Prevalence of Hypertension in Adolescents: Differences Between 2016 ESH and 2017 AAP Guidelines

Introduction: The American Academy of Pediatrics (AAP) published in 2017 new guidelines for the screening and management of hypertension in children containing different nomograms compared to the European guidelines, leading to a reclassification of blood pressure values, the consequences of which are still little investigated. The aim of our study was to evaluate the prevalence of high blood pressure values estimated with both the most recent American and European guidelines and to analyze the relationship of blood pressure increases with lifestyles and potentially risky behaviors in a school population in Western Sicily. Methods: On the occasion of the XV World Hypertension Day, blood pressure values of 1301 students aged between 13 and 18 were measured. Two questionnaires were administered, one relating to anamnestic data and anthropometric parameters and a second aimed at investigating lifestyle. For the diagnosis of increased blood pressure, both ESH and AAP criteria were considered. Results: The prevalence of elevated blood pressure was 7.5% according to ESH criteria and nearly twice as high using AAP criteria, with a more pronounced discrepancy in females. Individuals with elevated blood pressure were younger, exhibited higher body weight and BMI, and had an increased prevalence of overweight and obesity. Classification based on ESH criteria revealed higher alcohol and drug consumption among normotensive individuals. AAP criteria identified a higher proportion of males and greater height in the hypertensive group. Systolic blood pressure correlated significantly with height, weight, and BMI, with stronger associations in males, while diastolic pressure correlated with weight and BMI. Conclusions: To the best of our knowledge, our study is the only one to analyze the prevalence of increased blood pressure and its relationship with lifestyle factors and anthropometric data in adolescence in our region. Our study confirms that elevated blood pressure is common in adolescence, with higher prevalence using the 2017 AAP criteria than ESH guidelines.