Prevalence of Hypertension among Children Based on the New American Academy of Pediatrics Clinical Practice Guidelines
-
Simin Darvish Noori Kalaki
,
Fatemeh Darabi
,
Mohammed I M Gubari
,
Mehdi Yaseri
,
Mohammad Esmail Motlagh
,
Ramin Heshmat
,
Mostafa Qorbani
,
Michael E. Jones
,
Saeed Safari
,
Alireza Baratloo
,
Masoud Baikpour
,
Mahmoud Yousefifard
,
Mostafa Hosseini
,
Roya Kelishadi
Abstract
Background: In 2017, the American Academy of Pediatrics (AAP) updated clinical practice guidelines for the diagnosis and management of hypertension in children. The present study aimed to assess the prevalence of hypertension in Iranian children based on the latest guidelines.
Methods: Data on 7301 student participants (3589 boys and 3712 girls) aged between 7-12 yr were assessed. The data were extracted from the fifth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN V) school-based study conducted in the 30 provinces of Iran in 2015. Blood pressure (BP) was classified as normal, elevated BP, and stage 1 and 2 hypertension using weighted analysis and the 2017 AAP guidelines. All analyses were performed in STATA 14.0 statistical software, with findings presented in terms of prevalence.
Results: The overall prevalence of high BP in Iranian children was 14.7%. In addition, 15.1% of boys had high BP, with 9.4% and 1.7% of them with stage 1 and 2 hypertension, respectively. Moreover, 14.3% of girls had high BP, of which 10% had stage 1 and 1.3% with stage 2 hypertension. For elevated hypertension, it was observed in 4% of boys and 3% of girls.
Conclusion: Using the 2017 AAP guidelines demonstrated a higher prevalence of hypertension in children (14.7%) in Iran. The prevalence of hypertension in boys was slightly higher compared to girls.
1. Kelishadi R, Ardalan G, Gheiratmand R, et al (2008). Thinness, overweight and obesity in a national sample of Iranian children and adolescents: CASPIAN Study. Child Care Health Dev, 34:44-54.
2. Kelishadi R, Gouya MM, Ardalan G, et al (2007). First reference curves of waist and hip circumferences in an Asian population of youths: CASPIAN study. J Trop Pediatr, 53:158-164.
3. Muntner P, He J, Cutler JA, Wildman RP, Whelton PK (2004). Trends in blood pressure among children and adolescents. JAMA, 291:2107-2113.
4. Lurbe E, Rodicio JL (2004). Hypertension in children and adolescents. J Hypertens, 22:1423-1425.
5. Sorof J, Daniels S (2002). Obesity hypertension in children: a problem of epidemic proportions. Hypertension, 40:441-447.
6. Flynn JT, Kaelber DC, Baker-Smith CM, et al (2017). Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics, 140:e20171904.
7. Sinha MD, Reid CJ (2007). Evaluation of blood pressure in children. Curr Opin Nephrol Hypertens, 16:577-584.
8. Pediatrics AAo (2004). National high blood pressure education program working group on high blood pressure in children and adolescents. Pediatrics, 114:iv-iv.
9. Brady TM, Feld LG (2009). Pediatric approach to hypertension. Semin Nephrol, 29: 379-388.
10. Falkner B, Daniels SR, Flynn JT, et al (2004). The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics, 114:555-576.
11. Motlagh ME, Ziaodini H, Qorbani M, et al (2017). Methodology and early findings of the fifth survey of childhood and adolescence surveillance and prevention of adult noncommunicable disease: the CASPIAN-V study. Int J Prev Med, 8:4.
12. Kelishadi R, Motlagh ME, Roomizadeh P, et al (2013). First report on path analysis for cardiometabolic components in a nationally representative sample of pediatric population in the Middle East and North Africa (MENA): the CASPIAN-III Study. Ann Nutr Metab, 62:257-265.
13. Organization WH, Organization WH (2006). WHO multicentre growth reference study group: WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva: WHO, 2007.
14. Cole TJ, Green PJ (1992). Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med, 11:1305-1319.
15. Dong Y, Song Y, Zou Z, Ma J, Dong B, Prochaska JJ (2019). Updates to pediatric hypertension guidelines: influence on classification of high blood pressure in children and adolescents. J Hypertens, 37:297-306.
16. Al GK, Swasey K, Sharmeen A, Day B (2019). Estimated Change in Prevalence and Trends of Childhood Blood Pressure Levels in the United States After Application of the 2017 AAP Guideline. Prev Chronic Dis, 16:E12-E12.
17. Hakim A, Bagheri R (2014). Prevalence of hypertension and associated factors in ahvaz school age children in 2013. Int J Community Based Nurs Midwifery, 2:136-41.
18. Patil RR, Garg BS (2014). Prevalence of hypertension and variation in blood pressure among school children in rural area of Wardha. Indian J Public Health, 58:78-83.
19. Sharma AK, Metzger DL, Rodd CJ (2018). Prevalence and severity of high blood pressure among children based on the 2017 American Academy of Pediatrics Guidelines. Jama Pediatr, 172:557-565.
