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The population-based prevalence of hypertension and correlates of blood pressure among Australian children

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Abstract

Objective

Hypertension is increasingly recognized as a disease spanning the entire life course. Continued efforts to refine the diagnosis and management of hypertension in children are highlighted by the recent American Academy of Pediatrics (AAP) guidelines, which include lower threshold values than the previous reference standard (Fourth Report). We aimed to determine the population-based prevalence of children exceeding thresholds for hypertension using these two guidelines. We also sought to identify the correlates of blood pressure (BP) among Australian children.

Methods

Cross-sectional data from the Growing Up in Australia: Longitudinal Survey of Australian Children were analyzed. Blood pressure was measured in 7139 Australian children aged 10–12 years and sampled using population-based methodology. The association between BP and explanatory variables linked to BP in other populations was examined using multiple linear regression with fractional polynomial terms for continuous, non-linear relationships.

Results

The threshold for hypertension was exceeded in 3.1% and 5.4%, and prehypertension in 3.0% and 3.7% of children, using the Fourth Report and AAP guidelines respectively. Children at the threshold for obesity had a 9.1 mmHg higher adjusted BP than those on the 50th centile for body mass index (BMI) (95% CI 8.4 to 9.9). BMI had a non-linear relationship with BP, and the magnitude of association between BMI and BP increased with BMI. Socioeconomic status, hypertension during pregnancy, birth weight, and sports participation were also independently associated with BP.

Conclusions

Using the AAP guidelines is likely to substantially increase the population prevalence of hypertension. The association between BMI and BP was strongest and non-linear for obese children, who should be the focus of interventional trials.

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Acknowledgements

The Growing Up in Australia, the Longitudinal Study of Australian Children, is conducted in partnership between the Department of Social Services (DSS), the Australian Institute of Family Studies (AIFS), and the Australian Bureau of Statistics (ABS). The findings and views reported in this paper are those of the author and should not be attributed to DSS, AIFS, or the ABS.

Funding

Nicholas Larkins work on this project was funded by a Postgraduate Scholarship from the National Health and Medical Research Council (NHMRC; GNT1114218). Armando Teixeira-Pinto is partially supported by the NHMRC Program Grant BeatCKD (APP1092957). David Burgner is supported by a NHMRC Senior Research Fellowship (1064629) and is a National Heart Foundation Future Fellow (100026). For the remaining authors, none were declared.

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Authors and Affiliations

  1. Department of Nephrology, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, Western Australia, 6009, Australia

    Nicholas G. Larkins

  2. School of Public Health, University of Sydney, Sydney, New South Wales, Australia

    Nicholas G. Larkins, Armando Teixeira-Pinto & Jonathan C. Craig

  3. Centre for Kidney Research, Kids Research Institute, Westmead, New South Wales, Australia

    Nicholas G. Larkins, Armando Teixeira-Pinto & Jonathan C. Craig

  4. Department of Nephrology, Sydney Children’s Hospital, Randwick, New South Wales, Australia

    Siah Kim

  5. School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia

    Siah Kim

  6. Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia

    David P. Burgner

  7. Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia

    David P. Burgner

  8. Department of Paediatrics, Monash University, Melbourne, Victoria, Australia

    David P. Burgner

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  1. Nicholas G. Larkins
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  2. Armando Teixeira-Pinto
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  3. Siah Kim
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  5. Jonathan C. Craig
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Correspondence to Nicholas G. Larkins.

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Written informed consent was provided by families and the study was approved by the Australian Institute of Family Studies Ethics Committee.

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The authors declare that they have no conflict of interest.

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Larkins, N.G., Teixeira-Pinto, A., Kim, S. et al. The population-based prevalence of hypertension and correlates of blood pressure among Australian children. Pediatr Nephrol 34, 1107–1115 (2019). https://doi.org/10.1007/s00467-019-04206-w

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