A comparison of paediatric hypertension clinical practice guidelines and their ability to predict adult hypertension in an African birth cohort

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Abstract It remains unclear which paediatric hypertension clinical practice guideline (CPG) should be applied in an African population. We therefore aimed to compare three commonly used CPG (2017 AAP, 2016 ESH and 2004 Fourth Report) developed in high-income countries for use in South African children at four paediatric ages (children: 5yrs and 8yrs; adolescents: 13yrs and 17yrs) to determine which best predicts elevated blood pressure (EBP) in young adulthood (22yrs and 28yrs). Moreover, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each specific paediatric CPG was calculated. The 2017 AAP definition identified more children and adolescents with hypertension when compared to the 2004 Fourth Report and 2016 ESH guidelines. In computed hazards ratios, from ages 8yrs to 17yrs, all three paediatric CPG significantly predicted the risk of EBP in young adulthood (p≤0.008). However, sensitivity to predict EBP at age 22yrs for all CPG was generally low (17.0% - 33.0%) with higher specificity (87.4% - 93.1%). Sensitivity increased at age 28yrs (51.4.0% - 70.1%), while specificity decreased (52.8% - 65.1%). Both PPV and NPV at both adult age points varied widely (17.9% - 79.9% and 29.3% - 92.5% respectively). The performance of these paediatric CPG in terms of AUC were not optimal at both adult age points, however, the AAP definition at 17yrs met an acceptable level of performance (AUC= 0.71). Our results highlight the need for more research to examine if an African-specific CPG would better identify high-risk children to minimise their trajectory towards adult hypertension.

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