1. Blood Pressure in 57931 Overweight or Obese Paediatric Patients Based on Five Reference Systems Reinhard W. Holl University 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

2. What is the APV initiative? Standardized longitudinal documentation of (paediatric) patients with overweight or obesity treated at specialized obesity care facilities in Germany, Austria or Switzerland. Anonymized data are used for external quality monitoring, center certification (German working Group on obesity in children and adolescents) and for patient-oriented research. Funded by German ministry of education and research (competence network obesity)

3. Information available at http://www. a-p-v.de Available data: 200 centers 95 981 patients 354 660 visits

4. Inclusion Criteria Age6 – 18 years (normative data for all references available) BMI> 90. percentile according to German AGA charts (overweight or obese) Blood pressure recording  57 931 patients from 188 centres

5. Methods Anonymized data, APV registry October 2012 SAS Version 9.4 Hierarchic mixed multiple logistic regression analysis Center as random effect Denominator degrees of freedom: Kenward-Roger Iterations by Newton-Raphson Estimation method: Maximum likelihood marginal expansion

6. Co-Morbidity in Obese Adolescents

7. Hypertension in children / adolescents Definition: Normal: < 90. Percentile Pre-hypertension: 90.-95. Percentile or ≥120/80 mmHg Hypertension: ≥ 95th Percentile (Lurbe, ESH, 2009) Reference:

8. Hypertension in children / adolescents Reference: 1)Second Task Force, 1987 n = 72429, age-group and gender, 9 studies 2)European Pooled Data, deMan, 1991 n = 28043, age and gender, 6 studies 3)4th Report, 2004 n = 63227, age, gender and height 4)4th Report, non-overweight, Rosner 2008 n = 49967, age, gender and height 5) German KiGGS data, Neuhauser 2011 n = 14349, German, population based study, non-overweight children only, age, gender and height

9. Hypertension in 57931 overweight/obese children / adolescents

10. Hypertension by BMI category

11. Hypertension in overweight/obese children / adolescents More hypertension in shorter children: (exception: 2 nd TF, KiGGS) Gender difference: > ; 2 nd TF, 4 th Report, KiGGS > ; European Pooled Data

12. 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.

13. Every center is invited to participate in the APV initiative! For information see http://www.a-p-v.de Thank you for your attention!