Childhood elevated blood pressure (BP) is a public health problem worldwide. Subclinical cardiovascular disease (CVD) may already be present in children with elevated BP. Children with elevated BP were likely to have hypertension as adults, and childhood elevated BP was associated with increased risk of early onset subclinical CVD in adulthood. Therefore, accurate early identification of children with elevated BP is the central aspect in the primordial prevention of CVD. In adults, the definition of hypertension is based mainly on the association of BP levels with adverse cardiovascular outcomes. However, there is no evidence relating childhood BP levels to cardiovascular outcomes. Given that the upper limits of BP ranges in children were not ideal, the BP percentiles, rather than absolute levels, were used to define childhood elevated BP. As a result, the definition of childhood elevated BP was based on the BP distribution and, to some extent, arbitrary.
We aimed to compare the ability of the pediatric BP standards issued by the US Fourth Report, the recently proposed US, Chinese, and international standards to predict adult hypertension and subclinical cardiovascular disease (CVD).
2296 children were randomly selected from Beijing at baseline. The follow-up survey was conducted among 1177 adults. Subclinical adult CVD was assessed using the carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (CIMT), and left ventricular mass index (LVMI).
The prevalence of pediatric elevated BP was significantly higher according to the Chinese standards vs the Fourth Report, the updated US standards, and the international standards (18.7% vs 14.2%, 17.5%, and 18.0%, respectively; all Ps < .001). Children identified as elevated BP using any of the 4 standards were more likely to have adult hypertension, high cfPWV, and high LVMI than children without elevated BP. However, only the Chinese and updated US standards can predict the increased risk of adult high CIMT.
Our results indicated that the Chinese standards performed equally or better compared with 3 other standards in predicting adult hypertension and subclinical CVD.
Capital Institute of Pediatrics, Beijing, China