Changing trends in the levels of blood pressure and prevalence of hypertension among Chinese children and adolescents from 1991 to 2015

Objective: To examine the trends in blood pressure levels and prevalence of hypertension among Chinese children and adolescents aged 7-17 years from 1991 to 2015, using the four blood pressure references for children and adolescents, in order to provide basic data for the prevention and control of hypertension. Methods: A total of 14 622 children and adolescents aged 7-17 years were selected from the China Health and Nutrition Survey 1991-2015. Hypertension was defined under the four latest published references including the 2018 Health Industry pediatric blood pressure reference (Industry Reference), the 2018 Chinese Hypertension Prevention and Treatment Guideline reference (Guideline Reference), the 2016 International Child Blood Pressure Reference (International Reference), and the 2017 Blood Pressure Reference by the American Academy of Pediatrics (US Reference). Multivariable liner regression model was used to examine the trends in blood pressure levels from 1991 to 2015, and multivariable logistic regression model was used to examine the trend in prevalence of hypertension from 1991 to 2015. Results: After adjusted for factors as age, sex, region, and BMI, the SBP appeared an increase, from 96.1 mmHg in 1991 to 102.7 mmHg and DBP from 62.6 mmHg to 67.4 mmHg (all P for trend <0.001) in 2015. The prevalence rates of hypertension defined by Industry Reference, Guideline Reference, International Reference and US Reference increased from 5.7%, 8.9%, 4.4% and 8.1% in 1991, to 12.8%, 20.5%, 13.1% and 17.8% (all P for trend <0.001) in 2015, respectively. Conclusion: Both levels of blood pressure and the prevalence of hypertension increased significantly in Chinese children and adolescents from 1991 to 2015.