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Abstract
The prevalence of pediatric hypertension is growing. Hypertension during childhood remains a major risk factor for adverse cardiovascular events later in life. NPs should be aware of current guidelines on screening, diagnosis, and treatment of hypertension in children to improve care for this patient population.
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Dong Y, Jan C, Zou Z, Dong B, Hu P, Ma Y, Yang Z, Wang X, Li Y, Gao D, Wen B, Song Y, Ma J. Comprehensive physical fitness and high blood pressure in children and adolescents: A national cross-sectional survey in China. J Sci Med Sport 2020; 23:800-806. [PMID: 32197926 DOI: 10.1016/j.jsams.2020.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/30/2020] [Accepted: 02/29/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To assess the association between comprehensive physical fitness and high blood pressure (HBP) among Chinese children and adolescents. DESIGN National cross-sectional surveys. METHODS 214,301 school students' data aged 7-18years was extracted in 2014. Six components of physical fitness (forced vital capacity, standing long jump, sit-and-reach, body muscle strength, 50m dash and endurance running) were measured, standardized and aggregated as a summary physical fitness indicator (PFI). HBP, systolic HBP (SHBP) and diastolic HBP (DHBP) were defined according to sex-, age- and height-specific references in China. RESULTS The prevalence of HBP, SHBP and DHBP was 8.6%, 4.7% and 5.7%, respectively, and PFI was -0.9 in Chinese children and adolescents. A significant negative association between the PFI and HBP was observed with adjusted prevalence of HBP (10.8% (95% CI: 10.4-11.2) to 7.6% (95% CI: 7.3-8.0), Ptrend<0.001), SHBP (5.7% (95% CI: 5.4-6.1) to 4.4% (95% CI: 4.1-4.6), Ptrend<0.001), and DHBP (7.6% (95% CI: 7.2-7.9) to 4.6% (95% CI: 4.3-4.9), Ptrend<0.001) and their ORs (HBP: 0.87(95% CI: 0.82-0.93) to 0.68(95% CI: 0.64-0.73), Ptrend<0.001; SHBP: 0.86(95% CI: 0.79-0.94) to 0.75(95% CI:0.69-0.82), Ptrend<0.001; DHBP: 0.85(95% CI: 0.79-0.92) to 0.59(95% CI: 0.54-0.64), Ptrend<0.001) declined with the increase in PFI. Stratified nutritional status exhibited a similar negative association between PFI and HBP, SHBP and DHBP in children with normal weight, overnutrition, and undernutrition. Stand long jump, body muscle strength, 50m dash, and endurance running, had a negative association with HBP, SHBP and DHBP, but forced vital capacity had a positive such association. Sit-and-reach and HBP are not significantly associated. CONCLUSIONS Physical fitness was negatively correlated to the increased HBP in children and adolescents. Comprehensive policies and measures to enhance children and adolescents' physical fitness are urgently needed through the promotion of physical activity, healthy dietary patterns, and strategies of educational guidelines to reduce schoolwork, which will in turn reduce the cardiovascular burdens in the future.
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Affiliation(s)
- Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, China
| | - Catherine Jan
- The George Institute for Global Health, School of Medicine, University of New South Wales, Australia
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, China
| | - Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, China
| | - Peijin Hu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, China
| | - Yinghua Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, China
| | - Zhaogeng Yang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, China
| | - Xijie Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, China
| | - Yanhui Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University, China
| | - Di Gao
- Institute of Child and Adolescent Health, School of Public Health, Peking University, China
| | - Bo Wen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University, China.
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, China.
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53
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Havasi K, Maróti Z, Jakab A, Raskó I, Kalmár T, Bereczki C. Reference values for resting and post exercise hemodynamic parameters in a 6-18 year old population. Sci Data 2020; 7:26. [PMID: 31964867 PMCID: PMC6972850 DOI: 10.1038/s41597-020-0368-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
This database is the first large dataset of haemodynamic changes of normal-weight pupils during a field exercise test. Here, we present a dataset for anthropometric and hemodynamic parameters measured both during relaxation and after exercise containing 1,173,342 data segments from 65,345 acquisition points of 10,894 normal weight subjects, covering an age range of 6–18 years collected in a course of 12 years. Data acquisition was carried out under standardised measuring conditions and specifications. Hemodynamic parameters were measured in the normal-weight population with a new and simple Fit-Test which could facilitate new projects worldwide to study and compare cardiovascular fitness. Measurement(s) | anthropometric measurement • heart rate • blood pressure | Technology Type(s) | anthropometric analysis • Cardiac Monitoring | Factor Type(s) | age | Sample Characteristic - Organism | Homo sapiens |
Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.11417481
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Affiliation(s)
- Katalin Havasi
- Csongrád County Health Care Center Hódmezővásárhely-Makó, Csongrád, Hungary.,Department of Pediatrics, University of Szeged Albert Szent-Györgyi Medical Center Faculty of Medicine, Szeged, Hungary
| | - Zoltán Maróti
- Department of Pediatrics, University of Szeged Albert Szent-Györgyi Medical Center Faculty of Medicine, Szeged, Hungary
| | - Andrea Jakab
- Department of Pediatrics, University of Szeged Albert Szent-Györgyi Medical Center Faculty of Medicine, Szeged, Hungary
| | - István Raskó
- Department of Pediatrics, University of Szeged Albert Szent-Györgyi Medical Center Faculty of Medicine, Szeged, Hungary.,Inst. of Genetics, Biological Research Center, Szeged, Hungary
| | - Tibor Kalmár
- Department of Pediatrics, University of Szeged Albert Szent-Györgyi Medical Center Faculty of Medicine, Szeged, Hungary.
| | - Csaba Bereczki
- Department of Pediatrics, University of Szeged Albert Szent-Györgyi Medical Center Faculty of Medicine, Szeged, Hungary.
