2008 and 3,471 children in 2013-2016. Per the 2004 NIH/NHLBI guideline, 3.1% (95% confidence interval [CI], 2.3%-4.3%) had hypertension in 2005-2008 and 1.9% (95% CI, 1.4%-2.6%) had hypertension in 2013-2016. Per the 2017 AAP guideline, prevalence was 5.7% (95% CI, 4.6%-7.1%) in 2005-2008 and 3.5% (95% CI, 2.7%-4.5%) in 2013-2016. About 2.5% (95% CI, 2.0%-3.1%) children in 2005-2008 and 1.5% (95% CI, 0.9%-2.0%) children in 2013-2016 were reclassified as hypertensive. We observed a similar change in prevalence for high blood pressure after application of the new guideline. The prevalence of high blood pressure also declined from 2005-2008 to 2013-2016 per both guidelines.

Conclusion: Although the new guideline would reclassify a small proportion of children as having hypertension or high blood pressure, the prevalence declined from 2005-2008 to 2013-2016.