2017 American Academy of Pediatrics Clinical Practice Guideline: Impact on Prevalence of Arterial Hypertension in Children and Adolescents With Type 1 Diabetes.

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Clinical Guidelines
Authored By
Dost A, Bechtold S, Fink K, Bonfig W, Wiemann D, Kapellen TM, Witsch M, Schwab KO, Holl RW
Authored On
Interests
Endocrinology
Pediatric Medicine
Internal/Family Medicine
Pulmonology
Speciality
Pediatric Medicine
Endocrinology
Pulmonology
Internal/Family Medicine
Book Detail
volume
43
ISSN
1935-5548
No. of pages
8
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ISSN
1935-5548 ; Electronic
IS_Ebsco
true
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Additional Info
["Dost A, Bechtold S, Fink K, Bonfig W, Wiemann D, Kapellen TM, Witsch M, Schwab KO, Holl RW","initiative DPV-Science and the German Diabetes Research Center","Publisher: American Diabetes Association Country of Publication: United States NLM ID: 7805975 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1935-5548 (Electronic) Linking ISSN: 01495992 NLM ISO Abbreviation: Diabetes Care Subsets: MEDLINE","Historical Article; Journal Article; Research Support, Non-U.S. Gov't","2020-06-01","Diabetes care [Diabetes Care] 2020 Jun; Vol. 43 (6), pp. 1311-1318. Date of Electronic Publication: 2020 Mar 30.","English","1935-5548","Practice Guidelines as Topic*\/standards, Diabetes Mellitus, Type 1\/*therapy , Hypertension\/*diagnosis , Hypertension\/*epidemiology , Hypertension\/*therapy , Pediatrics\/*standards, Adolescent ; Adult ; Antihypertensive Agents\/therapeutic use ; Blood Pressure\/physiology ; Blood Pressure Determination\/adverse effects ; Blood Pressure Determination\/standards ; Child ; Child, Preschool ; Diabetes Mellitus, Type 1\/complications ; Diabetes Mellitus, Type 1\/epidemiology ; Diabetes Mellitus, Type 1\/physiopathology ; Diagnostic Techniques, Endocrine\/standards ; Female ; Guideline Adherence\/standards ; Guideline Adherence\/statistics & numerical data ; History, 21st Century ; Humans ; Hypertension\/etiology ; Male ; Pediatrics\/methods ; Prevalence ; Prospective Studies ; United States\/epidemiology ; Young Adult","Adolescent, Adult, Antihypertensive Agents therapeutic use, Blood Pressure physiology, Blood Pressure Determination adverse effects, Blood Pressure Determination standards, Child, Child, Preschool, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 1 epidemiology, Diabetes Mellitus, Type 1 physiopathology, Diagnostic Techniques, Endocrine standards, Female, Guideline Adherence standards, Guideline Adherence statistics & numerical data, History, 21st Century, Humans, Hypertension etiology, Male, Pediatrics methods, Prevalence, Prospective Studies, United States epidemiology, Young Adult, Diabetes Mellitus, Type 1 therapy, Hypertension diagnosis, Hypertension epidemiology, Hypertension therapy, Pediatrics standards, Practice Guidelines as Topic standards","Diabetes care","43"]
Description
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).<br />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).<br />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: &lt;10 years, AAP 2017 31.4%, KiGGS 30.7%, fourth report 19.6%; 10 to &lt;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.<br />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.<br /> (© 2020 by the American Diabetes Association.)
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