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
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.027 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".