P3.F101: Racial/Ethnic and Sex Disparities in Pediatric Primary Hypertension: A Systematic Review

Background: Racial/ethnic and sex disparities in the prevalence of adult hypertension are well documented. However, despite the ongoing escalation of hypertension rates among children and adolescents in the United States along with a parallel rise in obesity, a significant risk factor for hypertension, limited attention has been given to examining demographic differences in pediatric hypertension. The goal of this study is to systematically assess the current prevalence of hypertension in the pediatric population by sex, race/ethnicity, and body mass index (BMI) in the United States.

Methods: The PubMed database was searched for eligible studies from January 1996 to April 2024. Inclusion criteria consisted of studies conducted in the United States that contained demographic data (sex and race/ethnicity) and defined pediatric hypertension as elevated blood pressure after three consecutive non-sick visits with a clinician. Studies were excluded if study subjects had known causes for secondary hypertension or were greater than 20 years of age.

Results: The literature search identified 7,444 publications, from which 9 studies meeting the inclusion criteria were selected. These studies encompassed a collective sample size of 897,361 children and adolescents aged 3-19 years. The prevalence of pediatric hypertension among females ranged from 2.3% to 6.0%, while among males, it ranged from 2.0% to 7.5%. Across all racial/ethnic groups except African Americans, females exhibited lower prevalence rates compared to males. Among non-Hispanic blacks, the prevalence of pediatric hypertension ranged from 2.0% to 7.3%, while for Hispanics, it ranged from 2.4% to 7.9%. Similarly, prevalence among Asians ranged from 2.4% to 8.3%, and among non-Hispanic whites, it ranged from 1.8% to 6.7%. Six out of the nine studies indicated that Hispanics had the highest prevalence of pediatric hypertension. All studies demonstrated a positive association between increasing BMI and the prevalence of pediatric hypertension. However, among those with obesity, African Americans had the lowest prevalence of pediatric hypertension compared to all other racial/ethnic groups.

Conclusion: The increasing prevalence of pediatric hypertension in the United States remains a pressing concern. Timely diagnosis and treatment are crucial for mitigating the risk of cardiovascular events later in life. Although the latest guidelines on pediatric hypertension issued by the American Academy of Pediatrics in 2017 have made significant progress in simplifying the identification and diagnosis of pediatric hypertension, they do not incorporate consideration of race/ethnicity in screening recommendations. While ample evidence supports the link between weight and hypertension, this study highlights the racial/ethnic differences between that association. Additionally, this study underscores distinct sex disparities in pediatric hypertension. Understanding differences in risk factors among diverse demographic groups is essential for advancing efforts to reduce underdiagnosis and for offering tailored, sustainable treatment options for these young patients.