Send Orders for Reprints to reprints@benthamscience.net The Open Hypertension Journal, 2013, 5, 43-44 43 1876-5262/13 2013 Bentham Open Open Access CONGRESS COVERAGE Obese Children have a Quadrupled Risk of Becoming Hypertensive Adults in Comparison to Children with Normal Weight Emmanuel S. Ganotakis 1 , Aikaterini Papagianni 2 and Vasilios G. Athyros 3,* 1 Department of Internal Medicine, Heraklion Medical School, University Hospital of Heraklion, Crete, Greece; 2 Department of Nephrology, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece; 3 Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece Keywords: Childhood, obesity, overweight, adulthood, arterial hypertension, treatment options. A few days ago (Sept 12, 2013) the results of a large pro- spective study that included 1,117 healthy children who were followed up for 27 years were presented in the American Heart Association (AHA) High Blood Pressure Research Scientific Sessions in New Orleans [1]. The aim was to re- cord the development of obesity in childhood and to investi- gate the incidence of arterial hypertension (HTN) in adults that were obese or overweight children [1]. The original co- hort was established in 1986, and consisted of 1,117 healthy children (47% male), recruited from schools in Indianapolis, Indiana, USA (mean age 12 years). During follow-up, blood pressure (BP), height, and weight were measured twice a year. Body mass index (BMI) was calculated from height and weight; weight status was determined by age and sex- adjusted BMI percentile values (BMI %). Subjects were classified as normal weight, overweight (BMI%  85% and < 95%), or obese (BMI%  95%) of BMI distribution of the entire cohort [1]. The above revealed that 765 (68%) had normal weight, 176 (16%) were overweight, and 176 (16%) were obese [1]. The rate of adult HTN was higher for those classified as overweight or obese as children (14% and 26% respectively, p = <0.0001). Children classified as overweight or obese had double and quadruple the risk of having HTN in adulthood, respectively, as compared to normal weight children [odds ratio (OR) = 2.2; 95% confidence interval (CI) = 1.3 to 3.6, OR = 4.4; 95% CI = 2.8 to 6.9, respec- tively] [1]. It has also been shown that children who had one or more high BP readings are 3 times more likely to develop HTN as adults. Using the same pool of Indianapolis kids, researchers found that the rate of high BP during adulthood was 8.6% for children who didn't have a high BP reading when they were young. That rate jumped to 18% for adults who had at least 1 high reading as a kid, and 35% for adults who had 2 or more high readings as children [1]. This study highlights the need for pediatricians to regularly check BP *Address correspondence to this author at the Department of Internal Medi- cine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, 15 Marmara St, Thessaloniki, 55132, Greece; Tel: +30 2310 892606; Fax: +30 2310 835955; Emails: athyros@med.auth.gr and vathyros@gmail.com and weight. Authors conclude that the degree of adiposity in childhood significantly impacts the risk for HTN in adult- hood; childhood obesity is associated with a quadrupled risk of adult HTN [1]. All the above have significant implications and suggest that urgent steps should be taken for early prevention of childhood obesity. This is because, besides HTN, other health problems, such as renal injury, which further promote HTN within a vicious cycle [2], and finally vascular damage early in life, which leads to cardiovascular disease (CVD) [2] are also related to childhood obesity. It has been shown that there is substantial increase in the prevalence of end-stage renal disease (ESRD) over the last three decades, paralleling the increasing prevalence of obe- sity and insulin resistance (IR), including the pediatric popu- lation [2]. Overweight, obesity and the metabolic syndrome (MetS), which frequently coexist, contribute substantially to CVD and ESRD [2]. A higher BMI, the presence of type 2 diabetes (T2DM), HTN, and IR have recently emerged as strong independent risk factors for chronic kidney disease (CKD) and ESRD [2]. It should be noted that the long-term CVD impact of obesity, although expressed in adulthood, has its origin in childhood [2,3]. Childhood obesity is fast becoming a worldwide epidemic, with its prevalence tripled in the last three decades [2]. At present, approximately 20% of children and adolescents in Western countries are over- weight or obese; this prevalence has reached 10% in devel- oping countries [2]. By 2020 the prevalence of childhood overweight and obesity is estimated that will be >35% in Europe and >45% in America; even in Southeast Asia, the average prevalence will reach 20% [3]. Obesity, MetS, and IR lead, among others, increase an- giotensin II levels, BP, intraglomerular pressure, and prote- inuria, raise the production of intrarenal inflammatory cyto- kines/growth factors, and finally induce apoptosis. These have a deleterious effect on CV system and induce CKD in adulthood [2,3]. All the above are alarming and underline how obesity is a real threat not only for adults, but also for children and adolescents [4], since metabolic as well as CVD