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54
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Koskinen J, Juonala M, Dwyer T, Venn A, Petkeviciene J, Čeponienė I, Bazzano L, Chen W, Sabin MA, Burns TL, Viikari JSA, Woo JG, Urbina EM, Prineas R, Hutri-Kähönen N, Sinaiko A, Jacobs DR, Steinberger J, Daniels S, Raitakari O, Magnussen CG. Utility of Different Blood Pressure Measurement Components in Childhood to Predict Adult Carotid Intima-Media Thickness. Hypertension 2019; 73:335-341. [PMID: 30580683 DOI: 10.1161/hypertensionaha.118.12225] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Childhood blood pressure (BP) levels predict adult subclinical atherosclerosis. However, the best childhood BP component for prediction has not been determined. This study comprised 5925 participants aged 3 to 18 years from 6 cohorts who were followed into adulthood (mean follow-up 25.8±6.2 years). Childhood BP was measured by using a standard mercury sphygmomanometer in all cohorts. Study-specific carotid intima-media thickness ≥90th percentile was used to define subclinical atherosclerosis. Per SD change in the predictor, childhood systolic BP (SBP; age- and sex-adjusted odds ratio [95% CI], 1.24 [1.13-1.37]), mean arterial pressure (1.10 [1.07-1.13]), and pulse pressure (1.15 [1.05-1.27]) were associated with increased adulthood intima-media thickness. In age- and sex-adjusted analyses, area under the receiver operating characteristic curves for SBP ( C value [95% CI], 0.677 [0.657-0.704]) showed significantly improved prediction compared with diastolic BP (0.669 [0.646-0.693], P=0.006) or mean arterial pressure (0.674 [0.653-0.699], P=0.01). Pulse pressure provided a C value that was not different from SBP (0.676 [0.653-0.699], P=0.16). Combining different BP components did not improve prediction over SBP measurement alone. Based on the associations with adult carotid intima-media thickness, cut points for elevated SBP were 105 mm Hg for 3- to 6-year-old boys, 108 mm Hg for 3- to 6-year-old girls, 108 mm Hg for 7- to 12-year-old boys, 106 mm Hg for 7- to 12-year-old girls, 123 mm Hg for 13- to 18-year-old boys, and 115 mm Hg for 13- to 18-year-old girls. Our analyses suggest that several childhood BP measurement components are related to adulthood carotid intima-media thickness. Of these, SBP provided the best predictive ability.
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Affiliation(s)
- Juha Koskinen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (J.K., O.R., C.G.M.), University of Turku, Finland.,Heart Center, Kymenlaakso Central Hospital, Kotka, Finland (J.K.)
| | - Markus Juonala
- Department of Medicine (M.J., J.S.A.V.), University of Turku, Finland.,Division of Medicine (M.J., J.S.A.V.), Turku University Hospital, Finland.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia (M.J.)
| | - Terence Dwyer
- George Institute, University of Oxford, United Kingdom (T.D.)
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (A.V., C.G.M.)
| | - Janina Petkeviciene
- Faculty of Public Health, Medical Academy (J.P.), Lithuanian University of Health Sciences, Kaunas
| | - Indrė Čeponienė
- Department of Cardiology, Medical Academy (I.C.), Lithuanian University of Health Sciences, Kaunas
| | - Lydia Bazzano
- Department of Epidemiology and Department Biostatistics and Bioinformatics, Tulane University Health Sciences Center (L.B.), Tulane University, New Orleans, LA
| | - Wei Chen
- Department of Epidemiology, Tulane Center for Cardiovascular Health (W.C.), Tulane University, New Orleans, LA
| | - Matthew A Sabin
- Royal Children's Hospital, Parkville, Australia (M.A.S.).,Department of Pediatrics, University of Melbourne, Parkville, Australia (M.A.S.)
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, University of Iowa (T.L.B.)
| | - Jorma S A Viikari
- Department of Medicine (M.J., J.S.A.V.), University of Turku, Finland.,Division of Medicine (M.J., J.S.A.V.), Turku University Hospital, Finland
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH (J.G.W.)
| | - Elaine M Urbina
- The Heart Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (E.M.U.)
| | - Ronald Prineas
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (R.P.)
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere School of Medicine and Tampere University Hospital, Finland (N.H.-K.)
| | - Alan Sinaiko
- Department of Pediatrics (A.S.), University of Minnesota, Minneapolis
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health (D.R.J.), University of Minnesota, Minneapolis
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital (J.S.)
| | - Stephen Daniels
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (S.D.)
| | - Olli Raitakari
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (J.K., O.R., C.G.M.), University of Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, University of Turku (O.R.), Turku University Hospital, Finland
| | - Costan G Magnussen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (J.K., O.R., C.G.M.), University of Turku, Finland.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (A.V., C.G.M.)
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55
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Urbina EM, Khoury PR, Bazzano L, Burns TL, Daniels S, Dwyer T, Hu T, Jacobs DR, Juonala M, Prineas R, Raitakari O, Steinberger J, Venn A, Woo JG, Sinaiko A. Relation of Blood Pressure in Childhood to Self-Reported Hypertension in Adulthood. Hypertension 2019; 73:1224-1230. [PMID: 31067199 DOI: 10.1161/hypertensionaha.118.12334] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blood pressure (BP) tracking (maintaining a BP percentile) across life is not well defined but is important in predicting which children will become hypertensive adults. We computed BP tracking in subjects with BP measured in childhood and adulthood and performed logistic regression to determine the ability of childhood BP to predict adult hypertension (N=5035, 46.7 years, 74.2% white, 17.7% black; 39.6% male). Prevalence of hypertension was 29%. Correlations between systolic BP for child and adolescent were r=0.48; for adolescent and young adult were r=0.40, and for child and young adult were r=0.24 (all P<0.0001). Participants self-reporting adult hypertension were less likely to be white (38.7% black, 27.6% white, 20.9% other; P<0.0001) and female (26.4% females, 32.9% male, P<0.0001). Participants with adult hypertension were more likely to have higher BP and adiposity by age 10 years and abnormal lipids and glucose by age 16 years. There was a graded increase in the frequency of self-reported adult hypertension across the BP change groups, even within the persistently normotensive group (X2<0.0001) from 19% in children with a systolic BP% persistently below the median to 80% for individuals with elevated BP in both childhood and adolescence. Although our precision to predict which individual child is at risk of adult BP-related cardiovascular disease is weak, an increase in systolic BP and body mass index percentile from childhood to adolescence should signal a need for lifestyle intervention to prevent future sustained hypertension-related cardiovascular disease.
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Affiliation(s)
- Elaine M Urbina
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics (E.M.U., P.R.K.), University of Cincinnati College of Medicine, OH
| | - Philip R Khoury
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics (E.M.U., P.R.K.), University of Cincinnati College of Medicine, OH
| | | | - Trudy L Burns
- Department of Epidemiology, College of Public Health, University of Iowa (T.L.B.)
| | - Stephen Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora (S.D.)
| | | | - Tian Hu
- Division of Epidemiology and Community Health, School of Public Health (T.H., D.R.J.), University of Minnesota, Minneapolis
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health (T.H., D.R.J.), University of Minnesota, Minneapolis
| | - Markus Juonala
- Department of Internal Medicine (M.J.), University of Turku, Finland.,Division of Medicine (M.J.), Turku University Hospital, Finland.,Murdoch Children's Research Institute, Parkville, Victoria, Australia (M.J.)
| | - Ronald Prineas
- Division of Public Health Sciences, Wake Forest University School of Medicin-Winston Salem, NC (R.P.)
