New Pediatric Guidelines Better Predict CVD in Adulthood

The 2017 guidelines on pediatric blood pressure (BP), published by the American Academy of Pediatrics (AAP) and endorsed by the American Heart Association (AHA), more accurately predict cardiovascular disease (CVD) outcomes in children than the 2004 guidelines, according to a new analysis.

The new guidelines also identified more children with hypertension than the previous guidelines.

To analyze the effectiveness of the 2017 guidelines in identifying hypertension incidence, the researchers compared the impact of the newer guidelines’ definitions of pediatric hypertension with those from the AAP’s 2004 guidelines. The researchers evaluated the 2 guidelines in their ability to accurately predict adult hypertension, metabolic syndrome, and left ventricular hypertrophy (LVH).

The comparison included 3940 participants aged 3 to 18 years from the Bogalusa Heart Study with a 36-year follow-up since childhood.

When using the definitions from the 2004 guidelines, hypertension was identified in 7% of the participants. When using the definitions from the 2017 guidelines, that percentage increased to 11%.

In all, 329 participants were reclassified to higher BP categories under the 2017 guidelines, and they were more likely than their propensity-score–matched normotensive counterparts to develop hypertension, metabolic syndrome, and LVH in adulthood. 

The proportion of participants identified as having hypertension who developed adult LVH increased from 12% when defined by the 2004 guidelines to 19% when defined by the 2017 guidelines. 

Both guidelines demonstrated similar associations with adulthood hypertension, metabolic syndrome, and LVH. 

There were 38 participants who were reclassified to lower BP categories by the 2017 guidelines, and they had similar cardiometabolic outcomes compared with their propensity-score–matched normotensive counterparts. 

“Children who were reclassified to higher BP categories based on 2017 guidelines were at increased risk of developing hypertension, metabolic syndrome, and LVH in later life,” the researchers concluded. “The 2017 guidelines identified a group of children with adverse metabolic profile and cardiometabolic outcomes, whose cardiovascular risk seemed to be underestimated using the 2004 guidelines.”

—Colleen Murphy

Reference:

Du T, Fernandez C, Barshop R, Chen W, Urbina EM, Bazzano LA. 2017 pediatric hypertension guidelines improve prediction of adult cardiovascular outcomes [published online April 22, 2019]. Hypertension. Accessed April 22, 2019. https://doi.org/10.1161/HYPERTENSIONAHA.118.12469.