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 That means more kids will be identified as having a higher risk of
developing heart disease in adulthood, researchers point out.
After analyzing data on nearly 4,000 adults who had their blood
pressure recorded in childhood, researchers concluded that the new
guidelines would have done a better job at identifying the kids who
would later, as adults, have hypertension, an enlarged heart and
metabolic syndrome, according to a report in Hypertension.
"When you compare the old versus the new guidelines in this
population, eight percent of the kids would get up-classified as
having hypertension," said study coauthor Dr. Lydia Bazzano, an
associate professor and director of the Center for Lifespan
Epidemiology Research at the Tulane University School of Public
Health and Tropical Medicine. "Those kids were more likely to have
metabolic syndrome, enlarged hearts and hypertension as adults."
The children who would have been added to the ranks of those with
hypertension might also be at a higher risk of having heart attacks,
but it will be years before that data can be collected since most of
the people in those in the study are now in their mid-30s to
mid-50s, Bazzano said.
Unlike adults for whom there are specific blood pressure thresholds
for a diagnosis of hypertension, cutoffs for high blood pressure in
children depend on their age, sex and height, Bazzano explained.
The old guidelines were drawn up based on data from all children,
including those who were overweight and obese, which led to a higher
cut-point than the new charts which exclude information on
overweight and obese children. Although it's only a degree or two
difference, eight percent more kids would end up with a diagnosis of
hypertension under the new guidelines, Bazzano said.
The data for the new report came from the Bogalusa Heart Study, a
long-term series of studies that began in 1973. Between 1973 and
2016, there were nine cross-sectional surveys of children between
three and 18 years old and 11 surveys of adults who had been
previously examined as children.
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The 3,940 people in the new study were examined as children and were
followed for 36 years. When the researchers compared how the old and
new guidelines would have played out in this population, they found
that the newer ones would have caught a much larger number of
children who would eventually develop left ventricular hypertrophy.
"That condition develops when the left ventricle enlarges because it
is fighting against a higher pressure than it should be," Bazzano
said. "Just as weight lifter's muscles get bigger, the heart gets
bigger and that makes it more vulnerable to not getting enough
oxygen."
The changes also identified would have identified more children who
would eventually develop metabolic syndrome and hypertension in
adulthood.
The new study is assessing "how good this guideline change was at
helping identify the kids who were truly at risk," said Dr. Tammy
Brady, an associate professor of pediatrics and medical director of
the Pediatric Hypertension Program at Johns Hopkins University.
"It's fascinating. It showed that when kids were reclassified as
hypertensive according to the new guidelines they did in fact seem
to have more cardiovascular risk factors. So it does seem to do a
better job of identifying those who are at risk of developing long
term complications."
By having a lower threshold for hypertension in children, the new
guidelines may give pediatricians more ammunition when they try to
convince parents to get their kids to make lifestyle changes that
would result in lower blood pressure, Brady said. Sometimes parents
are resistant when the physician says, "we need to minimize weight
gain," she added. "They'll sometimes respond: 'He looks fine to me.
He looks like me.'"
But with an actual diagnosis of hypertension, "an alarm bell can go
off," Brady said. "And I can say we really, really need to work on
this."
SOURCE: http://bit.ly/2viYCyu Hypertension, online April 22, 2019.
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