Prevalence and long-term trends of arterial hypertension in adolescents aged 14-18 years in Novosibirsk (1989-2019) according to the new international guidelines for management of high blood pressure in adolescence

Abstract

The high prevalence of arterial hypertension (AH) among the adult population of many countries of the civilized world, incl. Russia (about 40% among people of working age) indicates the need for early detection and prevention of this disease. Assessment of blood pressure (BP) levels in adolescence presents certain methodological difficulties. To date, 3 guidelines based on the results of large population studies of children and adolescents have been developed in the world pediatric practice. However, the application of these guidelines is still not consistent, especially regarding the assessment of BP levels in adolescence.Objective. To study the prevalence and trends of elevated BP levels, including AH, among adolescents aged 14–18 years in Novosibirsk using the main international definitions.Design and methods. In one of the districts of Novosibirsk, cross-sectional population surveys of random representative samples of schoolchildren aged 14–18 years of both sexes were carried out with an interval of 5 years. Seven screenings were carried out from 1989 to 2019, 4579 adolescents were examined. The study program for adolescents was the same for all screenings and included standard questionnaire, measurement of BP by auscultatory method, anthropometry (height, body weight, chest circumference, waist and hips), the study of nutrition by the 24-h dietary recall method, collection of family history by postal parental interviews, biochemical blood tests. BP was measured twice with an interval of 2–3 minutes (before and after filling out the questionnaire), in a sitting position, on the right arm, with an aneroid sphygmomanometer. Systolic BP was recorded with the appearance of the first Korotkoff tone (I phase), diastolic BP — with the disappearance of the tones (V phase). The average of two measurements was included in the analysis. The prevalence of elevated BP levels was assessed using international criteria. To date, several guidelines have been proposed for the diagnosis of elevated BP and AH in adolescence, using both the percentile method (4th report of NHBPEP 2004) and the methods of fixed (AAP 2017) and mixed criteria (ESH 2016 / Russian recommendations 2020). Statistical analysis was performed using the SPSS package for Windows 13,5.Results. The frequency of prehypertension according to the criteria of the 4th report was 40,3% among boys and 26,4% among girls (P < 0,05), the frequency of elevated BP according to the AAP 2017 criteria was 20,4 % and 12,5% in boys and girls, respectively (P < 0,05), the prevalence of high normal BP was 24,6% and 13,5% (P < 0,05) according to the ESH 2016 criteria. The frequency of AH syndrome according to the AAP 2017 criteria was significantly higher when using 4th report definitions and ESH 2016. According to the criteria of 3 different guidelines, there were a fluctual trends of AH in adolescents in Novosibirsk over a 30-year period, without a pronounced trend to decrease or increase. The prevalence of AH according to the AAP 2017 criteria was 2–3 times higher than when using percentiles (4th report) or mixed (percentiles + fixed cut-off points) European criteria (ESH 2016) during all the period.Conclusions. Long-term population studies of adolescents aged 14–18 in Novosibirsk made it possible to study the frequency and trends of elevated levels of BP and AH syndrome in adolescence and to conduct a comparative study of a number of international and domestic criteria.