A significant number of overweight and obese young people who are classified as nonhypertensive by the European Society of Hypertension (ESH) criteria have high blood pressure and increased cardiovascular risk, according to newer American Academy of Pediatrics (AAP) guidelines. Results of the study were published in the European Journal of Preventive Cardiology.

The results indicate that the ESH criteria should be updated to better identify those at risk in this patient population.

The study included children and adolescents (aged 6-16 years) with overweight or obesity who were classified as nonhypertensive by ESH criteria and had complete anthropometric and biochemical data available (N=2929). Of these patients, 438 had available echocardiograph measurements. The researchers used logistic regression analysis adjusted for treatment center, age, and body mass index to compare cardiovascular risk factors in patients categorized as nonhypertensive by both the ESH and AAP guidelines and those reclassified as hypertensive by AAP guidelines.

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When the researchers applied the AAP criteria to the study cohort, 11% (n=327) were categorized as hypertensive. Individuals in this group were older, had lower high-density lipoprotein cholesterol (HDL-C) level, and had higher body mass index, homeostatic model assessment of insulin resistance (HOMA-IR) score, triglyceride level, total cholesterol to HDL-C ratio, blood pressure, and left ventricular mass index compared with those classified as normotensive by both ESH and AAP guidelines.

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Further, compared with the nonhypertensive group, children and adolescents reclassified as hypertensive under newer AAP criteria but recognized as normotensive under ESH guidelines had a higher percentage of insulin resistance (35% vs 25%; P <.0001), high total cholesterol to HDL-C ratio (35% vs 26%; P =.001), and left ventricular hypertrophy (67% vs 45%; P =.008).

The study’s limitations included the cross-sectional design and lack of a normal-weight group.

“[T]he use of AAP 2017 criteria may allow an earlier identification and management of high-risk obese youth in order to prevent the progression of cardiovascular damage,” the researchers wrote.


Di Bonito P, Licenziati MR, Baroni MG, et al. 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 [published online August 6, 2019]. Eur J Prev Cardiol. doi:10.1177/2047487319868326

This article originally appeared on Endocrinology Advisor