Prevalence Implications of the 2017 American Academy of Pediatrics Hypertension Guideline and Associations with Adult Hypertension

Michael Khoury, Philip Khoury, Lydia Bazzano, Trudy L. Burns, Stephen Daniels, Terence Dwyer, Johanna Ikonen, David Jacobs, Markus Juonala, Mika Kähönen, Ronald Prineas, Olli T. Raitakari, Julia Steinberger, Alison Venn, Jorma Viikari, Jessica G. Woo, Alan R Sinaiko, Elaine M. Urbina

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6 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)22-28.e4
JournalJournal of Pediatrics
StatePublished - Feb 2022

Bibliographical note

Funding Information:
We thank the study participants in each of the longitudinal assessments, as their repeated involvement made this work possible. Funded by National Heart, Lung, and Blood Institute (NHLBI), United States R01 HL121230. S.D. is an Associate Editor forThe Journal of Pediatrics. The authors declare no conflicts of interest.

Publisher Copyright:
© 2021 Elsevier Inc.


  • guideline
  • hypertension
  • pediatric
  • sensitivity
  • specificity


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