scholarly journals Obesity-Related Hypertension in Pediatrics, the Impact of American Academy of Pediatrics Guidelines

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2586
Author(s):  
Irene Rutigliano ◽  
Gianpaolo De Filippo ◽  
Luigi Pastore ◽  
Giovanni Messina ◽  
Carlo Agostoni ◽  
...  
Keyword(s):  
Blood Pressure ◽  
American Academy ◽  
Hepatic Steatosis ◽  
Laboratory Data ◽  
Age Groups ◽  
Positive Association ◽  
Obese Children ◽  
American Academy Of Pediatrics ◽  
The Impact ◽  
Diagnosis Of Hypertension

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.

scholarly journals Prevalence of high blood pressure among Canadian Children: 2017 American Academy of Pediatrics guidelines with the Canadian Health Measures Survey

2020 ◽  
Author(s):  
Suzanne K Robinson ◽  
Celia J Rodd ◽  
Daniel L Metzger ◽  
Atul K Sharma
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
American Academy ◽  
High Blood Pressure ◽  
Dietary Salt ◽  
Health Measures ◽  
American Academy Of Pediatrics ◽  
Canadian Health ◽  
The Impact ◽  
Canadian Health Measures Survey

Abstract Background We assess the impact of the 2017 American Academy of Pediatrics (AAP) guidelines on the prevalence of high blood pressure (BP) in generally healthy Canadian children and identify risk factors associated with high BP (elevated, stage 1, or stage 2 at a single visit). Methods A cohort of 7,387 children aged 6 to 18 years in the Canadian Health Measures Survey (CHMS, 2007 to 2015) had BPTru oscillometry with centiles and stages assigned using both the 2017 AAP guidelines and the 2004 Fourth Report from the National Institute of Health/National Heart Lung and Blood Institute (NIH/NHLBI). Results Although both shifted upwards significantly, mean population systolic BP and diastolic BP percentiles are now 24.2 (95% confidence interval: 23.3 to 25.2) and 46.4 (45.3 to 47.6). As a result, the population prevalence of high BP increased from 4.5% (3.9 to 5.2, NIH/NHLBI) to 5.8% (5.0 to 6.6, AAP), less than in US children measured by auscultation (14.2%, 13.4 to 15.0). Children with high BP were more likely to be overweight/obese, to be exposed to prenatal/household smoking, and to have hypertriglyceridemia, without differences in dietary salt, infant breastfeeding, neonatal hospitalizations, or exercise frequency. Conclusion The 2017 AAP guidelines increase the prevalence of high BP in Canadian children; Canadian prevalence appears lower than in the USA. This may reflect differences in measurement methods or in the prevalence of childhood overweight/obesity between countries, that is, 31.1% (28.9 to 33.3) versus 40.6% (39.5 to 42.0), respectively. Those with high BP were more likely to have other cardiac risk factors, including overweight/obesity, prenatal/household smoking exposure, and hypertriglyceridemia.

scholarly journals Use of physical activity and cardiorespiratory fitness in identifying cardiovascular risk factors in male brazilian adolescents

2016 ◽  
Vol 18 (6) ◽  
pp. 678
Author(s):  
Lilian Messias Sampaio Brito ◽  
Luis Paulo Gomes Mascarenhas ◽  
Deise Cristiane Moser ◽  
Ana Cláudia Kapp Titski ◽  
Monica Nunes Lima Cat ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Body Mass ◽  
Cardiorespiratory Fitness ◽  
High Blood Pressure ◽  
Abdominal Obesity ◽  
Age Groups ◽  
Cross Sectional ◽  
The Impact

DOI: http://dx.doi.org/10.5007/1980-0037.2016v18n6p678 The aim of this study was to investigate the impact of physical activity (PA) and cardiorespiratory fitness (CRF) levels on the prevalence of overweight and high blood pressure levels in adolescents. In this observational, cross-sectional study, 614 boys aged 10-14 years were assessed for height, body mass, body mass index (BMI), waist circumference (WC) and blood pressure (BP). CRF was assessed using a run test (Léger Test) and subjects were then grouped according to their CRF level. PA level was assessed through a questionnaire (The Three Day Physical Activity Recall) and classified into two groups, namely > 300 minutes of PA/week and < 300 minutes of PA/week. Maturational stage was evaluated according to the development of pubic hair (self-assessment) as proposed by Tanner. We used statistical descriptive analysis, univariate and multivariate analyses in the total participants and subjects were divided by age. Fifty percent of the sample performed < 300 minutes of PA/week and 67.6% had unsatisfactory CRF levels. There was a higher prevalence of unsatisfactory CRF levels among subjects with altered BMI (overweight), WC (abdominal obesity) or BP (high blood pressure) for all age groups. PA history, however, did not show any significance. A total of 31% of participants were overweight, 24.8% had abdominal obesity and 15.4% had increased BP. Unsatisfactory CRF levels were found to be a better predictor for the diagnosis of cardiovascular diseases (CV) risk factors than PA history, regardless of age group. 

scholarly journals 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

2019 ◽  
Vol 27 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Procolo Di Bonito ◽  
Maria Rosaria Licenziati ◽  
Marco G Baroni ◽  
Claudio Maffeis ◽  
Anita Morandi ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Young People ◽  
American Academy ◽  
Left Ventricular Mass Index ◽  
Left Ventricular ◽  
American Academy Of Pediatrics ◽  
Hypertension Guidelines ◽  
Obese Youth

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.

