Hypertension in a Cohort of Obese Caucasian Children and Adolescents and Its Association with Glycometabolic Indices: A Proposed Screening Tool.

Background and aim: Hypertension (HTN) is common among obese children and ad-olescents and increases their cardiovascular risk later in adulthood. The aim of the study was to evaluate the prevalence of HTN identified by office blood pressure (BP) measurement and ambulatory BP monitoring (ABPM) in a cohort of obese children and adolescents and its associ-ation with anthropometric and glycometabolic indices. Methods and results: Seventy consecutive obese Caucasian children and adolescents aged 7-16 years were enrolled. Patients underwent ABPM, echocardiogram and carotid ultrasonography. Sex-and age-adjusted logistic multivariable analysis models were used to assess the association between HOMA-IR, HOMA-0, QUICKI with HTN at ABPM. Receiver Operation Curve (ROC) anal-ysis with Youden J statistics was used to identify the optimal HOMA-IR, HOMA-0 and QUICKI cut-off to predict HTN at ABPM. Hypertensive office BP was found in 25.7% of obese patients. ABPM diagnosed HTN in 34.9% of patients: 20.6% of obese patients had masked HTN (MHTN), and 12.7% had white coat HTN (WCH). Hypertensive obese patients (according to ABPM) had higher HOMA-IR and HOMA-0, and a lower QUICKI than normotensive subjects. HOMA-IR, HOMA-0 and QUICKI predicted HTN at ABPM in obese patients in age-and sex-adjusted logistic multivariable models. Optimal cut-offs to predict HTN at ABPM in obese patients were: HOMA-IR >= 3.30, HOMA-0 >= 226.7 and QUICKI <0.33, with high sensitivity. Conclusions: A sequential testing strategy applying office BP and glycometabolic indices can iden-tify hypertensive obese pediatric patients with high diagnostic accuracy and potentially reducing costs. This strategy needs validation in an external and larger cohort. (c) 2023 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Ital-ian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.