OBJECTIVE In 2017, the American Academy of Pediatrics introduced a new guideline (2017 Clinical Practice Guideline of the American Academy of Pediatrics [AAP 2017]) to diagnose arterial hypertension (HTN) in children that included revised, lower normative blood pressure (BP) values and cut points for diagnosing high BP in adolescents. We studied the impact of the new AAP 2017 on prevalence of HTN in children with type 1 diabetes mellitus (T1DM). RESEARCH DESIGN AND METHODS Up to September 2018, 1.4 million office BP measurements in 79,849 children and adolescents (aged 5-20 years) with T1DM were documented in the DPV (Diabetes Prospective Follow-up) registry. BP values of the most recent year were aggregated, and BP values of 74,677 patients without antihypertensive medication were analyzed (median age 16 years and diabetes duration 5.3 years, 52.8% boys). BP values were classified according to AAP 2017 and the references of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) (2011) and the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (fourth report) (2004). RESULTS Of the patients, 44.1%, 29.5%, and 26.5% were hypertensive according to AAP 2017, KiGGS, and fourth report, respectively. Differences in prevalence of HTN were strongly age dependent: <10 years, AAP 2017 31.4%, KiGGS 30.7%, fourth report 19.6%; 10 to <15 years, AAP 2017 30.9%, KiGGS 31.2%, fourth report 22.4%; and ≥15 years, AAP 2017 53.2%, KiGGS 28.4%, fourth report 30.0%. Among teenagers ≥15 years, 59.1% of boys and only 46.3% of girls were classified as hypertensive by AAP 2017 but only 21.1%/26% of boys and 36.7%/34.4% of girls by KiGGS/fourth report, respectively. CONCLUSIONS Classification of BP as hypertension depends strongly on the normative data used. Use of AAP 2017 results in a significant increase in HTN in teenagers ≥15 years with T1DM, particularly in boys. AAP 2017 enhances the awareness of elevated BP in children, particularly in patients with increased risk for cardiovascular disease.

中文翻译：

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2017年美国儿科学会临床实践指南：对1型糖尿病儿童和青少年动脉高血压患病率的影响。

目的2017年，美国儿科学会引入了新指南（美国儿科学会2017临床实践指南[AAP 2017]）来诊断儿童的动脉高压（HTN），其中包括修订后的低标准血压（BP）值并为诊断青少年血压高确定了切入点。我们研究了新的AAP 2017对1型糖尿病（T1DM）儿童HTN患病率的影响。研究设计和方法截至2018年9月，DPV（糖尿病前瞻性随访）登记册中记录了79,849名患有T1DM的儿童和青少年（5至20岁）的140万办公室BP测量值。汇总最近一年的BP值，并分析了74,677例未使用降压药的患者的BP值（中位年龄16岁，糖尿病病程5.3年，52。8％的男孩）。BP值根据AAP 2017和德国儿童和青少年健康访问与检查调查（KiGGS）（2011）以及《儿童，青少年高血压诊断，评估和治疗第四次报告》（第四次报告）（2004年）。结果根据AAP 2017，KiGGS和第四次报告，分别有44.1％，29.5％和26.5％的患者患有高血压。HTN患病率差异主要取决于年龄：<10岁，AAP 2017年31.4％，KiGGS 30.7％，第四次报告19.6％; 10至<15年，2017年AAP为30.9％，KiGGS为31.2％，第四次报告为22.4％; 15岁及以上，AAP 2017年53.2％，KiGGS 28.4％，第四次报告30.0％。在AAP 2017中，≥15岁的青少年中，有59.1％的男孩和只有46.3％的女孩被归类为高血压，但只有21.1％/ 26％的男孩和36.7％/ 34。KiGGS /第四次报告分别报道了4％的女孩。结论将BP分类为高血压很大程度上取决于所使用的规范性数据。使用AAP 2017会导致T1DM≥15岁的青少年HTN显着增加，尤其是男孩。AAP 2017增强了儿童血压升高的意识，尤其是心血管疾病风险增加的患者。