Impact of the 2017 American Academy of pediatrics guideline on hypertension prevalence compared with the fourth report in an international cohort

Liu Yang, Roya Kelishadi, Young Mi Hong, Anuradha Khadilkar, Tadeusz Nawarycz, Małgorzata Krzywińska-Wiewiorowska, Hajer Aounallah-Skhiri, Mohammad Esmaeil Motlagh, Hae Soon Kim, Vaman Khadilkar, Alicja Krzyzaniak, Habiba Ben Romdhane, Ramin Heshmat, Shashi Chiplonkar, Barbara Stawińska-Witoszyńska, Jalila El Ati, Mostafa Qorbani, Neha Kajale, Pierre Traissac, Lidia Ostrowska-NawaryczGelayol Ardalan, Veena Ekbote, Min Zhao, Emerald G. Heiland, Yajun Liang, Bo Xi

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk.

Original languageEnglish
Pages (from-to)1343-1348
Number of pages6
Issue number6
StatePublished - 1 Dec 2019

Bibliographical note

Funding Information:
This work was supported by the National Natural Science Foundation of China (81673195) and the collaboration grant between Shandong University and Karolinska Institutet (SDU-KI-2019-7).

Publisher Copyright:
© 2019 American Heart Association, Inc.


  • Blood pressure
  • Child
  • Hypertension
  • Pediatrics


Dive into the research topics of 'Impact of the 2017 American Academy of pediatrics guideline on hypertension prevalence compared with the fourth report in an international cohort'. Together they form a unique fingerprint.

Cite this