Abstract Body: Hypertension in youth tracks into adulthood and has long-term negative health effects. In 2017, the American Academy of Pediatrics released new Clinical Practice Guidelines on pediatric hypertension. The guidelines updated blood pressure (BP) thresholds and age-sex-height percentile references for youth 1–17 years. Pediatric hypertension prevalence estimates since the new guideline are lacking.

This study aims to provide the latest nationally representative prevalence estimates of elevated BP and hypertension in youth aged 8–19 years, total and stratified by age group, sex, race and ethnicity, and body mass index (BMI) category. For adolescents aged 13–17 years, both percentile-based thresholds and adult BP thresholds are available in the guidelines. We therefore compared adult BP thresholds for elevated BP (120–129/<80 mmHg) and hypertension (≥130/≥80 mmHg) with percentile thresholds in adolescents.

We used data from 2017–March 2020 National Health and Nutrition Examination Survey to obtain a sample of 2600 youth after excluding those with no BMI or BP measures. Prevalence estimates of elevated BP and hypertension were 8.7% (95% CI: 6.9-10.6) and 5.4% (95% CI: 4.0-6.7), respectively. Estimates were higher among males and increased with age (Table). Youth with severe obesity had the highest prevalence of hypertension. Hispanic youth had the lowest prevalence of elevated BP. In adolescents, elevated BP prevalence was similar using percentile thresholds (11.9%, 95% CI: 9.3-15.1) and the adult threshold (10.8%, 95% CI: 8.5-13.7). Hypertension prevalence in adolescents was also similar for percentile thresholds (4.8%, 95% CI: 3.1-7.6) and the adult threshold (4.8%, 95% CI: 2.0-7.5).
Our findings suggest ongoing concern of elevated BP and hypertension among youth in the US. Either percentile or adult based thresholds for determining high BP could be used among adolescents by researchers. Knowledge of current national estimates can inform policies and interventions to support cardiovascular health in youth.