Exploring Determinants of Secular Decreases in Childhood Blood Pressure and Hypertension

Background-Childhood blood pressure is largely uninfluenced by medical treatment and behavioral changes associated with hypertension diagnosis. Examining secular trends in childhood blood pressure and its contributing factors will help us better understand population-level determinants of blood pressure and hypertension. Methods and Results-Data were from 4 waves of the Korean National Health and Nutrition Examination Survey between 1998 and 2008, including a total of 5909 boys and girls 10 to 19 years of age. Over the past 10 years, age- and height-adjusted mean systolic blood pressure decreased substantially from 115.6 to 106.9 mm Hg (by 8.7 mm Hg) among boys and from 111.8 to 101.8 mm Hg (by 10.0 mm Hg) among girls. Associated childhood hypertension and prehypertension/hypertension prevalences decreased by 52% to 86%. These remarkable decreases were found among all age and socioeconomic groups and were not explained by secular changes in childhood obesity (body mass index and waist circumferences), health behaviors (cigarette smoking and physical activity), nutritional factors (sodium, potassium, total energy, protein, and fat intake), psychological factors (perceived stress and sleep duration), and sociodemographic factors (annual household income and family size). Conclusions-We observed important population declines in blood pressure in Korea over a 10-year period in children 10 to 19 years of age, but the likely causes for these secular trends remain to be determined. (Circulation. 2011; 124: 397-405.)