Prehypertension and Hypertension in Community-Based Pediatric Practice

Prevalence of hypertension in children increased significantly over the past few decades, tracks into adulthood, and is a major risk factor for cardiovascular disease.However, current prevalence estimates in children have largely been based on studies conducted in school environments. WHAT THIS STUDY ADDS:The current study reports the prevalence of childhood hypertension in community pediatric practice, which provides a typical pediatric examination environment, unlike blood pressure measured in school.The results show a significantly lower prevalence than what has previously been reported.abstract OBJECTIVE: To examine the prevalence of prehypertension and hypertension among children receiving well-child care in community-based practices.METHODS: Children aged 3 to 17 years with measurements of height, weight, and blood pressure (BP) obtained at an initial (index) well-child visit between July 2007 and December 2009 were included in this retrospective cohort study across 3 large, integrated health care delivery systems.Index BP classification was based on the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents: normal BP, ,90th percentile; prehypertension, 90th to 94th percentile; hypertension, 3 BP measurements $95th percentile (index and 2 subsequent consecutive visits). RESULTS:The cohort included 199 513 children (24.3% aged 3-5 years, 34.5% aged 6-11 years, and 41.2% aged 12-17 years) with substantial racial/ethnic diversity (35.9% white, 7.8% black, 17.6% Hispanic, 11.7% Asian/Pacific Islander, and 27.0% other/unknown race).At the index visit, 81.9% of participants were normotensive, 12.7% had prehypertension, and 5.4% had a BP in the hypertension range ($95th percentile).Of the 10 848 children with an index hypertensive BP level, 3.8% of those with a follow-up BP measurement had confirmed hypertension (estimated 0.3% prevalence).Increasing age and BMI were significantly associated with prehypertension and confirmed hypertension (P , .001 for trend).Among racial/ethnic groups, blacks and Asians had the highest prevalence of hypertension. CONCLUSIONS:The prevalence of hypertension in this communitybased study is lower than previously reported from school-based studies.With the size and diversity of this cohort, these results suggest the prevalence of hypertension in children may actually be lower than previously reported.