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
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...
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| Veröffentlicht in: | European journal of preventive cardiology 2020-01, Vol.27 (1), p.8-15 |
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| creator | Bonito, Procolo Di Licenziati, Maria Rosaria Baroni, Marco G Maffeis, Claudio Morandi, Anita Manco, Melania Miraglia del Giudice, Emanuele Sessa, Anna Di Campana, Giuseppina Moio, Nicola Gilardini, Luisa Chiesa, Claudio Pacifico, Lucia Simone, Giovanni de Valerio, Giuliana |
| description | 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 |
| doi_str_mv | 10.1177/2047487319868326 |
| format | Article |
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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.</description><identifier>ISSN: 2047-4873</identifier><identifier>EISSN: 2047-4881</identifier><identifier>DOI: 10.1177/2047487319868326</identifier><identifier>PMID: 31387383</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adolescent ; Age Factors ; Blood Pressure ; Child ; Consensus ; Cross-Sectional Studies ; Decision Support Techniques ; Female ; Heart Disease Risk Factors ; Humans ; Hypertension - diagnosis ; Hypertension - epidemiology ; Hypertension - physiopathology ; Italy - epidemiology ; Male ; Pediatric Obesity - diagnosis ; Pediatric Obesity - epidemiology ; Pediatric Obesity - physiopathology ; Practice Guidelines as Topic ; Predictive Value of Tests ; Risk Assessment</subject><ispartof>European journal of preventive cardiology, 2020-01, Vol.27 (1), p.8-15</ispartof><rights>The European Society of Cardiology 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c379t-9764f23c03f76cbce0f40fc79463be6c988e756bd53ad111756579a46c449de53</citedby><cites>FETCH-LOGICAL-c379t-9764f23c03f76cbce0f40fc79463be6c988e756bd53ad111756579a46c449de53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/2047487319868326$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/2047487319868326$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31387383$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bonito, Procolo Di</creatorcontrib><creatorcontrib>Licenziati, Maria Rosaria</creatorcontrib><creatorcontrib>Baroni, Marco G</creatorcontrib><creatorcontrib>Maffeis, Claudio</creatorcontrib><creatorcontrib>Morandi, Anita</creatorcontrib><creatorcontrib>Manco, Melania</creatorcontrib><creatorcontrib>Miraglia del Giudice, Emanuele</creatorcontrib><creatorcontrib>Sessa, Anna Di</creatorcontrib><creatorcontrib>Campana, Giuseppina</creatorcontrib><creatorcontrib>Moio, Nicola</creatorcontrib><creatorcontrib>Gilardini, Luisa</creatorcontrib><creatorcontrib>Chiesa, Claudio</creatorcontrib><creatorcontrib>Pacifico, Lucia</creatorcontrib><creatorcontrib>Simone, Giovanni de</creatorcontrib><creatorcontrib>Valerio, Giuliana</creatorcontrib><creatorcontrib>CARITALY Study on the behalf of the Childhood Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology</creatorcontrib><creatorcontrib>for the CARITALY Study on the behalf of the Childhood Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology</creatorcontrib><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</title><title>European journal of preventive cardiology</title><addtitle>Eur J Cardiovasc Prev Rehabil</addtitle><description>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.</description><subject>Adolescent</subject><subject>Age Factors</subject><subject>Blood Pressure</subject><subject>Child</subject><subject>Consensus</subject><subject>Cross-Sectional Studies</subject><subject>Decision Support Techniques</subject><subject>Female</subject><subject>Heart Disease Risk Factors</subject><subject>Humans</subject><subject>Hypertension - diagnosis</subject><subject>Hypertension - epidemiology</subject><subject>Hypertension - physiopathology</subject><subject>Italy - epidemiology</subject><subject>Male</subject><subject>Pediatric Obesity - diagnosis</subject><subject>Pediatric Obesity - epidemiology</subject><subject>Pediatric Obesity - physiopathology</subject><subject>Practice Guidelines as Topic</subject><subject>Predictive Value of Tests</subject><subject>Risk Assessment</subject><issn>2047-4873</issn><issn>2047-4881</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU9r3DAQxUVpaUKSe05Fx17cyJYsycclpE0g0ELSs5Gl8VqpLW31Z8EfL9-sSjdJobS6aBj95vFGD6HzmnyqayEuGsIEk4LWneSSNvwNOn5qVUzK-u1rLegROovxgZTDSdNI-R4d0ZqWB0mP0eP9BHizQLBaObzRysCyYj_ib2CsSqUd8bTuICRw0XqHt9kamK2DiEvhkh0LPkAEvPqcJqwSnux2wloFY_1eRZ1nFXCw8QdWi3dbbJ2xe2uymiN23lV_5PeAhxWn4ugqB7-D4ujOawvpt6Prf9s4Re_GIgVnz_cJ-v756v7yurr9-uXmcnNbaSq6VHWCs7GhmtBRcD1oICMjoxYd43QArjspQbR8MC1Vpi4f3PJWdIpxzVhnoKUn6ONBdxf8zwwx9YuNGuZZOfA59k3DO0YaykhByQHVwccYYOx3wS4qrH1N-qfs-r-zKyMfntXzsIB5HXhJqgDVAYhqC_2Dz8GVbf8v-Avd4KYx</recordid><startdate>202001</startdate><enddate>202001</enddate><creator>Bonito, Procolo