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Abstract：
The aim of this study was to compare the impact of the European Society of Hypertension Guidelines 2016 (ESHG2016) and the American Academy of Pediatrics Guidelines 2017 (AAPG2017) on the screening of hypertension and classification of abnormal left ventricular geometry (ALVG) in overweight/obese youth.
This study included 6137 overweight/obese youth; 437 had echocardiographic assessment. Hypertension was defined using either ESHG2016 or AAPG2017. ALVG was defined using 95th percentile for age and sex of left ventricular mass index (LVMi) and/or relative wall thickness (RWT) more than 0.38 (juvenile cut-offs) according to ESHG2016 or LVMi more than 51 g/h and/or RWT more than 0.42 (adult cut-offs) according to AAPG2017.
Prevalence of youth at a high risk of hypertension was 13% higher using AAPG2017 than ESHG2016. The increase was larger in overweight youth at least 13 years of age (+43%). Using the juvenile cut-offs for ALVG, youth at a high risk of hypertension by ESHG2016 had an odds ratio [95% confidence interval (95% CI)] of 3.03 (1.31-7.05) for left ventricular concentric remodelling (LVcr) and 2.53 (1.43-4.47) for concentric left ventricular hypertrophy (cLVH) as compared with youth with normal LVG. Similarly, in youth at a high risk of hypertension by AAPG2017, the odds ratio for LVcr was 3.28 (1.45-7.41, P < 0.001) and 3.02 (95% CI: 1.73-5.27, P < 0.001) for cLVH. Using the adult cut-offs, no significant difference in ALVG was found with both guidelines.
The prevalence of overweight/obese youth at a high risk of hypertension increased by 13% comparing AAPG2017 vs. ESHG2016. The juvenile cut-offs for ALVG were more effective than the adult criteria in intercepting individuals with a potentially higher cardiovascular risk.
This study included 6137 overweight/obese youth; 437 had echocardiographic assessment. Hypertension was defined using either ESHG2016 or AAPG2017. ALVG was defined using 95th percentile for age and sex of left ventricular mass index (LVMi) and/or relative wall thickness (RWT) more than 0.38 (juvenile cut-offs) according to ESHG2016 or LVMi more than 51 g/h and/or RWT more than 0.42 (adult cut-offs) according to AAPG2017.
Prevalence of youth at a high risk of hypertension was 13% higher using AAPG2017 than ESHG2016. The increase was larger in overweight youth at least 13 years of age (+43%). Using the juvenile cut-offs for ALVG, youth at a high risk of hypertension by ESHG2016 had an odds ratio [95% confidence interval (95% CI)] of 3.03 (1.31-7.05) for left ventricular concentric remodelling (LVcr) and 2.53 (1.43-4.47) for concentric left ventricular hypertrophy (cLVH) as compared with youth with normal LVG. Similarly, in youth at a high risk of hypertension by AAPG2017, the odds ratio for LVcr was 3.28 (1.45-7.41, P < 0.001) and 3.02 (95% CI: 1.73-5.27, P < 0.001) for cLVH. Using the adult cut-offs, no significant difference in ALVG was found with both guidelines.
The prevalence of overweight/obese youth at a high risk of hypertension increased by 13% comparing AAPG2017 vs. ESHG2016. The juvenile cut-offs for ALVG were more effective than the adult criteria in intercepting individuals with a potentially higher cardiovascular risk.
摘要：
这项研究的目的是比较2016年欧洲高血压学会指南（ESHG2016）和2017年美国儿科学会指南（AAPG2017）对超重/肥胖青年高血压筛查和左心室几何结构异常（ALVG）分类的影响。
这项研究包括6137名超重/肥胖青年；437人进行了超声心动图评估。使用ESHG2016或AAPG2017定义高血压。根据ESHG2016，左心室质量指数（LVMi）和/或相对壁厚（RWT）超过0.38（青少年临界值）的年龄和性别使用第95百分位数定义ALVG，或根据AAPG2017，LVMi超过51g/h和/或RWT超过0.42（成人临界值）。
使用AAPG2017的高血压高危青少年患病率比ESHG2016高13%。在至少13岁的超重青年中，增幅更大（43％）。使用ALVG的青少年切口，与LVG正常的青年相比,ESHG2016时高血压高危青年的左心室同心重塑(LVcr)比值比[95%可信区间(95%CI)]为3.03(1.31~7.05),同心左心室肥厚(cLVH)比值比[1.43~4.47].同样，根据AAPG2017,在高血压高危人群中,LVcr的比值比为3.28(1.45~7.41,P<0.001),cLVH的比值比为3.02(95%CI:1.73~5.27,P<0.001).使用成人截止日期，两种指南在ALVG方面均无显著差异.
与AAPG2017相比，超重/肥胖青年高血压高危人群的患病率增加了13%ESHG2016.在截获具有潜在较高心血管风险的个体方面，ALVG的青少年截止比成人标准更有效。
这项研究包括6137名超重/肥胖青年；437人进行了超声心动图评估。使用ESHG2016或AAPG2017定义高血压。根据ESHG2016，左心室质量指数（LVMi）和/或相对壁厚（RWT）超过0.38（青少年临界值）的年龄和性别使用第95百分位数定义ALVG，或根据AAPG2017，LVMi超过51g/h和/或RWT超过0.42（成人临界值）。
使用AAPG2017的高血压高危青少年患病率比ESHG2016高13%。在至少13岁的超重青年中，增幅更大（43％）。使用ALVG的青少年切口，与LVG正常的青年相比,ESHG2016时高血压高危青年的左心室同心重塑(LVcr)比值比[95%可信区间(95%CI)]为3.03(1.31~7.05),同心左心室肥厚(cLVH)比值比[1.43~4.47].同样，根据AAPG2017,在高血压高危人群中,LVcr的比值比为3.28(1.45~7.41,P<0.001),cLVH的比值比为3.02(95%CI:1.73~5.27,P<0.001).使用成人截止日期，两种指南在ALVG方面均无显著差异.
与AAPG2017相比，超重/肥胖青年高血压高危人群的患病率增加了13%ESHG2016.在截获具有潜在较高心血管风险的个体方面，ALVG的青少年截止比成人标准更有效。