20. Akbari M, Moosazadeh M, Ghahramani S, et al (2017). High prevalence of hypertension among Iranian children and adolescents: a systematic review and meta-analysis. J Hypertens, 35:1155-1163.
21. Hosseini M, Yaseri M, Asady H, et al (2019). Prevalence of high blood pressure in Iranian adults based on the 2017 ACC/AHA guideline. Med J Islam Repub Iran, 33:26.
22. Khoury M, Khoury PR, Dolan LM, Kimball TR, Urbina EM (2018). Clinical implications of the revised AAP pediatric hypertension guidelines. Pediatrics, 142(2):e20180245.
23. Pirojsakul K, Paksi W, Sirijunpen S, Nuntnarumit P (2019). Increased prevalence of hypertensive-level blood pressure using the American Academy of Pediatrics 2017 guidelines: a cross-sectional study in a primary school in Thailand. Paediatr Int Child Health, 39:279-284.
24. Funtikova AN, Navarro E, Bawaked RA, Fíto M, Schröder H (2015). Impact of diet on cardiometabolic health in children and adolescents. Nutr J, 14:118.
25. Kant AK (2010). Dietary patterns: biomarkers and chronic disease risk. Appl Physiol Nutr Metab, 35:199-206.
26. Giontella A, Bonafini S, Tagetti A, et al (2019). Relation between dietary habits, physical activity, and anthropometric and vascular parameters in children attending the primary school in the Verona south district. Nutrients, 11:1070.
27. Assari S, Moghani Lankarani M (2018). Poverty status and childhood asthma in white and black families: National Survey of Children’s Health. Healthcare, 6(2):62.
28. Phelan JC, Link BG, Tehranifar P (2010). Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav, 51:S28-S40.
29. Assari S, Thomas A, Caldwell CH, Mincy RB (2018). Blacks’ diminished health return of family structure and socioeconomic status; 15 years of follow-up of a national urban sample of youth. J Urban Health, 95:21-35.
30. Rahmanian M, Kelishadi R, Qorbani M, et al (2014). Dual burden of body weight among Iranian children and adolescents in 2003 and 2010: the CASPIAN-III study. Arch Med Sci, 10:96-103.
31. Angoorani P, Mostafaei S, Kiani T, et al (2020). Determinants of childhood blood pressure using structure equation model: the CASPIAN–V study. BMC Cardiovasc Disord, 20:1-8.
32. Larkins NG, Teixeira-Pinto A, Craig JC (2018). The prevalence and predictors of hypertension in a National Survey of Australian children. Blood Press, 27:41-47.
33. Rosner B, Cook NR, Daniels S, Falkner B (2013). Childhood blood pressure trends and risk factors for high blood pressure: the NHANES experience 1988–2008. Hypertension, 62:247-254.
34. Yaseri M, Afarideh M, Hosseini M, et al (2017). Zero and Five End-Digit Preference and Blood Pressure Quality of Care Revisited. Arch Iran Med, 20:633-639.
35. Ayodele O, Okunola O, Akintunde A, Sanya E (2012). End digit preference in blood pressure measurement in a hypertension specialty clinic in southwest Nigeria. Cardiovasc J Afr, 23:85-89.
36. Greiver M, Kalia S, Voruganti T, et al (2019). Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study. BMJ Open, 9:e024970.
2. Kelishadi R, Gouya MM, Ardalan G, et al (2007). First reference curves of waist and hip circumferences in an Asian population of youths: CASPIAN study. J Trop Pediatr, 53:158-164.
3. Muntner P, He J, Cutler JA, Wildman RP, Whelton PK (2004). Trends in blood pressure among children and adolescents. JAMA, 291:2107-2113.
4. Lurbe E, Rodicio JL (2004). Hypertension in children and adolescents. J Hypertens, 22:1423-1425.
5. Sorof J, Daniels S (2002). Obesity hypertension in children: a problem of epidemic proportions. Hypertension, 40:441-447.
6. Flynn JT, Kaelber DC, Baker-Smith CM, et al (2017). Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics, 140:e20171904.
7. Sinha MD, Reid CJ (2007). Evaluation of blood pressure in children. Curr Opin Nephrol Hypertens, 16:577-584.
8. Pediatrics AAo (2004). National high blood pressure education program working group on high blood pressure in children and adolescents. Pediatrics, 114:iv-iv.
9. Brady TM, Feld LG (2009). Pediatric approach to hypertension. Semin Nephrol, 29: 379-388.
10. Falkner B, Daniels SR, Flynn JT, et al (2004). The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics, 114:555-576.
11. Motlagh ME, Ziaodini H, Qorbani M, et al (2017). Methodology and early findings of the fifth survey of childhood and adolescence surveillance and prevention of adult noncommunicable disease: the CASPIAN-V study. Int J Prev Med, 8:4.
12. Kelishadi R, Motlagh ME, Roomizadeh P, et al (2013). First report on path analysis for cardiometabolic components in a nationally representative sample of pediatric population in the Middle East and North Africa (MENA): the CASPIAN-III Study. Ann Nutr Metab, 62:257-265.
