Procolo Di Bonito1, Maria Rosaria Licenziati2, Marco G Baroni3, Claudio Maffeis4, Anita Morandi4, Melania Manco5, Emanuele Miraglia Del Giudice6, Anna Di Sessa6, Giuseppina Campana2, Nicola Moio7, Luisa Gilardini8, Claudio Chiesa9, Lucia Pacifico10, Giovanni de Simone11, Giuliana Valerio12. 1. Department of Internal Medicine, 'S. Maria delle Grazie', Pozzuoli Hospital, Naples, Italy. 2. Department of Paediatrics, AORN Santobono-Pausilipon, Naples, Italy. 3. Department of Experimental Medicine, Sapienza University of Rome, Italy. 4. Paediatric Diabetes and Metabolic Disorders Unit, University of Verona, Italy. 5. IRCCS Bambino Gesù Children's Hospital, Rome, Italy. 6. Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy. 7. Department of Cardiology, 'S. Maria delle Grazie', Pozzuoli, Naples, Italy. 8. IRCCS Istituto Auxologico Italiano, Department of Medical Sciences and Rehabilitation, Milan, Italy. 9. Institute of Translational Pharmacology, National Research Council, Rome, Italy. 10. Policlinico Umberto I Hospital, Sapienza University of Rome, Italy. 11. Hypertension Research Centre and Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy. 12. Department of Movement and Wellbeing Sciences, University of Naples Parthenope, Naples, Italy.
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.
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.
Entities:
Keywords:
Cardiometabolic risk factors; hypertension; left ventricular hypertrophy; paediatric obesity