Progress Turns to Regress for Child Hypertension — Obesity Suspected as Main Driver

Like their adult counterparts, U.S. children and adolescents had favorable blood pressure (BP) trends stalled or even reversed in the last decade, according to a large National Health and Nutrition Examination Survey (NHANES) analysis.

Children, ages 8 to 12 years, had age-adjusted mean BP fall from 102.4/57.2 mm Hg in 1999-2002 to 101.5/51.9 mm Hg in 2011-2014, and then increase to 102.5/53.2 mm Hg in 2015-2018. Prevalence of hypertension virtually stayed flat from 5.2% in 1999-2002 to 4.6% in 2015-2018.

Adolescents, ages 13 to 17 years, had mean BP decrease from 109.2/62.6 mm Hg in 1999-2002 to 108.4/59.6 mm Hg in 2011-2014, then change little to 108.4/60.8 mm Hg in 2015-2018, reported Shakia Hardy, PhD, of the University of Alabama at Birmingham, and colleagues.

However, teenagers had hypertension prevalence drop significantly from 6.6% in 1999-2002 to to 3.7% in 2015-2018, they stated in JAMA Network Open.

Nevertheless, stable or increased BP levels and hypertension prevalence from 2011-2014 to 2015-2018 could indicate a reversal of the previous trends of declining BP in younger patients — similar to what has been observed in adults, Hardy and colleagues said.

“As the prevalence of obesity in the U.S. continues to rise among children and adolescents, obesity-related increases in BP could further increase the prevalence of primary or obesity-related hypertension. Awareness of the effect of obesity on BP among children and effective interventions are needed to reduce the preventable development of hypertension among those aged 8 to 12 years,” according to Hardy’s group.

Obesity is likely the primary driver of the BP trends in youth, commented Joseph Flynn, MD, of Seattle Children’s Hospital and University of Washington. He suggested that prevention efforts be focused on physical activity in particular, especially under current circumstances.

“Over the last year, with the coronavirus pandemic, because of decreased physical activity and more eating at home, we’ve seen children gaining weight at a much faster rate. I’ve had [patients], whose BP were borderline, gain 10 pounds and pop right into the hypertension category. These were 10-, 12-, 13-year-old children,” he said in an interview.

“This is showing the importance of trying to focus on healthy lifestyles and getting kids active again, and addressing the issues of overweight and sedentary lifestyle,” Flynn added. NHANES participants included in the study were 9,117 children and 10,156 adolescents.

Study authors reported higher mean systolic BPs and greater prevalence of hypertension in pediatric patients with overweight or obesity, boys, or Black race. Thus, the report highlights racial disparities and social determinants of health in youth, Flynn noted.

Hardy and colleagues cautioned that the study was limited by the analysis of BP measurements taken at a single visit instead of the average from two or more visits. Additionally, the authors had no data on antihypertensive use on such young patients, and the response rate for NHANES has declined over the years.