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine (O.R.), University of Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine (O.R.), Turku University Hospital, Finland
| | - Julia Steinberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical School (J.S.), University of Minnesota, Minneapolis
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (A.V.)
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology Children's Hospital Medical Center, and Department of Pediatrics (J.G.W.), University of Cincinnati College of Medicine, OH
| | - Alan Sinaiko
- Division of Nephrology (A.S.), University of Minnesota Medical School, Minneapolis
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56
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Rinke ML, Singh H, Brady TM, Heo M, Kairys SW, Orringer K, Dadlez NM, Bundy DG. Cluster Randomized Trial Reducing Missed Elevated Blood Pressure in Pediatric Primary Care: Project RedDE. Pediatr Qual Saf 2019; 4:e187. [PMID: 31745503 PMCID: PMC6831043 DOI: 10.1097/pq9.0000000000000187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/28/2019] [Indexed: 11/26/2022] Open
Abstract
Recognition of childhood hypertension is essential, but pediatricians routinely fail to identify elevated blood pressure (BP). This study investigated if a quality improvement collaborative (QIC) reduces missed elevated BP in primary care. METHODS During a cluster-randomized clinical trial, a national cohort worked sequentially to reduce each of three different errors, including missed elevated BP. While working on their first error during an 8-month action period, practices collected control data for a different error. Practices worked to reduce two additional errors in subsequent action periods but continued to provide sustain and maintainenance data on BP. QIC intervention included video learning sessions, transparent data, failures analysis, coaching, and tools to reduce errors. Mixed-effects logistic regression models compared the mean percentage of patients with an elevated BP with appropriate actions taken and documented. RESULTS We randomized 43 practices and included 30 in the final analysis. Control and intervention phases included 1,728 and 1,834 patients with an elevated BP, respectively. Comparing control versus intervention phases, the mean percentage of patients who received appropriate actions increased from 58% to 74% [risk difference (RD) 16%; 95% CI;12%, 20%]. Practices continued to improve during the sustain phase as compared to the intervention phase (RD 5%; 95% CI; 2%, 9%) and did not worsen during the maintenance phase (RD 0.9%; 95% CI -5%, 7%). CONCLUSIONS Missed pediatric elevated BP can be sustainably reduced via a QIC intervention, demonstrating a possible model for other error reduction efforts.
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Affiliation(s)
- Michael L. Rinke
- From the Department of Pediatrics, The Children’s Hospital at Montefiore and the Albert Einstein College of Medicine, Bronx, N.Y
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Department of Medicine, Baylor College of Medicine, Center of Innovation, Houston, Tex
| | - Tammy M. Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Moonseong Heo
- Department of Public Health Sciences, and School of Mathematical Sciences, Clemson University, Clemson, S.C
| | - Steven W. Kairys
- Department of Pediatrics, K. Hovnanian Children’s Hospital, Neptune, N.J
- American Academy of Pediatrics and Quality Improvement Innovation Networks, Itasca, Ill
| | - Kelly Orringer
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Mich
| | - Nina M. Dadlez
- Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, Mass
| | - David G. Bundy
- Department of Pediatrics, Medical University of South Carolina, Charleston, S.C
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57
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Kahn FK, Wake M, Lycett K, Clifford S, Burgner DP, Goldsmith G, Grobler AC, Lange K, Cheung M. Vascular function and stiffness: population epidemiology and concordance in Australian children aged 11-12 years and their parents. BMJ Open 2019; 9:34-43. [PMID: 31273014 PMCID: PMC6624058 DOI: 10.1136/bmjopen-2017-020896] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To describe the epidemiology and parent-child concordance of vascular function in a population-based sample of Australian parent-child dyads at child age 11-12 years. DESIGN Cross-sectional study (Child Health CheckPoint), nested within a prospective cohort study, the Longitudinal Study of Australian Children (LSAC). SETTING Assessment centres in seven major Australian cities and eight regional towns or home visits, February 2015-March 2016. PARTICIPANTS Of all participating CheckPoint families (n=1874), 1840 children (49% girls) and 1802 parents (88% mothers) provided vascular function data. Survey weights and methods were applied to account for LSAC's complex sample design and clustering within postcodes and strata. OUTCOME MEASURES The SphygmoCor XCEL assessed vascular function, generating estimates of brachial and central systolic blood pressure and diastolic blood pressure, central pulse pressure, augmentation index and carotid-femoral pulse wave velocity. Pearson's correlation coefficients and multivariable linear regression models estimated parent-child concordance. RESULTS Hypertension was present in 3.9% of children and 9.0% of parents. Mean child and parent values for augmentation index were 4.5% (SD 11.6) and 21.3% (SD 12.3), respectively, and those for carotid-femoral pulse wave velocity were 4.48 m/s (SD 0.59) and 6.85 m/s (SD 1.14), respectively. Parent-child correlation for brachial systolic blood pressure was 0.20 (95% CI 0.15 to 0.24), brachial diastolic blood pressure 0.21 (95% CI 0.16 to 0.26), central systolic blood pressure 0.21 (95% CI 0.16 to 0.25), central diastolic blood pressure 0.21 (95% CI0.17 to 0.26), central pulse pressure 0.19 (95% CI 0.14 to 0.24), augmentation index 0.28 (95% CI 0.23 to 0.32) and pulse wave velocity 0.22 (95% CI 0.18 to 0.27). CONCLUSIONS We report Australian values for traditional and more novel vascular function markers, providing a reference for future population studies. Cross-generational concordance in multiple vascular function markers is already established by age 11-12 years, with mechanisms of heritability remaining to be explored.