Impact of the 2017 American Academy of Pediatrics’ Clinical Practice Guideline on the Identification and Risk Stratification of Youth at Increased Cardiovascular Disease Risk

Hypertension ◽  
2021 ◽  
Author(s):  
Tammy M. Brady ◽  
Kathleen Altemose ◽  
Elaine M. Urbina
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Clinical Practice ◽  
Risk Stratification ◽  
American Academy ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
American Academy Of Pediatrics

The updated clinical practice guideline (CPG) published by the American Academy of Pediatrics in 2017 introduced significant changes to the diagnostic and evaluative approach towards children with elevated blood pressure. The goals of this review were to summarize the current evidence regarding the impact of the new CPG on the identification and risk stratification of children at increased cardiovascular disease risk. Universally, the new CPG definitions of abnormal blood pressure led to more children classified as having a hypertensive blood pressure when compared with alternative definitions. Youth who moved to a higher blood pressure stage with the CPG typically had worse cardiometabolic profiles and more comorbidites. The association of CPG-defined hypertension and concurrent intermediate cardiovascular disease outcomes such as left ventricular hypertrophy and increased pulse wave velocity remains unclear; however, longitudinal data suggests an improved identification of those at greatest risk for adult cardiovascular disease with the CPG definitions. The majority of studies reviewed used blood pressure from one encounter, not replicate blood pressures from multiple visits, to define an abnormal or hypertensive blood pressure. Therefore, future studies investigating the prevalence of confirmed hypertension and the association between confirmed hypertension and outcomes are needed to optimally characterize the performance of the new CPG on identifying children at cardiovascular disease risk.

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

2019 ◽  
Vol 37 (4) ◽  
pp. 732-738 ◽  
Author(s):  
Procolo Di Bonito ◽  
Giuliana Valerio ◽  
Lucia Pacifico ◽  
Claudio Chiesa ◽  
Cecilia Invitti ◽  
...  
Keyword(s):  
Blood Pressure ◽  
American Academy ◽  
American Academy Of Pediatrics ◽  
Obese Youth

scholarly journals Impact of Model Choice When Studying the Relationship Between Blood Pressure Variability and Risk of Stroke Recurrence

Hypertension ◽  
2021 ◽  
Author(s):  
Hugues de Courson ◽  
Loïc Ferrer ◽  
Antoine Barbieri ◽  
Phillip J. Tully ◽  
Mark Woodward ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Proportional Hazards ◽  
Cox Model ◽  
Positive Association ◽  
Vascular Risk Factor ◽  
Stroke Recurrence ◽  
The Impact ◽  
Over Time

Long-term blood pressure variability (BPV), an increasingly recognized vascular risk factor, is challenging to analyze. The objective was to assess the impact of BPV modeling on its estimated effect on the risk of stroke. We used data from a secondary stroke prevention trial, PROGRESS (Perindopril Protection Against Stroke Study), which included 6105 subjects. The median number of blood pressure (BP) measurements was 12 per patient and 727 patients experienced a first stroke recurrence over a mean follow-up of 4.3 years. Hazard ratios (HRs) of BPV were estimated from 6 proportional hazards models using different BPV modeling for comparison purposes. The 3 commonly used methods first derived SD of BP measures observed over a given period of follow-up and then used it as a fixed covariate in a Cox model. The 3 more advanced modeling accounted for changes in BP or BPV over time in a single-stage analysis. While the 3 commonly used methods produced contradictory results (for a 5 mmHg increase in BPV, HR=0.75 [95% CI, 0.68–0.82], HR=0.99 [0.91–1.08], HR=1.19 [1.10–1.30]), the 3 more advanced modeling resulted in a similar moderate positive association (HR=1.08 [95% CI, 0.99–1.17]), whether adjusted for BP at randomization or mean BP over the follow-up. The method used to assess BPV strongly affects its estimated effect on the risk of stroke, and should be chosen with caution. Further methodological developments are needed to account for the dynamics of both BP and BPV over time, to clarify the specific role of BPV.

scholarly journals Association of BMI on Systolic and Diastolic Blood Pressure In Normal and Obese Children

2011 ◽  
Vol 1 (3) ◽  
pp. 101-105
Author(s):  
Zuhal Gundogdu
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Diastolic Blood Pressure ◽  
Body Mass ◽  
Age Groups ◽  
Normal Growth ◽  
Normal Weight ◽  
Obese Children ◽  
Normal Children ◽  
Age Related

Background Definition of childhood overweight/obesity should aim to identify children with excess body fat in order to treat the associated adverse health outcomes. Objective To investigate relationship between Body Mass Index (BMI) and systolic blood pressure (SBP) and diastolic blood pressure (DBP) values in children between the ages of 6 and 14 year old. Materials and Methods Secondary data gathered from public health screening days at Child Health and Diseases Polyclinic of Kocaeli Metropolitan Municipality Maternity and Children Hospital on 1899 children. Each child was classified on the basis of age- and sex-specific Body Mass Index percentile (BMI%) as normal weight (BMI% < 85th), overweight (BMI% ≥ 85th and < 95th), or obese (BMI% ≥ 95th). Systolic and diastolic blood pressures were compared among age-sex-BMI percentile groups. Results SBP and DBP values are higher in obese and overweight children compared to normal children. Among all children in this study, being overweight and obese increased the likelihood of elevated SBP and DBP values after adjusting for age.  Blood pressure (BP) is increasing with increasing BMI in all age groups (6 to 14 year old) and this is also found at a young age. The same trend is also present within the normal BMI% group. Conclusions Our results show that BMI is associated with elevated systolic and diastolic blood pressure in overweight and obese children as well as children in normal BMI% group. BP is increasing with increasing BMI values even in normal group but the increase is more in obese children. Hence, maintaining age related normal growth increase in the BMI in childhood is important in preventing higher BP values later in life.Keywords: Body Mass Index; BMI; Blood pressure; Children DOI: http://dx.doi.org/10.3126/nje.v1i3.5574 Nepal Journal of Epidemiology 2011;1(3) 101-105

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