Impact of the 2017 Blood Pressure Guidelines by the American Academy of Pediatrics in overweight/obese youth

CARITALY Study Group

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: The aim of this study was to compare the impact of the European Society of Hypertension Guidelines 2016 (ESHG2016) and the American Academy of Pediatrics Guidelines 2017 (AAPG2017) on the screening of hypertension and classification of abnormal left ventricular geometry (ALVG) in overweight/obese youth.

METHODS: This study included 6137 overweight/obese youth; 437 had echocardiographic assessment. Hypertension was defined using either ESHG2016 or AAPG2017. ALVG was defined using 95th percentile for age and sex of left ventricular mass index (LVMi) and/or relative wall thickness (RWT) more than 0.38 (juvenile cut-offs) according to ESHG2016 or LVMi more than 51 g/h and/or RWT more than 0.42 (adult cut-offs) according to AAPG2017.

RESULTS: Prevalence of youth at a high risk of hypertension was 13% higher using AAPG2017 than ESHG2016. The increase was larger in overweight youth at least 13 years of age (+43%). Using the juvenile cut-offs for ALVG, youth at a high risk of hypertension by ESHG2016 had an odds ratio [95% confidence interval (95% CI)] of 3.03 (1.31-7.05) for left ventricular concentric remodelling (LVcr) and 2.53 (1.43-4.47) for concentric left ventricular hypertrophy (cLVH) as compared with youth with normal LVG. Similarly, in youth at a high risk of hypertension by AAPG2017, the odds ratio for LVcr was 3.28 (1.45-7.41, P < 0.001) and 3.02 (95% CI: 1.73-5.27, P < 0.001) for cLVH. Using the adult cut-offs, no significant difference in ALVG was found with both guidelines.

CONCLUSION: The prevalence of overweight/obese youth at a high risk of hypertension increased by 13% comparing AAPG2017 vs. ESHG2016. The juvenile cut-offs for ALVG were more effective than the adult criteria in intercepting individuals with a potentially higher cardiovascular risk.

Original languageEnglish
JournalJournal of Hypertension
DOIs
Publication statusE-pub ahead of print - Oct 6 2018

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Guidelines
Pediatrics
Blood Pressure
Hypertension
Ventricular Remodeling
Left Ventricular Hypertrophy
Odds Ratio
Confidence Intervals

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Impact of the 2017 Blood Pressure Guidelines by the American Academy of Pediatrics in overweight/obese youth. / CARITALY Study Group.

In: Journal of Hypertension, 06.10.2018.

Research output: Contribution to journalArticle

@article{a3cca490e99c4da2bb5563e7bd81aadd,
title = "Impact of the 2017 Blood Pressure Guidelines by the American Academy of Pediatrics in overweight/obese youth",
abstract = "OBJECTIVES: The aim of this study was to compare the impact of the European Society of Hypertension Guidelines 2016 (ESHG2016) and the American Academy of Pediatrics Guidelines 2017 (AAPG2017) on the screening of hypertension and classification of abnormal left ventricular geometry (ALVG) in overweight/obese youth.METHODS: This study included 6137 overweight/obese youth; 437 had echocardiographic assessment. Hypertension was defined using either ESHG2016 or AAPG2017. ALVG was defined using 95th percentile for age and sex of left ventricular mass index (LVMi) and/or relative wall thickness (RWT) more than 0.38 (juvenile cut-offs) according to ESHG2016 or LVMi more than 51 g/h and/or RWT more than 0.42 (adult cut-offs) according to AAPG2017.RESULTS: Prevalence of youth at a high risk of hypertension was 13{\%} higher using AAPG2017 than ESHG2016. The increase was larger in overweight youth at least 13 years of age (+43{\%}). Using the juvenile cut-offs for ALVG, youth at a high risk of hypertension by ESHG2016 had an odds ratio [95{\%} confidence interval (95{\%} CI)] of 3.03 (1.31-7.05) for left ventricular concentric remodelling (LVcr) and 2.53 (1.43-4.47) for concentric left ventricular hypertrophy (cLVH) as compared with youth with normal LVG. Similarly, in youth at a high risk of hypertension by AAPG2017, the odds ratio for LVcr was 3.28 (1.45-7.41, P < 0.001) and 3.02 (95{\%} CI: 1.73-5.27, P < 0.001) for cLVH. Using the adult cut-offs, no significant difference in ALVG was found with both guidelines.CONCLUSION: The prevalence of overweight/obese youth at a high risk of hypertension increased by 13{\%} comparing AAPG2017 vs. ESHG2016. The juvenile cut-offs for ALVG were more effective than the adult criteria in intercepting individuals with a potentially higher cardiovascular risk.",
author = "{CARITALY Study Group} and {Di Bonito}, Procolo and Giuliana Valerio and Lucia Pacifico and Claudio Chiesa and Cecilia Invitti and Anita Morandi and Licenziati, {Maria Rosaria} and Melania Manco and Giudice, {Emanuele Miraglia Del} and Baroni, {Marco Giorgio} and Sandro Loche and Gianluca Tornese and Francesca Franco and Claudio Maffeis and {de Simone}, Giovanni",
year = "2018",
month = "10",
day = "6",
doi = "10.1097/HJH.0000000000001954",
language = "English",
journal = "Journal of Hypertension",
issn = "0263-6352",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Impact of the 2017 Blood Pressure Guidelines by the American Academy of Pediatrics in overweight/obese youth