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Affiliation(s)
- Freya K Kahn
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Cardiology, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Melissa Wake
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics and The Liggins Institute, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Kate Lycett
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Susan Clifford
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - David P Burgner
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Greta Goldsmith
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Anneke C Grobler
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Katherine Lange
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael Cheung
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Cardiology, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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58
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Persistence of elevated blood pressure during childhood and adolescence: a school-based multiple cohorts study. J Hypertens 2019. [PMID: 29517559 DOI: 10.1097/hjh.0000000000001699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Blood pressure (BP) screening is advocated in children. However, identification of children with sustained elevated BP is difficult because of high BP variability. We assessed the tracking of BP and the persistence of elevated BP across childhood and adolescence. METHODS Three cohorts of children from schools in the Seychelles were examined on two occasions at 3-4-year intervals. Obesity was defined as BMI at least 95th sex-specific, and age-specific percentile. On each visit, BP was based on the average of two readings and elevated BP was defined as BP at least 95th sex-specific, age-specific, and height-specific percentile. RESULTS Data was collected in 4519 children of mean ages of 5.5 and 9.2 years, 6065 of ages of 9.2 and 12.5 years, and 5967 of ages of 12.5 and 15.6 years, respectively. Prevalence of elevated BP was 10% at age 5.5 years, 10% at 9.2 years, 7% at 12.5 years, and 9% at 15.6 years, respectively. Among children with elevated BP at the initial visit, the proportions who had elevated BP at the subsequent visit 3-4 years later was 13% between ages of 5.5 and 9.2 years, 19% between 9.2 and 12.5 years, and 27% between 12.5 and 15.6 years. These proportions were higher among obese children with elevated BP, that is, 33, 35, and 39%, in each cohort, respectively. Tracking coefficients were slightly larger for SBP (range of tracking coefficients: 0.23-0.40) than for DBP (range: 0.19-0.35), and increased with age. By comparisons, tracking coefficients for BMI were much higher (range: 0.74-0.84). CONCLUSION During childhood and adolescence, having an elevated BP on one occasion is a weak predictor of elevated BP 3-4 years later. Tracking is, however, larger in older and obese children than in younger and nonobese children.
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59
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Predictors and Consequences of Pediatric Hypertension: Have Advanced Echocardiography and Vascular Testing Arrived? Curr Hypertens Rep 2019; 21:54. [PMID: 31134437 DOI: 10.1007/s11906-019-0958-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Pediatric hypertension is relatively common and associated with future adult hypertension. Elevated blood pressure in youth predicts future adult cardiovascular disease and blood pressure control can prevent progression of pediatric kidney disease. However, pediatric blood pressure is highly variable within a given child and among children in a population. RECENT FINDINGS Therefore, modalities to index aggregate and cumulative blood pressure status are of potential benefit in identifying youth in danger of progression from a risk factor of subclinical phenotypic alteration to clinically apparent event. In this review, we advocate for the health risk stratification roles of echocardiographically assessed cardiac remodeling, arterial stiffness assessment, and assessment by ultrasound of arterial thickening in children and adolescents with hypertension.
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60
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de Andrade GN, Matoso LF, Miranda JWB, de Lima TF, Gazzinelli A, Vieira EW. Anthropometric indicators associated with high blood pressure in children living in urban and rural areas. Rev Lat Am Enfermagem 2019; 27:e3150. [PMID: 31038641 PMCID: PMC6528627 DOI: 10.1590/1518-8345.2760-3150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 02/07/2019] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE to evaluate anthropometric and demographic indicators associated with high blood pressure in children aged 6 to 10 years in urban and rural areas of Minas Gerais. METHOD this is a cross-sectional study with 335 children. Anthropometric, demographic and blood pressure data were collected. The statistics analyzes were performed using the chi-square, t-student, Mann-Whitney and logistic regression tests, and the odds ratio was the association measure. RESULTS the prevalence of high blood pressure was significantly higher among rural children. In the urban area, the chance of high blood pressure was higher in children who had a high body mass index (2.97 [1.13-7.67]) and in the rural area, in those who had increased waist circumference (35.4 [3.0-406.2]) and the age range of 9-10 years (4.29 [1.46-12.6]). CONCLUSION elevated body mass index and waist circumference were important anthropometric indicators for high blood pressure, as well as age in children living in rural area. The evaluation of body mass index and waist circumference, in addition to nutritional assessments, represents an important action for the screening of high blood pressure in children from different territorial contexts.
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Affiliation(s)
- Gisele Nepomuceno de Andrade
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo
Horizonte, MG, Brasil
- Bolsista do Conselho Nacional de Desenvolvimento Científico e
Tecnológico (CNPq), Brasil
| | - Leonardo Ferreira Matoso
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo
Horizonte, MG, Brasil
- Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível
Superior (CAPES), Brasil
| | | | | | - Andréa Gazzinelli
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo
Horizonte, MG, Brasil
| | - Ed Wilson Vieira
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo
Horizonte, MG, Brasil
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Di Bonito P, Valerio G, Pacifico L, Chiesa C, Invitti C, Morandi A, Licenziati MR, Manco M, Giudice EMD, Baroni MG, Loche S, Tornese G, Franco F, Maffeis C, de Simone G. Impact of the 2017 Blood Pressure Guidelines by the American Academy of Pediatrics in overweight/obese youth. J Hypertens 2019; 37:732-738. [PMID: 30817454 DOI: 10.1097/hjh.0000000000001954] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to compare the impact of the European Society of Hypertension Guidelines 2016 (ESHG2016) and the American Academy of Pediatrics Guidelines 2017 (AAPG2017) on the screening of hypertension and classification of abnormal left ventricular geometry (ALVG) in overweight/obese youth. METHODS This study included 6137 overweight/obese youth; 437 had echocardiographic assessment. Hypertension was defined using either ESHG2016 or AAPG2017. ALVG was defined using 95th percentile for age and sex of left ventricular mass index (LVMi) and/or relative wall thickness (RWT) more than 0.38 (juvenile cut-offs) according to ESHG2016 or LVMi more than 51 g/h and/or RWT more than 0.42 (adult cut-offs) according to AAPG2017. RESULTS Prevalence of youth at a high risk of hypertension was 13% higher using AAPG2017 than ESHG2016. The increase was larger in overweight youth at least 13 years of age (+43%). Using the juvenile cut-offs for ALVG, youth at a high risk of hypertension by ESHG2016 had an odds ratio [95% confidence interval (95% CI)] of 3.03 (1.31-7.05) for left ventricular concentric remodelling (LVcr) and 2.53 (1.43-4.47) for concentric left ventricular hypertrophy (cLVH) as compared with youth with normal LVG. Similarly, in youth at a high risk of hypertension by AAPG2017, the odds ratio for LVcr was 3.28 (1.45-7.41, P < 0.001) and 3.02 (95% CI: 1.73-5.27, P < 0.001) for cLVH. Using the adult cut-offs, no significant difference in ALVG was found with both guidelines. CONCLUSION The prevalence of overweight/obese youth at a high risk of hypertension increased by 13% comparing AAPG2017 vs. ESHG2016. The juvenile cut-offs for ALVG were more effective than the adult criteria in intercepting individuals with a potentially higher cardiovascular risk.
