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Impact of ESH and AAP hypertension guidelines for children and adolescents on office and ambulatory blood pressure-based classifications

Lurbe, Empara,b; Torró, Isabela,b; Álvarez, Julioa,b; Aguilar, Franciscoa,b; Mancia, Giuseppec; Redon, Josepb,d; Redon, Paua,b

doi: 10.1097/HJH.0000000000002229
ORIGINAL PAPERS: BP measurement and hemodynamic aspects

Background: The objective was to assess the differences between the 2016 European Society of Hypertension (ESH) and the 2017 American Academy of Pediatrics (AAP) hypertension (HTN) guidelines in the distribution of office blood pressure (BP) categories as well as in the office and ambulatory BP mismatches.

Material and methods: The study included 4940 clinical evaluations performed in 2957 youth (5–18 years) of both sexes. BP and anthropometric parameters were measured following standard conditions. The classification of the BP measurements was normotension, high-normal, stages 1 and 2 HTN, following the criteria of both guidelines. In a subgroup of 2467 participants, 3941 office BP assessment was completed with 24-h ambulatory BP monitoring using an oscillometric monitor under standard conditions. The classification on white-coat (WCH) and masked HTN was recorded.

Results: The AAP classified more participants, 70 per 1000 BP evaluations in the categories of high-normal and stage 1 HTN, than the ESH did. The differences were greater in obese, but also present in normal weight participants. Likewise, significant discrepancies were observed in the prevalence of WCH and masked HTN. The AAP identified more participants with WCH, with greater differences in older participants, mainly in boys, independent of weight category. In contrast, the ESH identified more participants with masked HTN. The excess of WCH by AAP was three times higher than the excess of masked HTN by ESH.

Conclusion: The application of the two guidelines may result in marked differences in the classification of high-normal BP and HTN and in the mismatched conditions when ambulatory BP monitoring is applied.

aDepartment of Pediatrics, Consorcio Hospital General, University of Valencia, Valencia

bCIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Madrid, Spain

cClinica Medica, Department of Medicine and Surgery, University Milano-Bicocca, Milano, Italy

dHypertension Clinic, Hospital Clinico, INCLIVA, University of Valencia, Valencia, Spain

Correspondence to Empar Lurbe, MD, PhD, FAHA, Department of Pediatrics, Consorcio Hospital General, University of Valencia, Valencia, Spain. E-mail:

Abbreviations: AAP, American Academy of Pediatrics; ABPM, ambulatory blood pressure monitoring; ACC/AHA, American College of Cardiology/American Heart Association; BP, blood pressure; ESC/ESH, European Society of Cardiology/European Society of Hypertension; ESH, European Society of Hypertension; HR, heart rate; HTN, hypertension; WCH, white-coat hypertension

Received 17 July, 2019

Revised 30 July, 2019

Accepted 30 July, 2019

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