Prehypertension and hypertension in community-based pediatric practice.
OBJECTIVE
To examine the prevalence of prehypertension and hypertension among children receiving well-child care in community-based practices.


METHODS
Children aged 3 to 17 years with measurements of height, weight, and blood pressure (BP) obtained at an initial (index) well-child visit between July 2007 and December 2009 were included in this retrospective cohort study across 3 large, integrated health care delivery systems. Index BP classification was based on the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents: normal BP, <90th percentile; prehypertension, 90th to 94th percentile; hypertension, 3 BP measurements ≥95th percentile (index and 2 subsequent consecutive visits).


RESULTS
The cohort included 199 513 children (24.3% aged 3-5 years, 34.5% aged 6-11 years, and 41.2% aged 12-17 years) with substantial racial/ethnic diversity (35.9% white, 7.8% black, 17.6% Hispanic, 11.7% Asian/Pacific Islander, and 27.0% other/unknown race). At the index visit, 81.9% of participants were normotensive, 12.7% had prehypertension, and 5.4% had a BP in the hypertension range (≥95th percentile). Of the 10 848 children with an index hypertensive BP level, 3.8% of those with a follow-up BP measurement had confirmed hypertension (estimated 0.3% prevalence). Increasing age and BMI were significantly associated with prehypertension and confirmed hypertension (P < .001 for trend). Among racial/ethnic groups, blacks and Asians had the highest prevalence of hypertension.


CONCLUSIONS
The prevalence of hypertension in this community-based study is lower than previously reported from school-based studies. With the size and diversity of this cohort, these results suggest the prevalence of hypertension in children may actually be lower than previously reported.
Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA. joan.c.lo@kp.org
Joan C
JC
Lo
Alan
A
Sinaiko
Malini
M
Chandra
Matthew F
MF
Daley
Louise C
LC
Greenspan
Emily D
ED
Parker
Elyse O
EO
Kharbanda
Karen L
KL
Margolis
Kenneth
K
Adams
Ronald
R
Prineas
David
D
Magid
Patrick J
PJ
O'Connor
D000293:Adolescent; D000367:Age Factors; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D010808:Physical Examination; D058246:Prehypertension / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D014481:United States