Prevalence of and factors associated with hypertension in children and adolescents as observed by German pediatricians—a case–control study
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MDPI
Abstract
Background: Blood pressure elevation in children is an important health concern.
The extent to which hypertension is diagnosed in German pediatric practices is not yet
known. The aim of this study is, therefore, to examine the prevalence of hypertension
diagnosis in children and adolescents treated in pediatric practices, as well as the factors
associated with hypertension in this population. Methods: This retrospective case–control
study used electronic medical records from 258 primary care pediatricians in Germany and
included children and adolescents aged 0–17 years with an initial documented diagnosis of
primary hypertension between January 2005 and December 2023. Hypertension patients
were matched 1:5 with non-hypertension patients by age and sex. Conditional multivariable logistic regression models were used to estimate the association of chronic diseases
and therapies with a risk of hypertension. Results: After 1:5 matching, the present study
included 7482 children and adolescents with hypertension, and 37,410 controls without
hypertension. The average prevalence of hypertension was 0.12% and the incidence was
1.24 cases per 1000 person-years, both increasing with age. In the multivariable regression
analysis, a significant positive association was observed between hypertension and ten
disorders including obesity (odds ratio, OR: 6.91; 95% confidence intervals, CI: 6.28–7.60),
type 1 diabetes mellitus (OR: 2.85; 95% CI: 2.13–3.82), dyslipidemia (OR: 1.99; 95% CI:
1.46–2.72), chronic bronchitis (OR: 1.63; 95% CI: 1.39–1.90), hypothyroidism (OR: 1.62; 95%
CI: 1.30–2.02), migraine (OR: 1.52; 95% CI: 1.17–1.98), ADHD (OR: 1.45; 95% CI: 1.28–1.65),
scoliosis (OR: 1.40; 95% CI: 1.13–1.73), chronic rhinitis (OR: 1.31; 95% CI: 1.14–1.50), and
reaction to severe stress and adjustment disorders (OR: 1.31; 95% CI: 1.04–1.65). Furthermore, paracetamol prescription was positively associated with hypertension risk (OR: 1.68;
95% CI: 1.41–2.00). Conclusions: The significant associations between hypertension and
chronic disorders, particularly obesity, underscore the need for early prevention strategies.
Prospective studies are needed to confirm these associations. Similarly, pathophysiological and mechanistic explanations for the associations identified need to be explored and
verified in properly designed studies.
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Philipps-Universität Marburg
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