Michael Khoury1, Philip Khoury2, Lydia Bazzano3, Trudy L Burns4, Stephen Daniels5, Terence Dwyer6, Johanna Ikonen7, David R Jacobs8, Markus Juonala9, Mika Kähönen10, Ronald Prineas11, Olli T Raitakari7, Julia Steinberger8, Alison Venn12, Jorma Viikari9, Jessica G Woo13, Alan Sinaiko8, Elaine M Urbina13. 1. Department of Pediatrics, University of Alberta, Edmonton, Canada. Electronic address: Khoury1@ualberta.ca. 2. Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 3. Tulane University School of Public Health and Tropical Medicine, New Orleans, LA. 4. Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA. 5. University of Colorado School of Medicine, Aurora, CO. 6. Oxford Martin School, Oxford University, Oxford, United Kingdom. 7. Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland. 8. University of Minnesota, Minneapolis, MN. 9. Department of Medicine, Turku University Hospital, University of Turku, Turku, Finland. 10. Department of Clinical Physiology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. 11. Wake Forest University School of Medicine, Winston-Salem, NC. 12. Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia. 13. Cincinnati Children's Hospital Medical Center, Cincinnati, OH; University of Cincinnati College of Medicine, Cincinnati, OH.
Abstract
OBJECTIVE: To evaluate the impact of the 2017 American Academy of Pediatrics hypertension Clinical Practice Guideline (CPG), compared with the previous guideline ("Fourth Report"), on the frequency of hypertensive blood pressure (BP) measurements in childhood and associations with hypertension in adulthood using data from the International Childhood Cardiovascular Cohort Consortium. STUDY DESIGN: Childhood BPs were categorized in normal, prehypertensive/elevated, and hypertensive (stage 1 and 2) ranges using the Fourth Report and the CPG. Participants were contacted in adulthood to assess self-reported hypertension. The associations between childhood hypertensive range BPs and self-reported adult hypertension were evaluated. RESULTS: Data were available for 34 014 youth (10.4 ± 3.1 years, 50.6% female) with 92 751 BP assessments. Compared with the Fourth Report, the CPG increased hypertensive readings from 7.6% to 13.5% and from 1.3% to 2.5% for stage 1 and 2 hypertensive range, respectively (P < .0001). Of 12 761 adults (48.8 ± 7.9 years, 43% male), 3839 (30.1%) had self-reported hypertension. The sensitivity for predicting adult hypertension among those with hypertensive range BPs at any point in childhood, as defined by the Fourth Report and the CPG, respectively, was 13.4% and 22.4% (specificity 92.3% and 85.9%, P < .001), with no significant impact on positive and negative predictive values. Associations with self-reported adult hypertension were similar and weak (c-statistic range 0.61-0.68) for hypertensive range BPs as defined by the Fourth Report and CPG. CONCLUSIONS: The CPG significantly increased the prevalence of childhood BPs in hypertensive ranges and improved the sensitivity, without an overall strengthened association, of predicting self-reported adult hypertension.
OBJECTIVE: To evaluate the impact of the 2017 American Academy of Pediatrics hypertension Clinical Practice Guideline (CPG), compared with the previous guideline ("Fourth Report"), on the frequency of hypertensive blood pressure (BP) measurements in childhood and associations with hypertension in adulthood using data from the International Childhood Cardiovascular Cohort Consortium. STUDY DESIGN: Childhood BPs were categorized in normal, prehypertensive/elevated, and hypertensive (stage 1 and 2) ranges using the Fourth Report and the CPG. Participants were contacted in adulthood to assess self-reported hypertension. The associations between childhood hypertensive range BPs and self-reported adult hypertension were evaluated. RESULTS: Data were available for 34 014 youth (10.4 ± 3.1 years, 50.6% female) with 92 751 BP assessments. Compared with the Fourth Report, the CPG increased hypertensive readings from 7.6% to 13.5% and from 1.3% to 2.5% for stage 1 and 2 hypertensive range, respectively (P < .0001). Of 12 761 adults (48.8 ± 7.9 years, 43% male), 3839 (30.1%) had self-reported hypertension. The sensitivity for predicting adult hypertension among those with hypertensive range BPs at any point in childhood, as defined by the Fourth Report and the CPG, respectively, was 13.4% and 22.4% (specificity 92.3% and 85.9%, P < .001), with no significant impact on positive and negative predictive values. Associations with self-reported adult hypertension were similar and weak (c-statistic range 0.61-0.68) for hypertensive range BPs as defined by the Fourth Report and CPG. CONCLUSIONS: The CPG significantly increased the prevalence of childhood BPs in hypertensive ranges and improved the sensitivity, without an overall strengthened association, of predicting self-reported adult hypertension.
Authors: Nicholas G Larkins; Armando Teixeira-Pinto; Siah Kim; David P Burgner; Jonathan C Craig Journal: Pediatr Nephrol Date: 2019-02-18 Impact factor: 3.714
Authors: Joan C Lo; Alan Sinaiko; Malini Chandra; Matthew F Daley; Louise C Greenspan; Emily D Parker; Elyse O Kharbanda; Karen L Margolis; Kenneth Adams; Ronald Prineas; David Magid; Patrick J O'Connor Journal: Pediatrics Date: 2013-01-28 Impact factor: 7.124
Authors: Karen L McNiece; Timothy S Poffenbarger; Jennifer L Turner; Kathy D Franco; Jonathan M Sorof; Ronald J Portman Journal: J Pediatr Date: 2007-06 Impact factor: 4.406