Impact of the 2017 Blood Pressure Guidelines by the American Academy of Pediatrics in overweight/obese youth

Objectives: The aim of this study was to compare the impact of the European Society of Hypertension Guidelines 2016 (ESHG(2016)) and the American Academy of Pediatrics Guidelines 2017 (AAPG(2017)) on the screening of hypertension and classification of abnormal left ventricular geometry (ALVG) in overweight/obese youth. Methods: This study included 6137 overweight/obese youth; 437 had echocardiographic assessment. Hypertension was defined using either ESHG(2016) or AAPG(2017). ALVG was defined using 95th percentile for age and sex of left ventricular mass index (LVMi) and/or relative wall thickness (RWT) more than 0.38 (juvenile cutoffs) according to ESHG(2016) or LVMi more than 51 g/h(2.7) and/or RWT more than 0.42 (adult cut-offs) according to AAPG(2017). Results: Prevalence of youth at a high risk of hypertension was 13% higher using AAPG(2017) than ESHG(2016). The increase was larger in overweight youth at least 13 years of age (+43%). Using the juvenile cut-offs for ALVG, youth at a high risk of hypertension by ESHG(2016) had an odds ratio [95% confidence interval (95% CI)] of 3.03 (1.31-7.05) for left ventricular concentric remodelling (LVcr) and 2.53 (1.43-4.47) for concentric left ventricular hypertrophy (cLVH) as compared with youth with normal LVG. Similarly, in youth at a high risk of hypertension by AAPG(2017), the odds ratio for LVcr was 3.28 (1.45-7.41, P < 0.001) and 3.02 (95% CI: 1.73-5.27, P < 0.001) for cLVH. Using the adult cut-offs, no significant difference in ALVG was found with both guidelines. Conclusion: The prevalence of overweight/obese youth at a high risk of hypertension increased by 13% comparing AAPG(2017) vs. ESHG(2016). The juvenile cut-offs for ALVG were more effective than the adult criteria in intercepting individuals with a potentially higher cardiovascular risk.