Blood Pressure in 57931 Overweight or Obese Paediatric Patients Based on Five

Reference Systems

Reinhard W. HollUniversity of Ulm, Epidemiology und med. Biometry

Flechtner-Mors M, Neuhauser H, Reinehr T, Roost HP, Wiegand S, Siegfried W, Zwiauer K, APV initiative

(Ulm, Berlin RKI, Witten/Herdecke, Guglera Switzerland, Berlin Charité, Bischofswiesen, St. Pölten Austria)

ECOG 1014, Salzburg

What is the APV initiative?

Standardized longitudinal documentationof (paediatric) patients with overweight or obesity treated at specialized obesity carefacilities in Germany, Austria or Switzerland.

Anonymized data are used for external qualitymonitoring, center certification (German workingGroup on obesity in children and adolescents)and for patient-oriented research.

Funded by German ministry ofeducation and research (competence network obesity)

Information available at http://www.

a-p-v.de

Available data: 200 centers 95 981 patients354 660 visits

Inclusion Criteria

Age 6 – 18 years(normative data for all references available)

BMI > 90. percentile according toGerman AGA charts (overweight or obese)

Blood pressure recording

57 931 patients from 188 centres

Methods

Anonymized data, APV registry

October 2012

SAS Version 9.4

Hierarchic mixed multiple logistic regression analysisCenter as random effectDenominator degrees of freedom: Kenward-RogerIterations by Newton-RaphsonEstimation method: Maximum likelihood marginal expansion

Co-Morbidity in Obese Adolescents

Hypertension in children / adolescents

Definition:

Normal: < 90. Percentile

Pre-hypertension: 90.-95. Percentile or ≥120/80 mmHg

Hypertension: ≥ 95th Percentile (Lurbe, ESH, 2009)

Reference:

Hypertension in children / adolescents

Reference:1)Second Task Force, 1987

n = 72429, age-group and gender, 9 studies2)European Pooled Data, deMan, 1991

n = 28043, age and gender, 6 studies3)4th Report, 2004

n = 63227, age, gender and height4)4th Report, non-overweight, Rosner 2008 n = 49967, age, gender and height5) German KiGGS data, Neuhauser 2011

n = 14349, German, population based study, non-overweight children only,

age, gender and height

Hypertension in 57931 overweight/obesechildren / adolescents

Hypertension by BMI category

Hypertension in overweight/obesechildren / adolescents

More hypertension in shorter children: (exception: 2nd TF, KiGGS)

Gender difference: > ; 2nd TF, 4th Report, KiGGS

> ; European Pooled Data

Conclusions: The diagnosis of elevated blood pressure depends on the reference population used.

A non-overweight reference population substantially increases the prevalence of hypertension in overweight or obese children and adolescents.

The choice of the reference has significant implications for risk stratification and treatment decisions.

Every center is invited to participate in the APV initiative!

For information see http://www.a-p-v.de

Thank you for your attention!