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Affiliation(s)
- Procolo Di Bonito
- Department of Internal Medicine, 'S. Maria delle Grazie', Pozzuoli Hospital
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples
| | - Lucia Pacifico
- Policlinico Umberto I Hospital, Sapienza University of Rome
| | - Claudio Chiesa
- Institute of Translational Pharmacology, National Research Council, Rome
| | - Cecilia Invitti
- IRCCS Istituto Auxologico Italiano, Department of Medical Sciences & Rehabilitation, Milan
| | - Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona
| | | | | | | | | | - Sandro Loche
- Pediatric Endocrine Unit, Pediatric hospital for microcitemia, AO Brotzu, Cagliari
| | - Gianluca Tornese
- Institute for maternal and child health IRCCS 'Burlo Garofolo', Trieste
| | | | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona
| | - Giovanni de Simone
- Hypertension Research Center & Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy
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Samuels JA, Zavala AS, Kinney JM, Bell CS. Hypertension in Children and Adolescents. Adv Chronic Kidney Dis 2019; 26:146-150. [PMID: 31023449 DOI: 10.1053/j.ackd.2019.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 01/06/2023]
Abstract
Hypertension is a growing problem in children and adolescents, with primary hypertension becoming the most common etiology. In addition to demonstrating that high blood pressure in children and young adults is likely to remain elevated into adulthood, this review (1) addresses important aspects of measuring blood pressure in children and adolescents, (2) defines elevated blood pressure and hypertension in this age group, (3) describes the initial evaluation and workup of abnormally high blood pressure, and (4) introduces treatment strategies for youth with sustained hypertension.
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63
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Chung O, Juonala M, Mallat Z, Hutri‐Kähönen N, Viikari JS, Raitakari OT, Magnussen CG. Tracking of secretory phospholipase A2 enzyme activity levels from childhood to adulthood: a 21‐year cohort. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Tracking of secretory phospholipase A2 enzyme activity levels from childhood to adulthood: a 21-year cohort. J Pediatr (Rio J) 2019; 95:247-254. [PMID: 29476705 DOI: 10.1016/j.jped.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/11/2018] [Accepted: 01/15/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Secretory phospholipase A2 (sPLA2) enzyme activity is a potential inflammatory biomarker for cardiovascular disease. We examined the tracking, or persistence, of sPLA2 enzyme activity levels from childhood to adulthood, and identify potentially modifiable factors affecting tracking. METHOD Prospective cohort of 1735 children (45% females) who had serum sPLA2 enzyme activity levels and other cardiovascular disease risk factors measured in 1980 that were followed-up in 2001. RESULTS sPLA2 activity tracked from childhood to adulthood for males (r=0.39) and females (r=0.45). Those who decreased body mass index relative to their peers were more likely to resolve elevated childhood sPLA2 levels than have persistent elevated sPLA2 levels in childhood and adulthood. Those who consumed less fruit, and gained more body mass index relative to their peers, began smoking or were a persistent smoker between childhood and adulthood were more likely to develop incident elevated sPLA2 levels than those with persistent not elevated sPLA2 levels. CONCLUSIONS Childhood sPLA2 enzyme activity levels associate with adult sPLA2 levels 21 years later. Healthful changes in modifiable risk factors that occur between childhood and adulthood might prevent children from developing elevated sPLA2 levels in adulthood.
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Naidoo S, Kagura J, Fabian J, Norris SA. Early Life Factors and Longitudinal Blood Pressure Trajectories Are Associated With Elevated Blood Pressure in Early Adulthood. Hypertension 2019; 73:301-309. [DOI: 10.1161/hypertensionaha.118.11992] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Sanushka Naidoo
- From the MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health (S.N., J.K., S.A.N.), University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- From the MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health (S.N., J.K., S.A.N.), University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health (J.K.), University of the Witwatersrand, Johannesburg, South Africa
| | - June Fabian
- Wits Donald Gordon Medical Centre (J.F.), University of the Witwatersrand, Johannesburg, South Africa
- Division of Nephrology, Department of Internal Medicine, School of Clinical Medicine (J.F.), University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A. Norris
- From the MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health (S.N., J.K., S.A.N.), University of the Witwatersrand, Johannesburg, South Africa
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Abstract
The etiology of hypertension in children and adolescents is varied; however, the prevalence of pediatric primary hypertension is increasing. Early identification and appropriate management of hypertension in children and adolescents is important to prevent the development of hypertensive end organ disease. The 2017 American Academy of Pediatrics Clinical Practice Guidelines for the Screening and Management of High Blood Pressure in Children and Adolescents provide a comprehensive reference for evaluation and management of hypertension in this age group and should be used when assessing patients with elevated blood pressure and hypertension.
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Affiliation(s)
- Monica Guzman-Limon
- Division of Pediatric Nephrology and Hypertension, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin Street, MSB 3-121, Houston, TX 77030, USA
| | - Joshua Samuels
- Division of Pediatric Nephrology and Hypertension, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin Street, MSB 3-121, Houston, TX 77030, USA.
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67
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Jiang W, Hu C, Li F, Hua X, Zhang X. Association between sleep duration and high blood pressure in adolescents: a systematic review and meta-analysis. Ann Hum Biol 2019; 45:457-462. [PMID: 30387692 DOI: 10.1080/03014460.2018.1535661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CONTEXT Sleep has been assessed as a risk factor for health consequences. Among adults, excessively longer and shorter sleep durations are associated with high blood pressure (BP), but knowledge of the association between sleep duration and high BP among adolescents is limited. OBJECTIVES To estimate the associations between sleep duration and high BP in adolescents. METHODS PubMed, Web of Science, and Cochrane databases were searched for eligible publications up until 20 November 2017. This study reviewed the reference lists from retrieved articles to search for relevant studies. Pooled odds ratios (ORs) were calculated using a random-effects meta-analysis. Sub-group and sensitivity analyses were conducted to identify heterogeneity. Publication bias was evaluated using Egger's test. RESULTS Seven studies involving 21,150 participants were included, with ages ranging from 10-18 years. For primary analysis, compared with the reference sleep duration, the pooled OR for high BP was 1.51 (95% confidence interval [CI] = 1.04-2.19) for the short sleep duration overall. For long sleep duration, the pooled OR was 1.04 (95% CI = 0.78-1.38). Further sub-group analysis showed that short sleep duration had a higher risk of incident high BP in males (OR = 1.55, 95% CI = 1.24-1.93) than in females (OR = 1.23, 95% CI = 0.47-3.22). CONCLUSIONS Among adolescents, and particularly male adolescents, short sleep duration may be a risk factor for high BP. More attention should be given to this lifestyle factor.
