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. 2021 Oct;90(4):903-909.
doi: 10.1038/s41390-021-01369-x. Epub 2021 Jan 27.

Isolated diastolic high blood pressure: a distinct clinical phenotype in US children

Habeeb Alsaeed  1 , Daniel L Metzger  2 , Tom D Blydt-Hansen  3 , Celia Rodd  4 , Atul Sharma  5
Affiliations

Isolated diastolic high blood pressure: a distinct clinical phenotype in US children

Habeeb Alsaeed et al. Pediatr Res. 2021 Oct.

Abstract

Background: Screening studies have shown that 0.7-4.5% of generally healthy children have isolated diastolic high BP. We therefore studied the characteristics of children with diastolic BP in the elevated and hypertensive ranges according to current guidelines in US children from the National Health and Nutrition Examination Survey (NHANES, 1999-2016).

Methods: We studied 17,362 children (8-18 years) with BP measured by sphygmomanometry. High BP was categorized as isolated systolic (iSH), isolated diastolic (iDH), or Mixed.

Results: Overall, 86.0% (95% CI = 85.0-87.0) of the population had normal BP, 8.7% (8.0-9.3) elevated BP, 4.9% (4.4-5.5) Stage 1, and 0.4% (0.4-0.6) Stage 2. Moreover, 11.1% (10.3-12.0) had iSH, 1.9% (1.5-2.2) iDH, and 1.0% (0.8-1.2) Mixed. Children with iDH were more likely to be female, younger, white, and leaner than those with iSH, with lower rates of overweight/obesity. iDH was generally between normals and iSH. Resting heart rate was significantly higher in iDH even after adjustment for known covariates.

Conclusions: Children with iDH may have a distinct clinical picture. A leaner habitus and higher resting heart rate may reflect differences in underlying pathophysiology. Longitudinal follow-up studies are needed to better define the pathogenesis, progression, and long-term prognosis in iDH.

Impact: Using gold-standard auscultation and 2017 guidelines, isolated diastolic high BP (iDH) is found in 1.9% (95% CI 1.5-2.2) of American children; these children are younger, leaner, more female, and have fewer cardiometabolic risks. Resting heart rate is significantly higher in iDH compared to both normals and iSH even after adjustments for known covariates. Autonomic hyperactivity in iDH may speak to both etiology and therapeutic approaches. iDH appears to be a distinct clinical phenotype characterized by differences in anthropometric measures, sex, age, and resting heart rate. Follow-up studies are clearly needed to clarify its pathogenesis, progression, and prognosis.

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References

    1. Rosner, B., Cook, N., Portman, R., Daniels, S. & Falkner, B. Determination of blood pressure percentiles in normal-weight children: some methodological issues. Am. J. Epidemiol. 167, 653–666 (2008). - DOI
    1. Flynn, J. T. et al. Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140, e20171904 (2017). - DOI
    1. Sorof, J. M., Poffenbarger, T., Franco, K., Bernard, L. & Portman, R. J. Isolated systolic hypertension, obesity, and hyperkinetic hemodynamic states in children. J. Pediatr. 140, 660–666 (2002). - DOI
    1. Karatzi, K. et al. Prevalence of hypertension and hypertension phenotypes by age and gender among schoolchildren in Greece: The Healthy Growth Study. Atherosclerosis 259, 128–133 (2017). - DOI
    1. Yang, Y. et al. Prevalence of high blood pressure subtypes and its associations with BMI in Chinese children: a national cross-sectional survey. BMC Public Health 17, 598 (2017). - DOI

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