31 Implications of the new 2017 American Academy of Pediatrics (AAP) clinical practice guidelines for the management of elevated blood pressure (BP) in Canadian children aged 6–18 years: A descriptive & case-control study
Notice bibliographique
Résumé
New 2017 blood pressure (BP) guidelines were released by the American Heart Association and the American Academy of Pediatrics (AAP). As a result, the population prevalence of high BP (levels consistent with elevated BP or stage 1 or 2 hypertension) in US adults increased from 32 to 46%, with a corresponding increase from 11.8 to 14.2% in children aged 5-18y based on NHANES data. To assess the impact of the new guidelines on the prevalence of high BP in Canadian children, clinically characterize those with high BP, and compare risk factors between cases whose clinical stage worsened (“reclassified upwards”) and normotensive controls. Cycles 1–4(2007–2015) of the Canadian Health Measures Survey (CHMS) include demographic, laboratory, and examination data from generally healthy children age 6–18 years. Based on repeated BP measurements at a single visit, BP stages were assigned using both the 2017 AAP and the 2004 National Institute of Health (NIH/NHLBI) guidelines. Stata 15 was used to apply CHMS probability and bootstrap weights to estimate population means and prevalences. An unweighted case-control study compared laboratory and clinical characteristics in reclassified cases and controls. The population prevalence of high BP increased from 4.5% (NIH/NHLBI) to 5.8% (AAP), substantially less than in US children. The mean population systolic BP percentile was 24.2% and 46.4% for the mean diastolic BP percentile, compared to 46% and 32%, respectively, in US children. When comparing normal versus high BP populations, the latter were more likely to be overweight/obese (39.4 v 30.6%, p=0.02), exposed to household smoking (17.3 vs 10.3% p=0.002), and have hypertriglyceridemia (17.4 vs 10.4%, p = 0.02). They were also younger (-1.8y, p<0.001), but did not differ in birth weight, NICU history, chronic health issues, or other laboratory measures. In addition, 3.5% of the sample (n=261) were reclassified to a higher BP stage. Children reclassified upwards under the new guidelines were also more likely to be overweight/obese (36.4 vs 25.3%, p<0.01) with hypertriglyceridemia (p<0.03). High BP is less common in healthy Canadian children than in the US. New guidelines result in a small increase in numbers identified as having high BP; typically, they were younger, more likely to be overweight/obese, and have hypertriglyceridemia. Children whose BP stage worsened under the new guidelines were also more likely to suffer from other cardiometabolic risk factors, suggesting that we were previously underestimating their cardiovascular risk.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,014 | 0,027 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,004 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,003 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».