Difference in hypertension prevalence applying three childhood hypertension management guidelines in a national cohort study

The European Society of Hypertension (ESH) and American Academy of Pediatrics (AAP) recently updated their childhood hypertension management guidelines. We aimed to compare the hypertension prevalence determined using the two aforementioned guidelines and Fourth Report in a national cohort study. This 4.6-year follow-up study included 4276 children who had participated in the China Health and Nutrition Study. At baseline and during a follow-up survey, hypertension was defined using the three guidelines. We calculated the pediatric hypertension prevalence in at least one survey and in both surveys as the number of participants identified as hypertensive in at least one survey or in both surveys divided by 4276, respectively. Using Mc Nemar's test, we determined that the prevalence of pediatric hypertension differed significantly according to AAP vs. ESH guidelines and Fourth Report at the baseline (8.3% vs. 5.0% and 5.0%, respectively; reference, AAP; P-s < 0.001 for AAP vs. ESH guidelines and Fourth Report) and follow-up surveys (14.5% vs. 5.0% and 6.0%, respectively; reference, AAP; both P-s < 0.001), as well as among those detected with hypertension in at least one survey (21.0% vs. 9.4% and 10.4%, respectively; reference, AAP; both P-s < 0.001) and both surveys (1.8% vs. 0.5% and 0.6%, respectively; reference, AAP; both P-s < 0.001). We obtained similar results when using the three guidelines to define childhood elevated blood pressure. Our findings confirm the higher prevalence of pediatric hypertension using AAP guideline than those using ESH guideline and Fourth Report. Consequently, childhood hypertension management guidelines should be selected and used with caution.