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Blood Pressure in 57,915 Pediatric Patients Who Are Overweight or Obese Based on Five Reference Systems

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The aim of this study was to determine the prevalence of hypertension in overweight or obese pediatric subjects using different national or international references, which are based either on the entire population or on normal weight children only: 188 centers from Germany, Austria, and Switzerland participated in the Adipositas Patienten Verlaufsbeobachtung initiative. Data from 57,915 children aged 6 to 18 years who are overweight or obese were used to determine the prevalence of prehypertension and hypertension based on Second Task Force, European pooled data, Fourth Report all and Fourth Report nonoverweight, or German Health Interview and Examination Survey for Children and Adolescents (KiGGS) references. Three references included overweight children, whereas 2 (Fourth Report nonoverweight and KiGGS) were based on nonoverweight children only. Based on KiGGS, Fourth Report nonoverweight, Fourth Report all, European pooled data, or Second Task Force, the prevalence of hypertension was 47%, 42%, 36%, 32%, and 27%, respectively. Recent references classified more children as hypertensive, whereas fewer children fell into the prehypertensive group. Only 22% of children were classified as hypertensive by each of the 5 references (8% as prehypertensive). The prevalence of normal blood pressure was independent of the reference applied. Hypertension as defined by the different reference systems was significantly correlated, and all methods were significantly associated with impaired glucose metabolism or dyslipidemia, without significant differences in methods. In conclusion, the diagnosis of elevated blood pressure depends on the reference population used. A nonoverweight reference population substantially increases the prevalence of hypertension in children and adolescents who are overweight or obese. The choice of the reference has significant implications for risk stratification and treatment decisions.

Section snippets

Methods

The “Adipositas Patienten Verlaufsbeobachtung” (APV, obese patients observational study) is a standardized multicenter database of children and adolescents who are overweight or obese (www.a-p-v.de).4 A total of 188 specialized obesity care centers (161 outpatient programs and 27 inpatient rehabilitation institutions) in Germany, Austria, and Switzerland participated in the study from January 2000 to October 2012. The data were anonymized and transmitted for central analysis to the University

Results

In Figure 2, BP in children, aged 6 to 18 years, who were overweight/obese was evaluated according to Second Task Force published in 1987, ESH European pooled data (1991), ESH Fourth Report all (2004), ESH Fourth Report nonoverweight (2008), and KiGGS (2011). Major differences were observed in the classification of hypertension: Referred to a solely nonoverweight German reference population (KiGGS), the prevalence of hypertension was highest with 47.3%, followed by Fourth Report nonoverweight

Discussion

In the study population, the prevalence of hypertension depended on the reference used. The 2 most recent reference systems based on nonoverweight reference populations (Fourth Report nonoverweight and KiGGS) resulted in the highest rates of hypertension, whereas the 2 older references (Second Task Force and European pooled data) returned lower rates. Weight or BMI is an important predictor of BP in children: consequently, the highest percentage of abnormal BP was found when nonoverweight

Acknowledgment

We thank all health professionals of the APV study group taking care of the children and contributing to the APV database (list of all participating centers is provided in the Appendix).

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