By Jonathan Springston, Editor, Relias Media

In 2017, when the American Academy of Pediatrics updated its 2004 blood pressure guidelines, more children were classified as having high blood pressure. However, it was not clear at that time if the updated guidelines accurately identified children who were at high risk for premature heart disease.

The authors of a recently published longitudinal study looked at more than 3,900 participants drawn from the Bogalusa Heart Study (all patients in that study enrolled at childhood and were followed for more than 30 years into adulthood). Forty-seven percent of the 3,940 participants were male, and 35% were African-American. When following up with participants in adulthood, the authors of the longitudinal study found that 11% would be identified as having high blood pressure under the 2017 guidelines vs. 7% under 2004 criteria. Further, investigators found that 19% of participants with high blood pressure under 2017 guidelines developed heart muscle thickening during the follow-up period vs. 12% of those considered to have high blood pressure under 2004 guidelines.

“After reviewing years of information from the Bogalusa Heart Study, we concluded that compared with children with normal blood pressure, those reclassified as having elevated or high blood pressure were more likely to develop adult high blood pressure, thickening of the heart muscle wall, and the metabolic syndrome -- all risk factors for heart disease,” Lydia A. Bazzano, MD, PhD, senior author and associate professor of epidemiology at the Tulane School of Public Health and Tropical Medicine, said in a statement.

One possible silver lining: The authors do not believe all children classified with high blood pressure under the 2017 guidelines will need medicine to treat their condition. Still, the investigators stressed lifestyle improvements are important for everyone, even children.

“For most children with high blood pressure that is not caused by a separate medical condition or a medication, lifestyle changes are the cornerstone of treatment,” Bazzano said. “It’s important to maintain a normal weight, avoid excess salt, get regular physical activity, and eat a healthy diet that is high in fruit, vegetables, legumes, nuts, whole grains, lean protein, and limited in salt, added sugars, and saturated and trans fats to reduce blood pressure.”

In the May issue of Clinical Cardiology Alert, Editor Michael Crawford wrote about a retrospective contemporary review of acute ST-elevation myocardial infarction (STEMI) patients younger than 35 years of age that showed that these patients are predominantly overweight men who smoke (some also abuse drugs and present with dyslipidemia). STEMI is rare in this cohort, but Crawford noted these patients present with predisposing conditions that physicians can help modify to improve patients’ long-term health.

“These data inform a public health opportunity since the major factors predisposing these patients to STEMI are largely modifiable,” Crawford wrote. “Young men should not smoke, should maintain a normal weight, should keep their lipid values in the desirable range, and should not abuse drugs. If these goals are accomplished, the number of STEMI episodes in young men could approach zero.”

For even more news and information about pediatrics, be sure to check out the latest issues of Pediatric Emergency Medicine Reports and Pediatric Trauma 2019: Raising the Bar to Excellence.