New pediatric BP guidelines ‘justifiable,’ analysis finds

The American Academy of Pediatrics’ (AAP) updated blood pressure guidelines classify more kids in higher BP categories and can more accurately predict which children are prone to heart disease later in life, an extensive analysis of the Bogalusa Heart Study has found.

Senior author Lydia A. Bazzano, MD, PhD, and colleagues scrutinized 36 years of patient data for their review, which was published in Hypertension April 22. The team pulled stats from the Bogalusa Heart Study—an ongoing effort that’s tracked the cardiovascular health of kids in a small Louisiana town from childhood through the present—to assess the efficacy of the AAP’s and American Heart Association’s 2017 pediatric BP guideline update.

The 2017 publish was the AAP’s first update on the subject since 2004, Bazzano et al. said.

“Studies linking BP levels in childhood with heightened risk for subsequent adverse cardiovascular outcomes are required to better appraise the value of these new BP thresholds,” the authors wrote. “Furthermore, before these new BP thresholds are adopted as the basis for identifying children at high risk of CVD, it is necessary to answer the following questions: Do the additional children whose BP levels were reclassified upward indeed have adverse cardiometabolic outcomes? What are the cardiometabolic outcomes of the children whose BP is newly assigned to a lower level by the 2017 AAP guidelines?”

The team looked at test results from 3,940 children aged 3-18 who were enrolled in the Bogalusa study, stacking their 2004 prognoses against those outlined by the 2017 guideline update. They found more kids were classified as having high BP under the new guidelines—11% compared to 7% in 2004—though not all children identified with high BP under the new guidelines will require medication for the condition.

Of those classified with high BP per the 2017 recommendations, Bazzano et al. reported 19% developed left ventricular hypertrophy (LVH). That figure would be 12% under 2004 guidelines.

“Children reclassified to more advanced levels of abnormal BP based on the 2017 guidelines had more unfavorable CVD risk characteristics and experienced higher risks for adult hypertension, metabolic syndrome and LVH compared with their propensity score-matched normotensive children,” the authors wrote. “Our results also show that those children reclassified to lower levels have similar anthropometric and biochemical characteristics and cardiometabolic outcomes to normotensive children.”

The researchers said lifestyle changes are key for kids classified with high BP, and unless hypertension is caused by a medical condition or medication the child is taking, the imbalance can be mediated with weight maintenance, regular physical activity and a healthy diet.

“Implementing the 2017 guidelines would identify a group of children who were reclassified upward with newly diagnosed elevated BP or a worsening stage of hypertension with adverse metabolic profile and increased risks of progression to adult hypertension, metabolic syndrome and LVH,” they wrote. “[Our] findings have important health implications and support that the new BP thresholds are justifiable.”