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Affiliation(s)
- Wen Jiang
- a Department of Epidemiology and Biostatistics, School of Public Health , Anhui Medical University , Hefei , China
| | - Chengyang Hu
- a Department of Epidemiology and Biostatistics, School of Public Health , Anhui Medical University , Hefei , China
| | - Fengli Li
- a Department of Epidemiology and Biostatistics, School of Public Health , Anhui Medical University , Hefei , China
| | - Xiaoguo Hua
- a Department of Epidemiology and Biostatistics, School of Public Health , Anhui Medical University , Hefei , China
| | - Xiujun Zhang
- a Department of Epidemiology and Biostatistics, School of Public Health , Anhui Medical University , Hefei , China
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Patel A, Bharani A, Sharma M, Bhagwat A, Ganguli N, Chouhan DS. Prevalence of hypertension and prehypertension in schoolchildren from Central India. Ann Pediatr Cardiol 2019; 12:90-96. [PMID: 31143032 PMCID: PMC6521652 DOI: 10.4103/apc.apc_13_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: Epidemiological transition with increasing burden of cardiovascular risk factors is evident not only in adults but also in children. The data on the prevalence of prehypertension and hypertension in children show large regional differences in India and such data are not available from Central India. We, therefore, conducted a large cross-sectional study in Indore to determine the distribution of blood pressure (BP) and the prevalence of hypertension and prehypertension among schoolchildren. Methods: A total of 11,312 children (5305 girls, 6007 boys) aged 5–15 years, drawn from 80 government and private schools in equal proportion, were evaluated. Anthropometric measurements were obtained and BPs were measured using The Fourth Report on The Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents as reference standard. BP ≥90th to <95th percentile for given percentile of height was considered as prehypertension, whereas any BP ≥95th percentile was defined as hypertension. Multiple linear regression analysis was used to find out the determinants of hypertension in these children. Results: Prehypertension was detected in 6.9% and 6.5% and hypertension was found in 6.8% and 7.0% of boys and girls, respectively. Height and weight were found to be a significant predictor of systolic and diastolic BP among both boys and girls. Conclusions: Our results show a high prevalence of prehypertension and hypertension in Indore schoolchildren with age and height being significant determinants. This highlights the need for routine BP measurements in children by pediatricians when they treat them for intercurrent illnesses or vaccinate them. It should also be mandatory as a part of school health checkup programs to detect childhood hypertension for further counseling and therapy.
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Affiliation(s)
- Ashish Patel
- Department of Medicine, MGM Medical College, Indore, Madhya Pradesh, India
| | - Anil Bharani
- Department of Medicine, MGM Medical College, Indore, Madhya Pradesh, India
| | - Meenakshi Sharma
- Scientist 'F', Division of Noncommunicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Anuradha Bhagwat
- JVMM Project on Community Control of Rheumatic Fever/Rheumatic Heart Disease, Rheumatic Fever/Rheumatic Heart Disease Registry, Indore, Madhya Pradesh, India
| | - Neepa Ganguli
- JVMM Project on Community Control of Rheumatic Fever/Rheumatic Heart Disease, Rheumatic Fever/Rheumatic Heart Disease Registry, Indore, Madhya Pradesh, India
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69
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Arterial Stiffness in Early Phases of Prehypertension. UPDATES IN HYPERTENSION AND CARDIOVASCULAR PROTECTION 2019. [DOI: 10.1007/978-3-319-75310-2_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Sarganas G, Schaffrath Rosario A, Niessner C, Woll A, Neuhauser HK. Tracking of Blood Pressure in Children and Adolescents in Germany in the Context of Risk Factors for Hypertension. Int J Hypertens 2018; 2018:8429891. [PMID: 30356390 PMCID: PMC6178151 DOI: 10.1155/2018/8429891] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/10/2018] [Indexed: 11/17/2022] Open
Abstract
Blood pressure (BP) tracking from childhood to adulthood has two aspects: the ranking stability relative to others over time and the prediction of future values. This study investigates BP tracking in children and adolescents in Germany in the context of hypertension risk factors. BP was measured and analyzed in 2542 participants of the German Health Examination Survey for Children and Adolescents (t0 2003-2006; 3 to 17-year olds) and of a six year follow-up "Motorik Modul" (t1 2009-2012; 9 to 24-year olds). BP tracking coefficients were calculated from Spearman's rank-order correlations. Predictive values and logistic regression models were used to forecast t1-BP above the hypertension threshold from t0-BP as well as from baseline and follow-up hypertension risk factors. BP tracking was moderate (0.33-0.50 for SBP and 0.19-0.39 for DBP) with no statistically significant differences between sex and age groups. Baseline hypertensive BP was the strongest independent predictor of hypertensive BP at follow-up (OR 4.3 and 3.4 for age groups 3-10 and 11-17 years) after adjusting for sex, BMI trajectories, birthweight, parental hypertension, and age-group dependent-sports/physical activity. However, the positive predictive value of baseline hypertensive BP for hypertensive BP at follow-up in 3- to 10-year olds was only 39% (34% in 11- to 17-year olds) and increased only moderately in the presence of additional risk factors. Our analysis with population-based data from Germany shows that BP in children and adolescents tracks only moderately over six years. BP in childhood is the strongest independent predictor of future BP but its predictive value is limited.
