Trends in Blood Pressure and Hypertension Among US Children and Adolescents, 1999-2018

Shakia T Hardy,Daniel I Feig,Elaine M Urbina,Swati Sakhuja,Shakira F Suglia,Paul Muntner,Byron C Jaeger

doi:10.1001/jamanetworkopen.2021.3917

Abstract

Higher blood pressure (BP) levels in children are associated with an increased risk for hypertension and subclinical cardiovascular disease in adulthood. Identifying trends in BP could inform the need for interventions to lower BP. To determine whether systolic BP (SBP) and diastolic BP (DBP) levels among US children have changed during the past 20 years. This serial cross-sectional analysis of National Health and Nutrition Examination Survey data included 9117 children aged 8 to 12 years and 10 156 adolescents aged 13 to 17 years, weighted to the US population from 1999-2002 to 2015-2018. Data were collected from March 1999 to December 2018 and analyzed from March 26, 2020, to February 2, 2021. Calendar year. The primary outcomes were mean SBP and mean DBP. A total of 19 273 participants were included in the analysis. Among children aged 8 to 12 years in 2015-2018 (mean age, 10.5 [95% CI, 10.5-10.6] years), 48.7% (95% CI, 45.2%-52.2%) were girls and 51.3% (95% CI, 47.8%-54.8%) were boys; 49.7% (95% CI, 42.2%-57.1%) were non-Hispanic White; 13.7% (95% CI, 10.3%-18.1%) were non-Hispanic Black; 25.5% (95% CI, 19.9%-32.0%) were Hispanic; 4.7% (95% CI, 3.2%-6.7%) were non-Hispanic Asian; and 6.5% (95% CI, 4.9%-8.5%) were other non-Hispanic race/ethnicity. Among those aged 13 to 17 years in 2015-2018 (mean age, 15.5 [95% CI, 15.5-15.5] years), 49.1% (95% CI, 46.1%-52.2%) were girls and 50.9% (95% CI, 47.8%-53.9%) were boys; 53.3% (95% CI, 46.4%-60.1%) were non-Hispanic White; 13.9% (95% CI, 10.3%-18.7%) were non-Hispanic Black; 21.9% (95% CI, 16.6%-28.2%) were Hispanic; 4.6% (95% CI, 3.2%-6.5%) were non-Hispanic Asian; and 6.3% (95% CI, 4.7%-8.5%) were other non-Hispanic race/ethnicity. Among children aged 8 to 12 years, age-adjusted mean SBP decreased from 102.4 (95% CI, 101.7-103.1) mm Hg in 1999-2002 to 101.5 (95% CI, 100.8-102.2) mm Hg in 2011-2014 and then increased to 102.5 (95% CI, 101.9-103.2) mm Hg in 2015-2018. Age-adjusted mean DBP decreased from 57.2 (95% CI, 56.5-58.0) mm Hg in 1999-2002 to 51.9 (95% CI, 50.1-53.7) mm Hg in 2011-2014 and increased to 53.2 (95% CI, 52.2-54.1) mm Hg in 2015-2018. Among adolescents aged 13 to 17 years, age-adjusted mean SBP decreased from 109.2 (95% CI, 108.7-109.7) mm Hg in 1999-2002 to 108.4 (95% CI, 107.8-109.1) mm Hg in 2011-2014 and remained unchanged in 2015-2018 (108.4 [95% CI, 107.8-109.1] mm Hg). Mean DBP decreased from 62.6 (95% CI, 61.7-63.5) mm Hg in 1999-2002 to 59.6 (95% CI, 58.2-60.9) mm Hg in 2011-2014 and then increased to 60.8 (95% CI, 59.8-61.7) mm Hg in 2015-2018. Among children aged 8 to 12 years, mean SBP was 3.2 (95% CI, 1.7-4.6) mm Hg higher among those with overweight and 6.8 (95% CI, 5.6-8.1) mm Hg higher among those with obesity compared with normal weight; mean DBP was 3.2 (95% CI, 0.7-5.6) mm Hg higher among those with overweight and 3.5 (95% CI, 1.9- 5.1) mm Hg higher among those with obesity compared with normal weight. Among adolescents aged 13 to 17 years, mean SBP was 3.5 (95% CI 1.9-5.1) mm Hg higher among those with overweight and 6.6 (95% CI, 5.2-8.0) mm Hg higher among those with obesity compared with normal weight, 4.8 (95% CI, 3.8-5.8) mm Hg higher among boys compared with girls, and 3.0 (95% CI, 1.7-4.3) mm Hg higher among non-Hispanic Black compared with non-Hispanic White participants. Despite an overall decline in mean SBP and DBP from 1999-2002 to 2015-2018, BP levels among children and adolescents may have increased from 2011-2014 to 2015-2018.

