Nearly half of youth with obesity also have high BP

Almost half of the children and adolescents who were enrolled in a pediatric weight management program for obesity also had high BP, according to research published in The Journal of Clinical Hypertension.

“Because treatment of high BP in childhood could potentially reduce long-term cardiovascular risks, it is of particular importance to understand prevalence and risks for high BP among youth with obesity in the clinical setting to plan for their evaluation and management needs,” Helen Binns, MD, MPH, a director at the Ann & Robert H. Lurie Children's Hospital of Chicago, and colleagues wrote.

The researchers retrospectively analyzed data from 7,493 children and adolescents aged 3 to 17 years who presented to one of 35 pediatric weight management programs in the Pediatric Obesity Weight Evaluation Registry (POWER). Most of the youth in the study were girls (53.8%), non-Hispanic white (39.4%) and aged 9 to 11 years (32.1%). The researchers used AAP’s 2017 pediatric hypertension guidelines to put their findings into context.

According to Binns and colleagues, 48.9% of the participants had high BP (elevated = 18.9%; stage 1 = 23.9%; stage 2 = 6%). Among them, 60% had class 3 obesity, 45.9% had class 2 obesity and 37.7% had class 1 obesity.

A multivariate analysis found that children and adolescents who had high BP were more likely to be male and have severe obesity than those with normal BP. This analysis also showed that the youth aged 3 to 14 years were less likely to have high BP compared with those aged 15 to 17 years. Non-Hispanic white youth were more likely to have high BP than non-Hispanic Black youth but were closely aligned to the Hispanic and other/multiracial non-Hispanic cohorts.

Further analyses identified severe obesity and male sex as factors associated with stage 1 and stage 2 BP. A youth’s race was not significantly associated with BP status, according to the researchers.

“While a limitation within POWER is the lack of information about BP measurement validation, these data were obtained during clinical care and highlight the diversity of the frequency of high BP between pediatric weight management programs. Individual pediatric weight management programs may wish to examine the frequency of high BP for their program in comparison to these data and, as necessary, review adherence to protocols for BP measurement,” Binns and colleagues wrote. “Some patients may have already had a diagnosis of hypertension and were receiving antihypertensive medications for treatment at the time of their initial personal weight management visit. Diagnoses and medications were not uniformly collected and thus were not analyzed.”

The researchers called on pediatric weight management programs to create uniform BP assessments. They also encouraged repeated BP measurements of pediatric patients as it is a more accurate predictor of long-term BP status and a requirement to diagnose hypertension.