Background: The global prevalence of pediatric hypertension (HTN) is increasing and is a significant precursor of cardiovascular disease (CVD). We performed a comparative analysis of two guidelines for pediatric HTN: the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH); the Korean blood pressure (BP) reference was applied to the Korean pediatric population. Methods: Data from 2,060 children and adolescents aged 10-18 years from the Korean National Health and Nutrition Examination Survey (2016-2018) were analyzed. BP was classified according to the AAP, ESH, and Korea Regional BP Classification (KRC). High BP was defined as BP exceeding the normotensive range. Results: The prevalence of high BP in Korean youth was notably higher in the AAP group than that in the ESH group (19.5% vs. 10.6%, p<0.0001). There were variations in the prevalence based on age, sex, and obesity. No significant disparities were observed between the AAP and KRC groups in terms of high BP prevalence. The application of the AAP and KRC demonstrated a more comprehensive reflection of CVD risk factors, including obesity and metabolic profiles, compared to the ESH. The KRC showed a tendency for more non-obese individuals to be categorized as having elevated BP, although this difference was not statistically significant. Conclusions: This study advocates the adoption of the KRC for defining pediatric HTN in Korea. The KRC identified individuals with CVD risk as having a high BP, which raises the potential of the KRC for early intervention in CVD risk control.

The authors have declared no competing interest.

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The KNHANES protocol was approved by the Institutional Review Board of the KDCA. The present study was approved by the Institutional Review Board (IRB) of Samsung Medical Center (IRB number 21-10-074).

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