A clinical practice guideline for screening BP in youth was published in 2017. Key changes from the 2004 guideline are: the reference sample for BP percentile interpretations only includes youth with a healthy weight; BP values ≥120/≥80 mmHg are elevated; prehypertension is now called elevated BP. The aim of this study is to assess changes to BP classifications when applying the interpretation strategies of the 2017 guideline in comparison to the previous guideline for youth receiving obesity management at 35 Pediatric Obesity Weight Evaluation Registry (POWER) sites.


Data from first visits of subjects aged 3-18 years, with valid BP, height and weight measures, and body mass index (BMI) for age ≥95th percentile were evaluated. Demographic data were obtained. Data were used to compute % of the 95th BMI percentile (BMIp95). BP interpretations were done using references in each guideline (2017: SAS macro; 2004: Appendix B). Frequency data are reported.


Among 7943 subjects, 54% female, mean 11.7 years (SD 3.3), with mean BMIp95 137% (25). Subjects’ BPs were classified as normal BP, prehypertension/elevated BP, stage 1 hypertension, or stage 2 hypertension based on guideline strategies (2004: 58%, 22%, 17%, 3%, respectively, versus 2017: 51%, 19%, 24%, 6%, respectively). Among those with 2004 guideline Normal BP (n=4626), 12% of BPs would be newly classified elevated BP or stage 1 hypertension. Similarly, for 2004 guideline Prehypertension (n=1726) BPs, 46% moved to Stage 1 or 2 hypertension; for 2004 Stage 1 hypertension (n=1054) BPs, 16% increased to Stage 2; and 97% of Stage 2 BPs, remained Stage 2. Overall, 20% (1594/7943) of BPs increased to a higher BP classification group when applying the 2017 guideline.


Among treatment-seeking youth with obesity, substantial numbers of BP readings are now classified as abnormal according to the 2017 guideline. These findings support the need for coordinated care in this complex patient population.