Prevalence of and Factors Associated with Hypertension in Children and Adolescents as Observed by German Pediatricians-A Case-Control Study.

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.