Source:

Song
P
,
Zhang
Y
,
Yu
J
, et al
.
Global prevalence of hypertension in children: a systematic review and meta-analysis
.
JAMA Pediatr.
2019
;
173
(
12
):
1154
1163
; doi:
https://doi.org/10.1001/jamapediatrics.2019.3310

Investigators from multiple institutions conducted a meta-analysis to determine estimates of the global prevalence of hypertension in children. The authors identified published studies that provided numerical prevalence estimates of hypertension, prehypertension, and stage 1 or stage 2 hypertension in children <19 years old. Only studies that defined hypertension using distribution curves of systolic and diastolic blood pressure (SBP and DBP, respectively) based on age, height, and sex with predefined percentile thresholds were included in the meta-analysis. Prehypertension was defined as SBP and/or DBP ≥90th percentile and <95th percentile; hypertension as SBP and/or DBP ≥95th percentile; stage 1 hypertension as SBP and/or DBP ≥95th percentile and ≤99th percentile plus 5 mm Hg; and stage 2 hypertension as SBP and/or DBP >99th percentile plus 5 mm Hg. Additional information abstracted from selected studies included sex and BMI status of the participants; urban or rural setting; World Health Organization–defined world region; and World Bank–defined high-, medium-, or low-income countries. The type of sphygmomanometer used in the study, including mercury, oscillometric (automated digital), or aneroid (watch face), was noted. Random effects meta-analysis was used to calculate the prevalence of hypertension, prehypertension, and stage 1 and stage 2 hypertension. Multivariate meta-regression was used to estimate the prevalence of hypertension at different ages and over time (between 2000 and 2015).

Data from 47 articles were used for the meta-analysis. All of these included prevalence data on hypertension, 16 had prevalence data on prehypertension, and 6 had data on stage 1 and stage 2 hypertension. The pooled prevalence of hypertension was 4.00% (95% CI, 3.29%–4.78%). Prevalence estimates varied by type of sphygmomanometer used: 4.59% for mercury, 2.94% for oscillometric, and 7.23% for aneroid. There was no significant difference in prevalence associated with sex, urban or rural setting, global region, or country income status. However, the prevalence in obese and overweight children (15.27%; 95% CI, 7.31%–25.38% and 4.99%; 95% CI, 2.18%–8.81%, respectively) was substantially higher than in those with normal weight (1.90%; 95% CI, 1.06%–2.97%). Using multivariate meta-regression, the estimated prevalence of hypertension rose from 4.32% at 6 years of age to 7.89% at 14 years of age, before falling to 3.28% at 19 years of age. There was a significant increase in estimated prevalence between 2000 and 2015. Global prevalence estimates for prehypertension and stage 1 and stage 2 hypertension were 9.67% (95% CI, 7.26%–12.38%), 4.00% (95% CI, 2.10%–6.48%), and 0.95% (95% CI, 0.48%–1.57%), respectively.

The authors conclude that there is a positive secular trend in the global prevalence of hypertension in children, and the prevalence is increased among obese children.

Dr Sanchez-Kazi has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

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