High Blood Pressure Trends in Children and Adolescents in National Surveys, 1963 to 2002

Abstract

Background-Secular trend data on hypertension in children and adolescents are scarce and inconsistent. In the face of growing obesity, we sought to assess high blood pressure (HBP) secular trends in children and adolescents enrolled in national surveys and to determine whether the HBP trend reversed its course with the rise in obesity. Methods and Results-National survey data obtained from multistage probability sampling of the US noninstitutionalized population from 1963 to 2002 were examined; 8-to 17-year-old non-Hispanic blacks and whites and Mexican Americans were included. HBP ascertainment was based on age-, gender-, and height percentile-specific systolic and diastolic BPs. Weighted analyses were performed to account for the complex design. The BP, pre-HBP, and HBP trends were downward from 1963 to 1988 and upward thereafter. Pre-HBP and HBP increased 2.3% (Pϭ0.0003) and 1% (Pϭ0.17), respectively, between 1988 and 1999. Obesity increase, more so abdominal than general obesity, partially explained the rise in HBP and pre-HBP from 1988 to 1999. BP and HBP reversed their downward trends 10 years after the increase in the prevalence of obesity. Additionally, an ethnic and gender gap appeared in 1988 for pre-HBP and in 1999 for HBP; non-Hispanic blacks and Mexican Americans had a greater prevalence of HBP and pre-HBP than non-Hispanic whites, and males had a greater prevalence than females. Conclusions-HBP and pre-HBP in children and adolescents are on the rise. These new findings have implications for the cardiovascular disease public health burden, particularly the risk of a new cardiovascular disease transition. They reinforce the urgent call for early prevention of obesity and HBP and illustrate racial/ethnic disparities in this age group.

The trend of hypertension and its relationship to the weight status among Taiwanese young adolescents

“…However, in Taiwan the prevalence of overweight young adolescents (including obesity) increased from 31.6 to 38.0% in boys, but remained stable (24.5-24.4%) in girls during the same period (data not shown). Overweight children with prehypertension or hypertension have a lower risk than normal weight groups, especially in girls, which are similar to the US NHNAES surveys from 1988 to 2002 (Muntner et al 14 ; Din-Dzietham et al 15 ). In US NHNAES surveys from 1988 to 2002, the ageadjusted mean rise in SBP between 1988-1994 and 1999-2002 is comparable for lean (1.0 mm Hg), overweight (0.9 mm Hg) and obese (0.6 mm Hg) children.…”

“…Hypertension during the same period was 1.09-1.27 and 1.04-1.11 (all Po0.05) among children with the same BMI and WC unit elevation, respectively. 15 This study reveals no significant risks of pre-hypertension from BMI or WC among girls in 2006. Other than the adipose factors (such as lifestyle), may make these finding statistically insignificant.…”

“…7,8,14,15,22 In the United States, the Princeton School Study demonstrated that both the mean SBP and DBP were significantly higher in 1973-1975, than 1989-1990 among children aged 7-12 (Morrison et al 22 ). Between the US NHANES III (1988)(1989)(1990)(1991)(1992)(1993)(1994) and the NHANES (1999-2000) surveys, the mean BP and the prevalence of hypertension also increased among both genders between the ages of 8 and 17 (Muntner et al 14 ; Din-Dzietham et al 15 ). The prevalence of hypertension also increased among girls in NHANES (2003)(2004)(2005)(2006)) when compared with NHANES III (1988)(1989)(1990)(1991)(1992)(1993)(1994).…”

“…7,8,14,15,22,34,35 Past studies reported that over the past decade, the prevalence of hypertension remains stable or decreases in economically developed countries, however, it increases in developing countries. 3 Taiwan, an economically developed country, also experienced a decrease in the prevalence of hypertension (age-adjusted prevalence: 26.6-23.5%, from 1993 to 2002) and a decrease in the mean BP in adults.…”

“…13,14 The growing obesity epidemic may contribute to an unexpected increase in the number of children with hypertension. 15,16 Since childhood hypertension is associated with adulthood hypertension and other chronic diseases, 4 previous studies advocate the early detection and prevention of childhood hypertension. 11,15,[17][18][19] In Taiwan, the increasing availability of high fat, high calorie foods has contributed to the continually increasing obesity levels of adults and children.…”