New blood pressure guidelines identify more kids at high risk of heart disease later

New stricter blood pressure guidelines identify more kids at high risk of heart disease later.

The updated 2017 guidelines from the American Academy of Pediatrics not only increased the number of children considered to have high blood pressure, but it also helped predict children who were at higher risk for premature heart disease.

Children reclassified as having elevated blood pressure under the 2017 guidelines issued by the American Academy of Pediatrics (AAP) are more likely to develop heart disease when they reach adulthood, according to a new study published in the Hypertension: Journal of the American Heart Association. Such children are at higher risk of developing high blood pressure (BP), thickening of the heart muscle and other conditions that increase the risk of heart disease in their adulthood compared to children with normal BP.

Compared with the 2004 guidelines from the AAP, the 2017 guidelines increased the number of children classified as being in higher BP categories, but it was not clear if the new criteria effectively identified children who were at higher risk of premature heart disease.

The study conducted by Lydia A. Bazzano, associate professor of epidemiology at the Tulane School of Public Health and Tropical Medicine in New Orleans. and colleagues to evaluate the consequences of the 2017 pediatric hypertension definitions, compared with the 2004 pediatric hypertension definitions on the prevalence of hypertension and to assess the performance of these 2 sets of guidelines in predicting adult hypertension, metabolic syndrome, and left ventricular hypertrophy (LVH).

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The Bogalusa Heart Study consisted of 3,940 children (47 percent male, ages 3-18 years and 35 percent African-American) who were followed up to their adulthood for 36 years. The study revealed that:

• Hypertension was identified in 7% and 11% as defined in the 2004 and 2017 guidelines, respectively.


• The 2004 and 2017 guidelines demonstrated similar associations with adulthood hypertension, metabolic syndrome, and LVH.


• The proportion of children 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.


• Overall, the 329 (8%) children who were reclassified to higher blood pressure categories by the 2017 guidelines were more likely than their propensity score–matched normotensive counterparts to develop hypertension, metabolic syndrome, and LVH in later life, whereas 38 (1%) children who were reclassified to lower blood pressure categories by the 2017 guidelines had similar cardiometabolic outcomes to their propensity score–matched normotensive counterparts.


• Children who were reclassified to higher blood pressure categories based on 2017 guidelines were at increased risk of developing hypertension, metabolic syndrome, and LVH in later life.


• 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.

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"After reviewing years of information from the Bogalusa Heart Study, we concluded that compared with children with normal blood pressure, those reclassified as having elevated or high blood pressure were more likely to develop adult high blood pressure, thickening of the heart muscle wall and the metabolic syndrome - all risk factors for heart disease," said Bazzano.

"For most children with high blood pressure that is not caused by a separate medical condition or a medication, lifestyle changes are the cornerstone of treatment. It's important to maintain a normal weight, avoid excess salt, get regular physical activity and eat a healthy diet that is high in fruit, vegetables, legumes, nuts, whole grains, lean protein and limited in salt, added sugars, saturated - and trans- fats to reduce blood pressure," said Bazzano.

Bazzano stressed that lifestyle changes can improve the health of the entire family as well as the child who has been found to have high blood pressure.

For detailed guidelines log on to https://doi.org/10.1161/HYPERTENSIONAHA.118.12469