Di</creator><creator>Licenziati, Maria Rosaria</creator><creator>Baroni, Marco G</creator><creator>Maffeis, Claudio</creator><creator>Morandi, Anita</creator><creator>Manco, Melania</creator><creator>Miraglia del Giudice, Emanuele</creator><creator>Sessa, Anna Di</creator><creator>Campana, Giuseppina</creator><creator>Moio, Nicola</creator><creator>Gilardini, Luisa</creator><creator>Chiesa, Claudio</creator><creator>Pacifico, Lucia</creator><creator>Simone, Giovanni de</creator><creator>Valerio, Giuliana</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202001</creationdate><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</title><author>Bonito, Procolo Di ; Licenziati, Maria Rosaria ; Baroni, Marco G ; Maffeis, Claudio ; Morandi, Anita ; Manco, Melania ; Miraglia del Giudice, Emanuele ; Sessa, Anna Di ; Campana, Giuseppina ; Moio, Nicola ; Gilardini, Luisa ; Chiesa, Claudio ; Pacifico, Lucia ; Simone, Giovanni de ; Valerio, Giuliana</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c379t-9764f23c03f76cbce0f40fc79463be6c988e756bd53ad111756579a46c449de53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Age Factors</topic><topic>Blood Pressure</topic><topic>Child</topic><topic>Consensus</topic><topic>Cross-Sectional Studies</topic><topic>Decision Support Techniques</topic><topic>Female</topic><topic>Heart Disease Risk Factors</topic><topic>Humans</topic><topic>Hypertension - diagnosis</topic><topic>Hypertension - epidemiology</topic><topic>Hypertension - physiopathology</topic><topic>Italy - epidemiology</topic><topic>Male</topic><topic>Pediatric Obesity - diagnosis</topic><topic>Pediatric Obesity - epidemiology</topic><topic>Pediatric Obesity - physiopathology</topic><topic>Practice Guidelines as Topic</topic><topic>Predictive Value of Tests</topic><topic>Risk Assessment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bonito, Procolo Di</creatorcontrib><creatorcontrib>Licenziati, Maria Rosaria</creatorcontrib><creatorcontrib>Baroni, Marco G</creatorcontrib><creatorcontrib>Maffeis, Claudio</creatorcontrib><creatorcontrib>Morandi, Anita</creatorcontrib><creatorcontrib>Manco, Melania</creatorcontrib><creatorcontrib>Miraglia del Giudice, Emanuele</creatorcontrib><creatorcontrib>Sessa, Anna Di</creatorcontrib><creatorcontrib>Campana, Giuseppina</creatorcontrib><creatorcontrib>Moio, Nicola</creatorcontrib><creatorcontrib>Gilardini, Luisa</creatorcontrib><creatorcontrib>Chiesa, Claudio</creatorcontrib><creatorcontrib>Pacifico, Lucia</creatorcontrib><creatorcontrib>Simone, Giovanni de</creatorcontrib><creatorcontrib>Valerio, Giuliana</creatorcontrib><creatorcontrib>CARITALY Study on the behalf of the Childhood Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology</creatorcontrib><creatorcontrib>for the CARITALY Study on the behalf of the Childhood Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of preventive cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bonito, Procolo Di</au><au>Licenziati, Maria Rosaria</au><au>Baroni, Marco G</au><au>Maffeis, Claudio</au><au>Morandi, Anita</au><au>Manco, Melania</au><au>Miraglia del Giudice, Emanuele</au><au>Sessa, Anna Di</au><au>Campana, Giuseppina</au><au>Moio, Nicola</au><au>Gilardini, Luisa</au><au>Chiesa, Claudio</au><au>Pacifico, Lucia</au><au>Simone, Giovanni de</au><au>Valerio, Giuliana</au><aucorp>CARITALY Study on the behalf of the Childhood Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology</aucorp><aucorp>for the CARITALY Study on the behalf of the Childhood Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>European journal of preventive cardiology</jtitle><addtitle>Eur J Cardiovasc Prev Rehabil</addtitle><date>2020-01</date><risdate>2020</risdate><volume>27</volume><issue>1</issue><spage>8</spage><epage>15</epage><pages>8-15</pages><issn>2047-4873</issn><eissn>2047-4881</eissn><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.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>31387383</pmid><doi>10.1177/2047487319868326</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of preventive cardiology, 2020-01, Vol.27 (1), p.8-15 |
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| subjects | Adolescent Age Factors Blood Pressure Child Consensus Cross-Sectional Studies Decision Support Techniques Female Heart Disease Risk Factors Humans Hypertension - diagnosis Hypertension - epidemiology Hypertension - physiopathology Italy - epidemiology Male Pediatric Obesity - diagnosis Pediatric Obesity - epidemiology Pediatric Obesity - physiopathology Practice Guidelines as Topic Predictive Value of Tests Risk Assessment |
| 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 |
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