Screening for hypertension in young people with obesity: Feasibility in the real life

• Published in: Nutrition, metabolism, and cardiovascular diseases metabolism, and cardiovascular diseases, 2022-05, Vol.32 (5), p.1301-1307
• Main Authors: Di Bonito, P., Licenziati, M.R., Morandi, A., Maffeis, C., Miraglia del Giudice, E., Di Sessa, A., Campana, G., Wasniewska, M., Corica, D., Valerio, G.
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Blood Pressure; Blood Pressure Determination; Child; Children; Familial hypertension; Feasibility Studies; Humans; Hypertension; Hypertension - diagnosis; Hypertension - epidemiology; Obesity; Obesity - diagnosis; Obesity - epidemiology; Overweight; Overweight - diagnosis
• ISSN: 0939-4753; 1590-3729
• DOI: 10.1016/j.numecd.2022.02.001

Screening for pediatric hypertension (HTN) is based on several measurements of blood pressure (BP) in different visits. We aimed to assess its feasibility in outpatient youths with overweight/obesity (OW/OB) in terms of adherence to two-repeated measurements of BP and to show the features of youths who missed the follow-up and the predictive role of clinical and/or anamnestic features on confirmed HTN. Six hundred, eighty-eight youths (9–17 years) with OW/OB, consecutively recruited, underwent a first measurement of BP. Those exhibiting BP levels within the hypertensive range were invited to repeat a second measurement within 1–2 weeks. Confirmed HTN was diagnosed when BP in the hypertensive range was confirmed at the second measurement. At entry, 174 youths (25.1%) were classified as hypertensive. At the second visit, 66 youths (37.9%) were lost to follow-up. In the remaining 108 participants, HTN was confirmed in 59, so that the prevalence of confirmed HTN was 9.5% in the overall sample; it was higher in adolescents than children (15.9% vs 6.8%, P = 0.001). HTN at first visit showed the best sensitivity (100%) and a good specificity (91%) for confirmed HTN. The association of HTN at first visit plus familial HTN showed high specificity (98%) and positive predictive value of 70%. The high drop-out rate confirms the real difficulty to obtain a complete diagnostic follow up in the obese population. Information about family history of HTN may assist pediatricians in identifying those children who are at higher risk of confirmed HTN. •Screening for hypertension needs repeated measurements and several visits.•Drop-out of 38% was found in overweight/obese youths after the first measurement.•Information about familial hypertension helps identifying children at risk.•Feasibility to fulfill repeated measurements is crucial in obese youths.•Simplification of the screening procedure is needed to confirm hypertension.