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Affiliation(s)
- Giselle Sarganas
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
| | | | - Claudia Niessner
- Institute for Sports and Sport Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Alexander Woll
- Institute for Sports and Sport Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Hannelore K. Neuhauser
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
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Prevalence of hypertension and prehypertension and its association with anthropometrics among children: a cross-sectional survey in Tianjin, China. J Hum Hypertens 2018; 32:789-798. [DOI: 10.1038/s41371-018-0088-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/17/2018] [Accepted: 07/04/2018] [Indexed: 11/08/2022]
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72
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Changes in muscular fitness and its association with blood pressure in adolescents. Eur J Pediatr 2018; 177:1101-1109. [PMID: 29740692 DOI: 10.1007/s00431-018-3164-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 01/02/2023]
Abstract
The aims of this study were to examine the longitudinal association between muscular fitness (MF) and blood pressure (BP) 2 years later, and to determine whether changes in MF over a 2-year period were associated with BP at follow-up, in adolescents. The sample comprised 734 youths (349 girls) aged from 12 to 18 years. MF was assessed with the standing long jump and handgrip tests. Socioeconomic status, pubertal stage, waist circumference, resting BP, and cardiorespiratory fitness were measured according to standard procedures. Regression analyses showed a significant inverse association between MF at baseline and systolic BP (β = - 0.072; p = 0.032) and rate pressure product (β = - 0.124; p < 0.001) at follow-up, after adjustments for age, sex, height, pubertal stage, and socioeconomic status. However, when analyses were further adjusted for waist circumference and cardiorespiratory fitness, these associations did not remain significant. Adolescents with persistently high and increasing MF exhibited the lowest levels of diastolic BP (F(3, 721) = 3.814, p = 0.018) and systolic BP (F(3, 721) = 3.908, p = 0.014) when compared to those with persistent low MF after adjustment for age, sex, height, socioeconomic status, cardiorespiratory fitness, and waist circumference.Conclusion: This study suggests that persistent greater and increasing MF in youth are associated with lower levels of BP across the adolescence. What is Known: • Currently, there is a growing interest on the health benefits of muscular fitness. • Cross-sectional studies have identified an association between muscular fitness and blood pressure in adolescents. What is New: • Changes in muscular fitness during adolescence were associated with systolic and diastolic BP over a 2-year period. • Adolescents with persistently low muscular fitness exhibited the highest levels of diastolic and systolic BP.
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Khoury M, Urbina EM. Cardiac and Vascular Target Organ Damage in Pediatric Hypertension. Front Pediatr 2018; 6:148. [PMID: 29881718 PMCID: PMC5976785 DOI: 10.3389/fped.2018.00148] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/03/2018] [Indexed: 12/17/2022] Open
Abstract
Atherosclerosis begins in youth and is associated with the presence of numerous modifiable cardiovascular (CV) risk factors, including hypertension. Pediatric hypertension has increased in prevalence since the 1980s but has plateaued in recent years. Elevated blood pressure levels are associated with impairments to cardiac and vascular structure and both systolic and diastolic function. Blood pressure-related increases in left ventricular mass (LVM) and abnormalities in cardiac function are associated with hard CV events in adulthood. In addition to cardiac changes, key vascular changes occur in hypertensive youth and adults. These include thickening of the arteries, increased arterial stiffness, and decreased endothelial function. This review summarizes the epidemiologic burden of pediatric hypertension, its associations with target organ damage (TOD) of the cardiac and vascular systems, and the impact of these adverse CV changes on morbidity and mortality in adulthood.
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Affiliation(s)
| | - Elaine M. Urbina
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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Hu J, Teng CG, Chu GP, Han D, Fu H, Zhou YK, Wang Q, Wang B, Shen H, Liu F, Yang HB. Effects of resting heart rate on blood pressure and hypertension in Chinese children: findings from blood pressure surveillance program. Clin Exp Hypertens 2018; 41:1-7. [PMID: 29553835 DOI: 10.1080/10641963.2018.1451537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/28/2018] [Accepted: 03/07/2018] [Indexed: 01/13/2023]
Abstract
The purpose of this study was to analyze the association between resting heart rate (RHR) and prevalence of hypertension in Chinese children and to identify if this association was mediated by body mass index (BMI). The data of 5445 children who participated in the Blood Pressure Surveillance Program (2011-2017) were analyzed in this study. Children were divided into four groups according to quartiles of RHR in boys and girls, respectively. Compared to those in the first quartile, boys and girls in the fourth quartile were 3.06 (95% CI 2.12, 4.41) and 4.94 (95% CI 3.21, 7.61) times more likely to have hypertension, respectively. Meanwhile, every 10 beats per minute (bpm) increase in RHR was associated with a 41% (95% CI 1.27, 1.56) and 66% (95% CI 1.49, 1.85) greater risk of hypertension in boys and girls, respectively. There were no significant interactions between RHR and BMI on the prevalence of hypertension. This study confirms the existence of a relationship between elevated RHR and increased risk of hypertension in children, independent of BMI. An elevated RHR could be considered as a risk factor for the risk assessment of hypertension, no matter from a clinical setting or a public health perspective.
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Affiliation(s)
- Jia Hu
- a Suzhou Center for Disease Prevention and Control , Suzhou , Jiangsu , China
| | - Chen-Gang Teng
- a Suzhou Center for Disease Prevention and Control , Suzhou , Jiangsu , China
| | - Guang-Ping Chu
- b Health Center for Women and Children of Gusu District , Suzhou , Jiangsu , China
| | - Di Han
- a Suzhou Center for Disease Prevention and Control , Suzhou , Jiangsu , China
| | - Han Fu
- c Xi'an Center for Disease Control and Prevention , Xi'an , Shaanxi , China
| | - Yi-Kai Zhou
- d MOE Key Lab of Environment and Health , Institute of Environmental Medicine, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology , Wuhan , Hubei , China
| | - Qi Wang
- e Department of Epidemiology and Biostatistics, School of Public Health , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei , China
| | - Bo Wang
- a Suzhou Center for Disease Prevention and Control , Suzhou , Jiangsu , China
| | - Hui Shen
- a Suzhou Center for Disease Prevention and Control , Suzhou , Jiangsu , China
| | - Fang Liu
- a Suzhou Center for Disease Prevention and Control , Suzhou , Jiangsu , China
| | - Hai-Bing Yang
- a Suzhou Center for Disease Prevention and Control , Suzhou , Jiangsu , China
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Benmohammed K, Valensi P, Nguyen MT, Benmohammed F, Benlatreche M, Benembarek K, Lezzar A. Influence of waist circumference on blood pressure status in non-obese adolescents. Int J Adolesc Med Health 2018; 32:ijamh-2017-0127. [PMID: 29332014 DOI: 10.1515/ijamh-2017-0127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/09/2017] [Indexed: 11/15/2022]
Abstract
Objectives To check whether excess in abdominal adiposity and metabolic factors were associated with blood pressure abnormalities in non-obese adolescents. Methods We randomly selected 1100 adolescent students, aged 12-18 years, from schools and classrooms in the city of Constantine, Algeria. Among them 179 were overweight and 51 were obese (IOTF criteria). Waist circumference (WC) was considered high if >74 cm in boys and 75 cm in girls (mean of WC of all population studied). Hypertension (HBP) and prehypertension (preHBP) were defined by the NHBPEP's 2004 criteria. Results The prevalence of HBP/preHBP were 13.0%/12.4% with no difference between boys and girls. The percentages of HBP/preHBP patients were 15.6%/15.6% in overweight adolescents, 5.9%/31.4% in obese adolescents and 12.9%/10.6% in adolescents with normal body weight (p < 0.0001). In obese adolescents, the prevalence of HBP was higher among boys than girls (36% vs. 27%, p = 0.002). In normal and overweight adolescents, the prevalence of HBP and preHBP was similar in boys and girls (11.9% vs. 11.0% and 14.7% vs. 12.1%); the association of WC (high vs. not high) with HBP was found in boys (16.1% vs. 8.8%, p = 0.009) but not in girls (12.1% vs. 10.2%), and with preHBP in girls (15.5% vs. 8.0%, p = 0.029) but not in boys (16.2% vs. 13.6%). Waist circumference [OR: 1.04 (1.03-1.06); p < 0.0001] and HOMA index [OR: 1.65 (1.13-2.39); p = 0.009] were associated with an increased risk of HBP. Conclusion In non-obese adolescents, a high WC, defined by values over the mean WC observed in our population, is associated with a higher risk of HBP in boys.
