Diagnostic Implications of the Endocrine Society and American Academy of Pediatrics Guidelines on blood pressure: associations with sex, blood pressure components, and metabolic syndrome in Korean Adolescents

Purpose: Pediatric hypertension and metabolic syndrome (MS) are increasing in parallel with childhood obesity. Variations in diagnostic thresholds between the Endocrine Society (ES) and American Academy of Pediatrics (AAP) guidelines may affect detection and intervention timing.Methods: We analyzed data from 1,035 Korean adolescents aged 13–17 years drawn from the Korea National Health and Nutrition Examination Survey (2014–2016). Blood pressure (BP) abnormalities and MS were assessed according to ES and AAP guidelines. Differences by sex, age, and body mass index (BMI) category were examined.Results: The ES guidelines identified significantly more cases of diastolic BP (DBP) abnormalities than the AAP guidelines. For example, ES identified DBP abnormalities in 15.2% in 16-year-old males versus 8.1% identified by AAP. This difference was especially prominent for prehypertensive categories. ES percentile-based thresholds were more sensitive to subtle diastolic elevations, while AAP uses fixed cutoffs that may underestimate early risk. MS prevalence exceeded 30% in multiple age groups among adolescents with BMI≥85th percentile. However, MS prevalence did not significantly differ between the 2 guidelines in any age or sex subgroup.Conclusion: Awareness of hypertensive status is essential in the era of increasing childhood and adolescent obesity. The ES guidelines might be more suitable for cardiometabolic screening in Korean adolescents than the AAP guidelines because they effectively detect hypertensive status, including DBP abnormalities.