Highlights

Among children aged 8 to 12 years, mean systolic BP (SBP) was 3.2 mm Hg higher among those with overweight and 6.8 mm Hg higher among those with obesity compared with normal weight; mean diastolic BP (DBP) was 3.2 mm Hg higher
Key Points Question Have systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels among US children changed during the past 20 years? Findings In this serial cross-sectional study of 19 273 children and adolescents included in the National Health and Nutrition Examination Survey (NHANES), age-adjusted mean SBP was lower in the 2015-2018 cycle compared with the 1999-2002 cycle among adolescents aged 13 to 17 years, and mean DBP was lower in the 2015-2018 cycle compared with the 1999-2002 cycle among children aged 8 to and adolescents aged to 17 years. Meaning These representative findings suggest that from 1999-2002 to 20152018, mean SBP decreased among adolescents aged 13 to 17 years and mean DBP decreased among children and adolescents aged 8 to 12 and 13 to 17 years, respectively, in the US
Among adolescents aged 13 to 17 years, mean SBP was 3.5 mm Hg higher among those with overweight and 6.6 mm Hg higher among those with obesity compared with normal weight, 4.8 mm Hg higher among boys compared with girls, and 3.0 mm Hg higher among non-Hispanic Black compared with non-Hispanic White participants

Summary

Introduction

Hypertension is one of the most important modifiable risk factors for morbidity and mortality due to cardiovascular disease (CVD).[1,2] Longitudinal studies have shown that higher blood pressure (BP) levels in childhood are associated with an early onset of hypertension in adulthood.[3,4] epidemiologic and pathophysiologic studies[5,6,7] suggest that hypertension in childhood is associated with subclinical atherosclerosis, target organ damage, and increased CVD risk in adulthood, emphasizing the importance of identifying and preventing increases in BP levels and hypertension in childhood.Studies have shown that the proportion of US children and adolescents with elevated BP and hypertension may have decreased from 2005-2008 to 2013-2016.8-10 a study among US adults reported that systolic BP (SBP) and diastolic BP (DBP) increased from 2013-2014 to 2017-2018.11 Whether the trend of increasing SBP and DBP among adults extends to children and adolescents remains unknown. Estimating 20-year trends in the distribution of SBP and DBP and the prevalence of elevated BP and hypertension with the 2017 American Academy of Pediatrics Clinical Practice Guideline definitions[12] could identify differences in BP among subpopulations and inform the need for evidence-based interventions to prevent increases in BP among children who are at increased risk for hypertension. We analyzed data from 10 cycles of the US National Health and Nutrition Examination Survey (NHANES) to determine whether reported decreases in the prevalence of elevated BP and hypertension from 2005-2008 to 2013-2016 among US children and adolescents have continued through 2017-2018 and whether these changes reflect shifts in the entire distributions of SBP and DBP. We determined whether mean SBP and DBP and elevated BP and hypertension prevalence were different in 2015-2018 between groups defined by demographic and socioeconomic factors and body mass index (BMI)

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Discussion

Conclusion