Original Article
Development of Hypertension in Adolescents with Pre-Hypertension

https://doi.org/10.1016/j.jpeds.2011.07.010Get rights and content

Objective

To evaluate the risk for developing incident hypertension (HTN) in adolescents with pre-hypertension.

Study design

A secondary analysis of students participating in multiple school-based blood pressure (BP) screens from 2000 to 2007 was completed. At each screen, height, weight, and 2 to 4 BPs were measured on as many as 3 occasions when BP remained ≥95th percentile. Students with confirmed HTN at their initial screen were excluded, and incident HTN was defined as having a BP ≥95th percentile at all 3 visits of a later screen. Incidence rates (IR) and hazard ratios (HR) were calculated by using Cox Proportional models.

Results

Of 1006 students, HTN developed in 11 (IR 0.5%/year) in a mean of 2.1 years of observation. IRs were higher in “at-risk” students (pre-hypertensive or hypertensive with follow-up BP <95th percentile), 1.4%/year (HR, 4.89; 1.48-16.19) and students with a BP ≥90th percentile at 3 baseline visits, 6.6%/year HR 24.33 (5.68-104.29)]. Although not significant, students with pre-hypertension by the 2004 Task Force definition also had an increased IR of 1.1%/year (HR, 2.98; 0.77-11.56)].

Conclusion

Elevated BP increases the risk for the development of HTN during adolescence. Effective strategies for preventing HTN in at-risk adolescents are needed.

Section snippets

Methods

Between 2000 and 2007, >18 000 children aged 10 to 19 years participated in a school-based BP screening program performed within 21 secondary schools of the Houston and Katy, Texas Independent School districts by the University of Texas–Houston Pediatric and Adolescent Hypertension Program. Schools were selected on the basis of willingness to participate and published demographic characteristics, with a goal of maintaining a roughly equal number of African-American, Caucasian, and Hispanic

Results

A total of 1193 students were identified with repeated participation in the screening database. The final cohort included 1006 students, 926 of whom participated in the screening process twice, and 80 of whom participated on 3 or more occasions. Students excluded consisted of 129 with <3 valid BP readings per record, 30 with confirmed HTN at baseline, and 28 with a BP ≥95th percentile, but inadequate follow-up to determine baseline BP status. Demographic data at baseline by initial BP category

Discussion

Our study showed that the rate of development of HTN in adolescents as a whole is relatively low at 0.5% to 0.8% per year. This rate increased significantly in adolescents with an elevated BP on multiple occasions and in obese students. Obarzanek et al12 reported a similar incidence of 5% at 8 years for African-American girls, but a slightly lower incidence in Caucasian girls at 2.1% at 8 years; however, these rates were based on two BP measurement sessions separated by 1 year. Race did not

References (17)

There are more references available in the full text version of this article.

Cited by (99)

  • Changes in Ambulatory Blood Pressure Phenotype over Time in Children and Adolescents with Elevated Blood Pressures

    2020, Journal of Pediatrics
    Citation Excerpt :

    However, information on the risk for progression of PreHTN to sustained HTN on ABPM over time is not available. Limited data in adult and pediatric patients suggest that those with office PreHTN are at risk for progression to HTN.7,8,27 Further investigation into the outcome of those with elevated BP loads on ABPM is needed.

View all citing articles on Scopus

Portions of the screening program were funded by unrestricted grants from AstraZeneca, Daiichi Sankyo, and King Pharmaceuticals. K.R. received salary support in part by an unrestricted grant from the Arkansas Children’s Hospital Research Institute and the Arkansas Bioscienses Institute, the major research component of the Tobacco Settlement Proceeds Act of 2000. These companies and institutions had no input into the design, content, or interpretation of the study or the development of this manuscript. The other authors declare no conflicts of interest.

View full text