13. Organization WH, Organization WH (2006). WHO multicentre growth reference study group: WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva: WHO, 2007.
14. Cole TJ, Green PJ (1992). Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med, 11:1305-1319.
15. Dong Y, Song Y, Zou Z, Ma J, Dong B, Prochaska JJ (2019). Updates to pediatric hypertension guidelines: influence on classification of high blood pressure in children and adolescents. J Hypertens, 37:297-306.
16. Al GK, Swasey K, Sharmeen A, Day B (2019). Estimated Change in Prevalence and Trends of Childhood Blood Pressure Levels in the United States After Application of the 2017 AAP Guideline. Prev Chronic Dis, 16:E12-E12.
17. Hakim A, Bagheri R (2014). Prevalence of hypertension and associated factors in ahvaz school age children in 2013. Int J Community Based Nurs Midwifery, 2:136-41.
18. Patil RR, Garg BS (2014). Prevalence of hypertension and variation in blood pressure among school children in rural area of Wardha. Indian J Public Health, 58:78-83.
19. Sharma AK, Metzger DL, Rodd CJ (2018). Prevalence and severity of high blood pressure among children based on the 2017 American Academy of Pediatrics Guidelines. Jama Pediatr, 172:557-565.
20. Akbari M, Moosazadeh M, Ghahramani S, et al (2017). High prevalence of hypertension among Iranian children and adolescents: a systematic review and meta-analysis. J Hypertens, 35:1155-1163.
21. Hosseini M, Yaseri M, Asady H, et al (2019). Prevalence of high blood pressure in Iranian adults based on the 2017 ACC/AHA guideline. Med J Islam Repub Iran, 33:26.
22. Khoury M, Khoury PR, Dolan LM, Kimball TR, Urbina EM (2018). Clinical implications of the revised AAP pediatric hypertension guidelines. Pediatrics, 142(2):e20180245.
23. Pirojsakul K, Paksi W, Sirijunpen S, Nuntnarumit P (2019). Increased prevalence of hypertensive-level blood pressure using the American Academy of Pediatrics 2017 guidelines: a cross-sectional study in a primary school in Thailand. Paediatr Int Child Health, 39:279-284.
24. Funtikova AN, Navarro E, Bawaked RA, Fíto M, Schröder H (2015). Impact of diet on cardiometabolic health in children and adolescents. Nutr J, 14:118.
25. Kant AK (2010). Dietary patterns: biomarkers and chronic disease risk. Appl Physiol Nutr Metab, 35:199-206.
26. Giontella A, Bonafini S, Tagetti A, et al (2019). Relation between dietary habits, physical activity, and anthropometric and vascular parameters in children attending the primary school in the Verona south district. Nutrients, 11:1070.
27. Assari S, Moghani Lankarani M (2018). Poverty status and childhood asthma in white and black families: National Survey of Children’s Health. Healthcare, 6(2):62.
28. Phelan JC, Link BG, Tehranifar P (2010). Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav, 51:S28-S40.
29. Assari S, Thomas A, Caldwell CH, Mincy RB (2018). Blacks’ diminished health return of family structure and socioeconomic status; 15 years of follow-up of a national urban sample of youth. J Urban Health, 95:21-35.
30. Rahmanian M, Kelishadi R, Qorbani M, et al (2014). Dual burden of body weight among Iranian children and adolescents in 2003 and 2010: the CASPIAN-III study. Arch Med Sci, 10:96-103.
31. Angoorani P, Mostafaei S, Kiani T, et al (2020). Determinants of childhood blood pressure using structure equation model: the CASPIAN–V study. BMC Cardiovasc Disord, 20:1-8.
32. Larkins NG, Teixeira-Pinto A, Craig JC (2018). The prevalence and predictors of hypertension in a National Survey of Australian children. Blood Press, 27:41-47.
33. Rosner B, Cook NR, Daniels S, Falkner B (2013). Childhood blood pressure trends and risk factors for high blood pressure: the NHANES experience 1988–2008. Hypertension, 62:247-254.
34. Yaseri M, Afarideh M, Hosseini M, et al (2017). Zero and Five End-Digit Preference and Blood Pressure Quality of Care Revisited. Arch Iran Med, 20:633-639.
35. Ayodele O, Okunola O, Akintunde A, Sanya E (2012). End digit preference in blood pressure measurement in a hypertension specialty clinic in southwest Nigeria. Cardiovasc J Afr, 23:85-89.
36. Greiver M, Kalia S, Voruganti T, et al (2019). Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study. BMJ Open, 9:e024970.
| Files | ||
| Issue | Vol 52 No 1 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v52i1.11679 | |
| Keywords | ||
| Hypertension Children Prevalence Blood pressure Iran | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Darvish Noori Kalaki S, Darabi F, Gubari M, Yaseri M, Motlagh ME, Heshmat R, Qorbani M, Jones M, Safari S, Baratloo A, Baikpour M, Yousefifard M, Hosseini M, Kelishadi R. Prevalence of Hypertension among Children Based on the New American Academy of Pediatrics Clinical Practice Guidelines. Iran J Public Health. 2023;52(1):166-174.
