The American Academy of Pediatrics hypertension guidelines identify obese youth at high cardiovascular risk among individuals non-hypertensive by the European Society of Hypertension guidelines

CARITALY Study on the behalf of the Childhood Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Two different systems for the screening and diagnosis of hypertension (HTN) in children currently coexist, namely, the guidelines of the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH). The two systems differ in the lowered cut-offs proposed by the AAP versus ESH.

OBJECTIVES: We evaluated whether the reclassification of hypertension by the AAP guidelines in young people who were defined non-hypertensive by the ESH criteria would classify differently overweight/obese youth in relation to their cardiovascular risk profile.

METHODS: A sample of 2929 overweight/obese young people (6-16 years) defined non-hypertensive by ESH (ESH-) was analysed. Echocardiographic data were available in 438 youth.

RESULTS: Using the AAP criteria, 327/2929 (11%) young people were categorized as hypertensive (ESH-/AAP+). These youth were older, exhibited higher body mass index, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), triglycerides, total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, blood pressure, left ventricular mass index and lower HDL-C (p <0.025-0.0001) compared with ESH-/AAP-. The ESH-/AAP+ group showed a higher proportion of insulin resistance (i.e. HOMA-IR ≥3.9 in boys and 4.2 in girls) 35% vs. 25% (p <0.0001), high TC/HDL-C ratio (≥3.8 mg/dl) 35% vs. 26% (p = 0.001) and left ventricular hypertrophy (left ventricular mass index ≥45 g/h2.16) 67% vs. 45% (p = 0.008) as compared with ESH-/AAP-.

CONCLUSIONS: The reclassification of hypertension by the AAP guidelines in young people overweight/obese defined non-hypertensive by the ESH criteria identified a significant number of individuals with high blood pressure and abnormal cardiovascular risk. Our data support the need of a revision of the ESH criteria.

Original languageEnglish
Pages (from-to)2047487319868326
JournalEuropean Journal of Preventive Cardiology
DOIs
Publication statusE-pub ahead of print - Aug 6 2019

Fingerprint

Guidelines
Pediatrics
Hypertension
HDL Cholesterol
Insulin Resistance
Cholesterol
Left Ventricular Hypertrophy
Triglycerides
Body Mass Index
Blood Pressure

Cite this

The American Academy of Pediatrics hypertension guidelines identify obese youth at high cardiovascular risk among individuals non-hypertensive by the European Society of Hypertension guidelines. / CARITALY Study on the behalf of the Childhood Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology.

In: European Journal of Preventive Cardiology, 06.08.2019, p. 2047487319868326.

Research output: Contribution to journalArticle

CARITALY Study on the behalf of the Childhood Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology. / The American Academy of Pediatrics hypertension guidelines identify obese youth at high cardiovascular risk among individuals non-hypertensive by the European Society of Hypertension guidelines. In: European Journal of Preventive Cardiology. 2019 ; pp. 2047487319868326.
@article{2a88006f5cb94555b684bbc7ce31da04,
title = "The American Academy of Pediatrics hypertension guidelines identify obese youth at high cardiovascular risk among individuals non-hypertensive by the European Society of Hypertension guidelines",
abstract = "BACKGROUND: Two different systems for the screening and diagnosis of hypertension (HTN) in children currently coexist, namely, the guidelines of the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH). The two systems differ in the lowered cut-offs proposed by the AAP versus ESH.OBJECTIVES: We evaluated whether the reclassification of hypertension by the AAP guidelines in young people who were defined non-hypertensive by the ESH criteria would classify differently overweight/obese youth in relation to their cardiovascular risk profile.METHODS: A sample of 2929 overweight/obese young people (6-16 years) defined non-hypertensive by ESH (ESH-) was analysed. Echocardiographic data were available in 438 youth.RESULTS: Using the AAP criteria, 327/2929 (11{\%}) young people were categorized as hypertensive (ESH-/AAP+). These youth were older, exhibited higher body mass index, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), triglycerides, total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, blood pressure, left ventricular mass index and lower HDL-C (p <0.025-0.0001) compared with ESH-/AAP-. The ESH-/AAP+ group showed a higher proportion of insulin resistance (i.e. HOMA-IR ≥3.9 in boys and 4.2 in girls) 35{\%} vs. 25{\%} (p <0.0001), high TC/HDL-C ratio (≥3.8 mg/dl) 35{\%} vs. 26{\%} (p = 0.001) and left ventricular hypertrophy (left ventricular mass index ≥45 g/h2.16) 67{\%} vs. 45{\%} (p = 0.008) as compared with ESH-/AAP-.CONCLUSIONS: The reclassification of hypertension by the AAP guidelines in young people overweight/obese defined non-hypertensive by the ESH criteria identified a significant number of individuals with high blood pressure and abnormal cardiovascular risk. Our data support the need of a revision of the ESH criteria.",
author = "{CARITALY Study on the behalf of the Childhood Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology} and Bonito, {Procolo Di} and Licenziati, {Maria Rosaria} and Baroni, {Marco G} and Claudio Maffeis and Anita Morandi and Melania Manco and {Miraglia Del Giudice}, Emanuele and Sessa, {Anna Di} and Giuseppina Campana and Nicola Moio and Luisa Gilardini and Claudio Chiesa and Lucia Pacifico and Simone, {Giovanni de} and Giuliana Valerio",
year = "2019",
month = "8",
day = "6",
doi = "10.1177/2047487319868326",
language = "English",
pages = "2047487319868326",
journal = "European Journal of Preventive Cardiology",
issn = "2047-4873",
publisher = "SAGE Publications Ltd",

