Table 1.
Changes in hypertensive blood pressure prevalence when applying the American Academy of Pediatrics Clinical Practice Guideline Definitions
| Study Location | Study Authors | Study design and Participant Pool |
Population | Overweight and/or Obesity Prevalence | Blood Pressure determination and staging | 4th report Pre-HTN | CPG Elevated BP | 4th report HTN | CPG HTN | Agreement between categories |
|---|---|---|---|---|---|---|---|---|---|---|
| US Studies | Sharma et al, 2018 | Cross-sectional 8 NHANES cycles | 5–18 years NHANES cycles A to H (1999-2014) N= 15,647 |
Obesity: 10% | Auscultation Standardized research measurements Mean of last 2-3 BPs One visit |
9.1 % | 8.7% |
Stage 1: 2.6% Stage 2: 0.06% |
Stage 1: 5.1% Stage 2: 0.4% |
κ = 0.73 (95% CI, 0.71-0.75; P < .001) |
| Al Kibria, et al, 2019 | Cross-sectional 2 groups of NHANES cycles, considered separately |
8 to 17 years NHANES: 2005-2008 cycles N=3,633 2013-2016 cycles N=3,471 |
Overweight/Obesity: 41% (2005-2008) 42% (2013-2016) |
Auscultation Standardized research measurements Mean of first 1-3 BPs One visit |
2005-2008: 10.3% 2013-2016: 7.5% |
2005-2008: 9.5% 2013-2016: 7.1% |
2005-2008: 3.1% 2013-2016: 1.9% |
2005-2008: 5.7% 2013-2016: 3.5% |
||
| Khoury et al, 2018 | Cross-sectional Secondary analysis of data from established research cohort (ref) |
10-18 years N=364 |
Obesity: 47% | Auscultation Standardized research measurements Mean of 3 BPs One visit |
21% | 16% | 8% | 13% | ||
| Condren et al, 2018 | Cross-sectional Electronic health record data |
3-18 years 73% < 13 yrs Well child visits 4 primary care clinics Oklahoma July-December 2017 N=2600 |
Overweight/obesity: 44% | Automated Clinical care measurement One BP One visit |
16.1% | 16.3% | 9.5% | 17.9% | κ = 0.71 (95% CI: 0.69, 0.73). Bowker’s test of symmetry: p<0.0001 |
|
| Bell et al., 2019 | Cross-sectional with repeated measures School-based screening study |
10 to 17 years Majority 11-15 yrs Houston, TX 2000-2017 N= 22,224 |
Overweight/ obesity: 37% |
Automated - ABPM device - Office device If BP normal: one BP, one visit If BP ≥ elevated: mean of 2nd and 3rd BP, 2-3 visits Standardized research measurements Used BPs from up to 3 visits to classify hypertension stage |
Based on mean BP at initial screen: 14.7% |
Based on mean BP at initial screen: 16.3% |
Based on mean BP at initial screen: 7.8% Based on mean BPs at 3 screenings: 2.7% |
Based on mean BP at initial screen: 6.9% Based on mean BPs at 3 screenings: 2.3% |
κ = 0.86 Overall agreement = 93.4% |
|
| Du et al, 2019 | Cross-sectional Bogalusa Heart Study |
3-18 years 1973-2016 N=3940 |
Not reported | Auscultation Standardized research measurements Mean of 6 BPs Highest mean BP from any one study visit |
19% | 17% | 6.5% | 11% | κ = 0.83 (95% CI, 0.82-0.85) | |
| Kharbanda et al, 2019 | Retrospective cohort study Electronic health record data |
10-17 years PCP visits 21 PCP sites in upper Midwest 4/15/14-4/14/16 N= 2025 with pre-HTN/elevated BP at study entry and with 3 subsequent BPs available over 2 years |
Overweight/obesity: 48.9% | Automated Standardized clinical care measurements Mean of 1-2 BPs/visit 60% with only 1 BP per visit 3 visits |
Had pre-HTN at study entry | Had elevated BP at study entry |
Overall: 1.1% Among youth with obesity: 1.9% |
Overall: 5.9% Among youth with obesity: 10.2% |
Not reported | |
| International Studies | Yang, et al, 2019 | Cross-sectional 6 national surveys |
6-17 years 6 countries: China, India, Iran, Korea, Poland, Tunisia N = 47,200 |
Overweight/obesity: 19.9% | Auscultation Standardized research measurements Mean of last 2 BPs One visit |
14.9% | 8.6% | 7% | 16.2% | Not reported |
| Pirojsakul, et al, 2019 | Cross-sectional with repeated measures School-based screening study |
8-13 years Bangkok, Thailand August 2017 to February 2018 N=536 |
Overweight/obesity: 36% | Automated Standardized research measurements Mean of last 2 BPs 2 visits |
Not reported | Not reported | 6.9% | 10.8% | Not reported | |
| Antolini, et al, 2019 | Cross-sectional Patients from an obesity and elevated BP clinic |
4-17 years - 81% < 13 yrs Milan, Italy January 2009 to August 2018 N=951 |
Overweight/obesity: 76% | Automated Standardized measurements Mean of 3 BPs One visit Hypertensive BP for the entire cohort was determined using percentile based thresholds for all, using separate normograms for 4th report and CPG estimates. Reclassification of children 13 years of age and older when using static cutpoints was determined separately |
16% |
Percentile based cutpoints for all ages (N=951): 14.8% Static-cutpoints for ≥13 years only (N=177): 38% |
34.9% |
Percentile based cutpoints for all ages (N=951): 40.9% Static-cutpoints for ≥13 years only (n=177): 33.9% |
Not reported | |
| Dong et al, 2019 | Cross sectional Baseline data from RCT |
6-17 years 7 provinces in China 2013 N = 50,336 |
Overweight/obesity: 22.4% | Auscultation Standardized research measurements Mean of 3 BPs One visit |
Not reported | Not reported |
Children 6-12 years: 10.8% Adolescents 13-17 years: 6.3% |
Children 6-12 years: 16.7% Adolescents 13-17 years: 7.9% |
Abbreviations: BP – blood pressure; HTN – hypertension; NHANES – National Health and Nutrition Examination Study; PCP – primary care provider; RCT – randomized clinical trial