Key result
The 2017 AAP guidelines increased the diagnosis of elevated blood pressure in overweight and obese children to 23.1% compared to 12.5% with the 2004 guidelines (p < 0.001).
Why the study?
The study evaluated the impact of the 2017 AAP guidelines on pediatric hypertension diagnosis and their capacity to identify cardiovascular and metabolic risk.
Does the application of the 2017 AAP guidelines compared to the 2004 AAP guidelines improve the identification of cardiovascular and metabolic risk in overweight and obese children?
Cohort (n=489)
Does the application of the 2017 AAP guidelines compared to the 2004 AAP guidelines improve the identification of cardiovascular and metabolic risk in overweight and obese children?
Absolute Event Rate: 23.1% vs 12.5%
p-value: p=< 0.001
The 2017 AAP guidelines for pediatric hypertension identify more overweight and obese children at risk for organ damage compared to the 2004 guidelines, allowing for earlier prevention strategies.
May increase elevated BP diagnoses in overweight children; leaves open whether 2017 guidelines improve risk stratification or outcomes.
The prevalence of primary hypertension in pediatric patients is increasing, especially as a result of the increased prevalence of obesity in children. New diagnostic guidelines for blood pressure were published by the American Academy of Pediatrics (AAP) in 2017 to better define classes of hypertension in children. The aim of our study is to evaluate the impact of new guidelines on diagnosis of hypertension in pediatrics and their capacity to identify the presence of cardiovascular and metabolic risk. Methods: Retrospective clinical and laboratory data from 489 overweight and obese children and adolescents were reviewed. Children were classified according to the 2004 and 2017 AAP guidelines for systolic and diastolic blood pressure. Lipid profile and glucose metabolism data were recorded; triglyceride/HDL ratio (TG/HDL) was calculated as an index of endothelial dysfunction. Hepatic steatosis was detected using the ultrasonographic steatosis score. Results: Children with elevated blood pressure increased from 12.5% with the 2004 AAP to 23.1% with the 2017 AAP criteria (p < 0.001). There was a statistically significant increase in children with high blood pressure in all age groups according to the new cut-off values. Notably, the diagnosis of hypertension according to 2017 AAP criteria had a greater positive association with Hepatic Steatosis (rho 0.2, p < 0.001) and TG/HDL ratio (rho 0.125, p = 0.025). Conclusions: The 2017 AAP tables offer the opportunity to better identify overweight and obese children at risk for organ damage, allowing an earlier and more impactful prevention strategy to be designed.
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Rutigliano et al. (2021) conducted a cohort in Obesity-Related Hypertension (n=489). 2017 AAP guidelines vs. 2004 AAP guidelines was evaluated on Elevated blood pressure (p=< 0.001). The 2017 AAP guidelines increased the diagnosis of elevated blood pressure in overweight and obese children to 23.1% compared to 12.5% with the 2004 guidelines (p < 0.001).
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