}

TY - JOUR

T1 - The American Academy of Pediatrics hypertension guidelines identify obese youth at high cardiovascular risk among individuals non-hypertensive by the European Society of Hypertension guidelines

AU - CARITALY Study on the behalf of the Childhood Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology

AU - Bonito, Procolo Di

AU - Licenziati, Maria Rosaria

AU - Baroni, Marco G

AU - Maffeis, Claudio

AU - Morandi, Anita

AU - Manco, Melania

AU - Miraglia Del Giudice, Emanuele

AU - Sessa, Anna Di

AU - Campana, Giuseppina

AU - Moio, Nicola

AU - Gilardini, Luisa

AU - Chiesa, Claudio

AU - Pacifico, Lucia

AU - Simone, Giovanni de

AU - Valerio, Giuliana

PY - 2019/8/6

Y1 - 2019/8/6

N2 - BACKGROUND: Two different systems for the screening and diagnosis of hypertension (HTN) in children currently coexist, namely, the guidelines of the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH). The two systems differ in the lowered cut-offs proposed by the AAP versus ESH.OBJECTIVES: We evaluated whether the reclassification of hypertension by the AAP guidelines in young people who were defined non-hypertensive by the ESH criteria would classify differently overweight/obese youth in relation to their cardiovascular risk profile.METHODS: A sample of 2929 overweight/obese young people (6-16 years) defined non-hypertensive by ESH (ESH-) was analysed. Echocardiographic data were available in 438 youth.RESULTS: Using the AAP criteria, 327/2929 (11%) young people were categorized as hypertensive (ESH-/AAP+). These youth were older, exhibited higher body mass index, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), triglycerides, total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, blood pressure, left ventricular mass index and lower HDL-C (p <0.025-0.0001) compared with ESH-/AAP-. The ESH-/AAP+ group showed a higher proportion of insulin resistance (i.e. HOMA-IR ≥3.9 in boys and 4.2 in girls) 35% vs. 25% (p <0.0001), high TC/HDL-C ratio (≥3.8 mg/dl) 35% vs. 26% (p = 0.001) and left ventricular hypertrophy (left ventricular mass index ≥45 g/h2.16) 67% vs. 45% (p = 0.008) as compared with ESH-/AAP-.CONCLUSIONS: The reclassification of hypertension by the AAP guidelines in young people overweight/obese defined non-hypertensive by the ESH criteria identified a significant number of individuals with high blood pressure and abnormal cardiovascular risk. Our data support the need of a revision of the ESH criteria.

AB - BACKGROUND: Two different systems for the screening and diagnosis of hypertension (HTN) in children currently coexist, namely, the guidelines of the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH). The two systems differ in the lowered cut-offs proposed by the AAP versus ESH.OBJECTIVES: We evaluated whether the reclassification of hypertension by the AAP guidelines in young people who were defined non-hypertensive by the ESH criteria would classify differently overweight/obese youth in relation to their cardiovascular risk profile.METHODS: A sample of 2929 overweight/obese young people (6-16 years) defined non-hypertensive by ESH (ESH-) was analysed. Echocardiographic data were available in 438 youth.RESULTS: Using the AAP criteria, 327/2929 (11%) young people were categorized as hypertensive (ESH-/AAP+). These youth were older, exhibited higher body mass index, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), triglycerides, total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, blood pressure, left ventricular mass index and lower HDL-C (p <0.025-0.0001) compared with ESH-/AAP-. The ESH-/AAP+ group showed a higher proportion of insulin resistance (i.e. HOMA-IR ≥3.9 in boys and 4.2 in girls) 35% vs. 25% (p <0.0001), high TC/HDL-C ratio (≥3.8 mg/dl) 35% vs. 26% (p = 0.001) and left ventricular hypertrophy (left ventricular mass index ≥45 g/h2.16) 67% vs. 45% (p = 0.008) as compared with ESH-/AAP-.CONCLUSIONS: The reclassification of hypertension by the AAP guidelines in young people overweight/obese defined non-hypertensive by the ESH criteria identified a significant number of individuals with high blood pressure and abnormal cardiovascular risk. Our data support the need of a revision of the ESH criteria.

U2 - 10.1177/2047487319868326

DO - 10.1177/2047487319868326

M3 - Article

C2 - 31387383

SP - 2047487319868326

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

SN - 2047-4873

ER -