Response to “Right Analysis—Wrong Conclusion: Obese Youth With Higher BP Are at Risk for Target Organ Damage”

To the Editor: We thank Drs Urbina and Falkner very much for their stimulating commentary “Right Analysis—Wrong Conclusion”1 to our contribution on blood pressure (BP) percentiles in youth.2 We acknowledge that they “agreed that BP levels on average are higher in obese youth, but these should not be “forgiven” but rather, they should be evaluated and managed.” We agree that there is no outcome data for pediatric hypertension and therefore no clinical threshold, but only associations between BP and preclinical organ damage. There is no doubt that risk factors should be detected and eliminated as early as possible according to the established guidelines. However, an independent contribution of overall and abdominal obesity has to be considered3 Furthermore, despite increases in obesity in the Bogalusa Heart Study there was no increase in systolic BP (SBP) or diastolic BP (DBP) levels4 and in UK children SBP increased in the past 3 decades, but the parallel increase of body mass index explains only 15% of SBP increase.5