Hypertension in Adolescents

 Blood pressure problems were found in nearly 20% of students in one school system.

New guidelines for classifying hypertension in children are based on normative tables but parallel those in adults. Hypertension is now classified into one of two stages based on severity, and a new prehypertension category has been created. To determine prevalence, a cross-sectional sample of 6790 children aged 11 to 17 in one large school system had blood pressure (BP) measured. Measurement was repeated on two subsequent occasions if the mean of three baseline readings was elevated.

For all or most measurements, prehypertension was defined as mean systolic BP (SBP) or diastolic BP (DBP) 90th percentile; stage 1 hypertension was defined as mean SBP or DBP 95th percentile; and stage 2 was defined as >99th percentile +5 mm Hg. At the initial screening, 81.1% of the students were normotensive, 9.5% were prehypertensive, 8.4% had stage 1 hypertension, and 1% had stage 2 hypertension. After three screenings (completed by 64%), the prevalence of normotensive children remained unchanged, while prehypertension rose to 15.7% and hypertension fell to 3.2%. Sex, overweight, and race and ethnicity were risk factors for prehypertension; overweight was the only risk factor for hypertension.

Comment: As the authors note, results and implications are limited by the dropout rate, a somewhat arbitrary classification of hypertension (e.g., BP measurements fluctuating between categories), and the need for more study of the consequences of prehypertension. Nevertheless, the findings in this large sample alert us that as many as 20% of adolescents may have blood pressure problems that require careful monitoring and possible intervention to reduce their future risk for cardiovascular disease.

— Robert A. Dershewitz, MD, MSc

Published in Journal Watch General Medicine June 26, 2007

Citation(s):

McNiece KL et al. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 2007 Jun; 150:640-4.