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Original Article

Comparative analysis of adolescent hypertension definitions for predicting early-adulthood carotid artery intima-media thickness: Tehran lipid and glucose study

Maryam Barzin¹  , Shirin Yaghoobpoor¹, Maryam Mahdavi¹, Behnaz Abiri¹  , Majid Valizadeh¹  , Fereidoun Azizi²  , Pooneh Dehghan³  , Farhad Hosseinpanah¹ 

¹Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
²Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
³Imaging Department, Taleghani Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran

Correspondence Farhad Hosseinpanah ,Email: fhospanah@endocrine.ac.ir

Received: February 12, 2024; Revised: June 10, 2024   Accepted: June 18, 2024.

Abstract

Background
Definitions of childhood and adolescent hypertension (HTN) do not precisely elucidate the relationship between HTN and cardiovascular outcomes. Carotid intima-media thickness (CIMT), as a substitute for cardiovascular outcomes, enables the early identification of cardiovascular events throughout early adulthood.
Purpose
This study aimed to compare the ability of childhood HTN definitions to predict a high CIMT in early adulthood.
Methods
This prospective cohort study included 921 individuals aged 10–17 years from the Tehran Lipid and Glucose Study (TLGS). The CIMT was measured after 18 years of follow-up. Participants were categorized into normal blood pressure (BP), high-normal BP, HTN stage 1, and HTN stage 2 groups based on the childhood HTN definitions of the 4th report, European Society of Hypertension (ESH), and American Academy of Pediatrics Clinical Practice Guidelines (AAP-CPG). Akaike’s information criterion (AIC) and relative efficiencies (RE) were calculated to compare the ability of each to predict a high CIMT (≥95th percentile) during early adulthood.
Results
The highest and lowest prevalence of stage 1 HTN was observed with the AAP-CPG (17.7%) and ESH (8.8%), respectively. Similarly, the highest and lowest prevalence of stage 2 HTN was noted with the AAP-CPG (1.5%) and ESH (0.8%), respectively. According to the RE values, the highest to lowest predictive abilities belonged to the 4th report, ESH, and AAP-CPG, respectively. In all models, the 4th report’s pediatric HTN definition had the lowest AIC value and offered the best predictive ability.
Conclusion
Among the various definitions of pediatric HTN, the 4th report offered the best ability to predict a high CIMT during early adulthood, followed by the ESH and AAP-CPG. Because the reference population of the 4th report includes overweight, obese, and normal-weight individuals, our findings suggest that excessive adiposity is among the main predictors of early adulthood atherosclerosis risk.

Keywords :Children, Adolescents, Hypertension definitions, Predictor, Carotid artery intima-media thickness