AU - CARITALY Study Group

AU - Di Bonito, Procolo

AU - Valerio, Giuliana

AU - Pacifico, Lucia

AU - Chiesa, Claudio

AU - Invitti, Cecilia

AU - Morandi, Anita

AU - Licenziati, Maria Rosaria

AU - Manco, Melania

AU - Giudice, Emanuele Miraglia Del

AU - Baroni, Marco Giorgio

AU - Loche, Sandro

AU - Tornese, Gianluca

AU - Franco, Francesca

AU - Maffeis, Claudio

AU - de Simone, Giovanni

PY - 2018/10/6

Y1 - 2018/10/6

N2 - OBJECTIVES: The aim of this study was to compare the impact of the European Society of Hypertension Guidelines 2016 (ESHG2016) and the American Academy of Pediatrics Guidelines 2017 (AAPG2017) on the screening of hypertension and classification of abnormal left ventricular geometry (ALVG) in overweight/obese youth.METHODS: This study included 6137 overweight/obese youth; 437 had echocardiographic assessment. Hypertension was defined using either ESHG2016 or AAPG2017. ALVG was defined using 95th percentile for age and sex of left ventricular mass index (LVMi) and/or relative wall thickness (RWT) more than 0.38 (juvenile cut-offs) according to ESHG2016 or LVMi more than 51 g/h and/or RWT more than 0.42 (adult cut-offs) according to AAPG2017.RESULTS: Prevalence of youth at a high risk of hypertension was 13% higher using AAPG2017 than ESHG2016. The increase was larger in overweight youth at least 13 years of age (+43%). Using the juvenile cut-offs for ALVG, youth at a high risk of hypertension by ESHG2016 had an odds ratio [95% confidence interval (95% CI)] of 3.03 (1.31-7.05) for left ventricular concentric remodelling (LVcr) and 2.53 (1.43-4.47) for concentric left ventricular hypertrophy (cLVH) as compared with youth with normal LVG. Similarly, in youth at a high risk of hypertension by AAPG2017, the odds ratio for LVcr was 3.28 (1.45-7.41, P < 0.001) and 3.02 (95% CI: 1.73-5.27, P < 0.001) for cLVH. Using the adult cut-offs, no significant difference in ALVG was found with both guidelines.CONCLUSION: The prevalence of overweight/obese youth at a high risk of hypertension increased by 13% comparing AAPG2017 vs. ESHG2016. The juvenile cut-offs for ALVG were more effective than the adult criteria in intercepting individuals with a potentially higher cardiovascular risk.

AB - OBJECTIVES: The aim of this study was to compare the impact of the European Society of Hypertension Guidelines 2016 (ESHG2016) and the American Academy of Pediatrics Guidelines 2017 (AAPG2017) on the screening of hypertension and classification of abnormal left ventricular geometry (ALVG) in overweight/obese youth.METHODS: This study included 6137 overweight/obese youth; 437 had echocardiographic assessment. Hypertension was defined using either ESHG2016 or AAPG2017. ALVG was defined using 95th percentile for age and sex of left ventricular mass index (LVMi) and/or relative wall thickness (RWT) more than 0.38 (juvenile cut-offs) according to ESHG2016 or LVMi more than 51 g/h and/or RWT more than 0.42 (adult cut-offs) according to AAPG2017.RESULTS: Prevalence of youth at a high risk of hypertension was 13% higher using AAPG2017 than ESHG2016. The increase was larger in overweight youth at least 13 years of age (+43%). Using the juvenile cut-offs for ALVG, youth at a high risk of hypertension by ESHG2016 had an odds ratio [95% confidence interval (95% CI)] of 3.03 (1.31-7.05) for left ventricular concentric remodelling (LVcr) and 2.53 (1.43-4.47) for concentric left ventricular hypertrophy (cLVH) as compared with youth with normal LVG. Similarly, in youth at a high risk of hypertension by AAPG2017, the odds ratio for LVcr was 3.28 (1.45-7.41, P < 0.001) and 3.02 (95% CI: 1.73-5.27, P < 0.001) for cLVH. Using the adult cut-offs, no significant difference in ALVG was found with both guidelines.CONCLUSION: The prevalence of overweight/obese youth at a high risk of hypertension increased by 13% comparing AAPG2017 vs. ESHG2016. The juvenile cut-offs for ALVG were more effective than the adult criteria in intercepting individuals with a potentially higher cardiovascular risk.

U2 - 10.1097/HJH.0000000000001954

DO - 10.1097/HJH.0000000000001954

M3 - Article

C2 - 30299422

JO - Journal of Hypertension

JF - Journal of Hypertension

SN - 0263-6352

ER -