Abstract
Background: Hypertension is a leading cause of cardiovascular-related morbidity and mortality. Elevated blood pressure (BP) in children is related to long-term adverse health effects. Until recently, few studies have reported the secular trend and associated factors of hypertension phenotypes in Chinese children and adolescents.Methods: From the China Health and Nutrition Survey (CHNS) 1991–2015, a total of 15,143 records of children aged 7–17 years old were included. Following definitions of hypertension from the Chinese Child Blood Pressure References Collaborative Group, we estimated the prevalence of prehypertension, hypertension, stage 1 hypertension, stage 2 hypertension and its phenotypes (ISH, isolated systolic hypertension; IDH, isolated diastolic hypertension; SDH, combined systolic and diastolic hypertension). General estimation equation was used to analyze the trends in the prevalence of hypertension and hypertension phenotypes, and a multivariable logistic regression was constructed to explore the associated factors.Results: During 1991–2015, increasing trends were revealed in BP and hypertension prevalence (P < 0.001) in Chinese children and adolescents. For ISH, IDH and SDH, the age-standardized prevalence increased dramatically from 0.9 to 2.2%, from 6.2 to 14.1%, and from 1.4 to 2.9%, respectively (all P < 0.001). Adolescents aged 13–17 years (OR = 1.76, 95% CI: 1.56–1.97, P < 0.001), general obesity (OR = 2.69, 95% CI: 2.10-3.44, P < 0.001) and central obesity (OR = 1.49, 95% CI: 1.21–1.83, P < 0.001) were positively associated with hypertension, whereas the South region (OR = 0.65, 95% CI: 0.58–0.73, P < 0.001) was a negative factor. Furthermore, body mass index (BMI) and general obesity were linked to the presence of ISH, IDH and SDH. Age, waist circumference (WC) and central obesity were additionally associated with ISH, and sex, age, urban/rural setting, North/South region, WC and central obesity were additionally associated with IDH.Conclusion: BP levels and prevalence of hypertension and phenotypes increased dramatically in Chinese children and adolescents from 1991 to 2015. Regional discrepancy, demographic features, BMI, WC and overweight/obesity status were associated factors of hypertension among youths.
Highlights
Hypertension, or elevated blood pressure (BP), is a highly prevalent chronic disease globally
A total of 18,603 records of children and adolescents were available from CHNS 1991 to 2015, of which 15,143 were with BP measurements
From 1991 to 2015, SBP and DBP values increased significantly from 96.18 mmHg to 101.54 mmHg, and from 62.61 mmHg to 66.65 mmHg, respectively
Summary
Hypertension, or elevated blood pressure (BP), is a highly prevalent chronic disease globally. Hypertension has been recognized as a primary modifiable contributor to cardiovascular and cerebrovascular diseases [1]. It was estimated that the direct costs caused by hypertension reached 210.3 billion Yuan in 2013, accounting for 6.61% of the total Chinese health-care expenditure [5]. Pathophysiologic and epidemiologic evidence has shown an association between childhood hypertension and long-term adverse health effects [7]. Hypertension is a leading cause of cardiovascular-related morbidity and mortality. Elevated blood pressure (BP) in children is related to long-term adverse health effects. Few studies have reported the secular trend and associated factors of hypertension phenotypes in Chinese children and adolescents
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