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Affiliation(s)
- Karima Benmohammed
- Department of Endocrinology and Diabetology, Dr Benbadis University Hospital, Constantine University 3, Constantine, Algeria
| | - Paul Valensi
- Department of Endocrinology, Diabetology and Nutrition, Jean Verdier hospital, APHP, Paris Nord University, CRNH-IDF, CINFO, Bondy, France
| | - Minh Tuan Nguyen
- Department of Endocrinology, Diabetology and Nutrition, Jean Verdier hospital, APHP, Paris Nord University, CRNH-IDF, CINFO, Bondy, France
| | | | - Moufida Benlatreche
- Department of Animal Biology, Faculty of Life and Natural Sciences, University of Constantine 1, Biology and genetics research laboratory, Constantine, Algeria
| | - Karima Benembarek
- Department of Biochemistry, Research Laboratory on Biology and Genetic, Constantine University3, Constantine, Algeria
| | - Alkassem Lezzar
- Department of Endocrinology and Diabetology, Dr Benbadis University Hospital, Constantine University 3, Constantine, Algeria
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Agostinis-Sobrinho C, Ruiz JR, Moreira C, Abreu S, Lopes L, Oliveira-Santos J, Mota J, Santos R. Cardiorespiratory Fitness and Blood Pressure: A Longitudinal Analysis. J Pediatr 2018; 192:130-135. [PMID: 29246334 DOI: 10.1016/j.jpeds.2017.09.055] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/18/2017] [Accepted: 09/21/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine the association between cardiorespiratory fitness and cardiovascular indices 2 years later, and to determine whether changes in cardiorespiratory fitness are associated with cardiovascular indices at a 2-year follow-up in adolescents. STUDY DESIGN The sample comprised 734 adolescents (349 girls) aged 12-18 years followed for 3 years from the LabMed Physical Activity Study. Cardiorespiratory fitness was assessed by the 20-meter shuttle run test. Height, weight, waist circumference, and resting blood pressure (BP) were measured according to standard procedures. RESULTS Regression analyses showed a significant inverse association between cardiorespiratory fitness at baseline and systolic BP (B = -0.126; P = .047) and rate pressure product (B = -29.94; P = .016), at follow-up after adjustments for age, sex, height, pubertal stage, socioeconomic status, and waist circumference. Significant differences were found between cardiorespiratory fitness groups (fit vs unfit) at baseline and systolic BP and rate pressure product at follow-up (P < .05 for all). Analysis of covariance showed a significant association between cardiorespiratory fitness changes and systolic BP (P = .024) and rate pressure product (P = .014), after adjustment for age, sex, height, pubertal status, socioeconomic status, and waist circumference. CONCLUSIONS Changes in cardiorespiratory fitness during adolescence were associated with cardiovascular indices over a 2-year period. Adolescents with persistently low levels of cardiorespiratory fitness exhibited the highest levels of systolic BP and rate pressure product.
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Affiliation(s)
- César Agostinis-Sobrinho
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal.
| | - Jonatan R Ruiz
- PROFITH Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Carla Moreira
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - Sandra Abreu
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - Luís Lopes
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - José Oliveira-Santos
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - Jorge Mota
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - Rute Santos
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal; Early Start Research Institute, Faculty of Social Sciences, School of Education. University of Wollongong, Wollongong, Australia
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77
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Wyszyńska J, Podgórska-Bednarz J, Leszczak J, Mazur A. Prevalence of hypertension and prehypertension in children and adolescents with intellectual disability in southeastern Poland. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:995-1002. [PMID: 28675574 DOI: 10.1111/jir.12398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 03/22/2017] [Accepted: 06/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND There is insufficient information on the prevalence of hypertension (HPT) among children and adolescents with ID. AIM The aim of this study was to determine the prevalence of HPT in children and adolescents with ID in comparison with the control group, which accounted for children and adolescents without ID. METHODS The study included 568 students with ID, aged from 7 to 18, attending special education institutions in southeastern Poland. The control group consisted of 568 students (matched to the study group for age and gender) without ID, attending randomly selected elementary and secondary schools located in the same area. Blood pressure was measured in compliance with the European Society of Hypertension recommendations. RESULTS The overall prevalence of HPT and pre-HPT in children and adolescents with ID were 18.5 and 20.6% respectively. Prevalence of HPT and pre-HPT in children and adolescents without ID were 5.8 and 18.5% respectively. Children and adolescents with a higher level of ID were found to be at a greater risk of HPT. An excessive body mass and older age were predisposing factors to a significantly higher prevalence of HPT in children and adolescents with ID. CONCLUSION The prevalence of HPT among students with ID was more than three times higher than in the general population. The level of ID, age, sex and body mass significantly correlated with HPT in the study group.
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Affiliation(s)
- J Wyszyńska
- Institute of Physiotherapy, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - J Podgórska-Bednarz
- Institute of Physiotherapy, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - J Leszczak
- Institute of Physiotherapy, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - A Mazur
- Institute of Nursing and Health Sciences, Medical Faculty, University of Rzeszów, Rzeszów, Poland
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78
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Weight status, cardiorespiratory fitness and high blood pressure relationship among 5-12-year-old Chinese primary school children. J Hum Hypertens 2017; 31:808-814. [PMID: 28906485 DOI: 10.1038/jhh.2017.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/17/2017] [Accepted: 07/28/2017] [Indexed: 02/07/2023]
Abstract
Cardiorespiratory fitness (CRF) and adiposity contribute to high blood pressure (HBP) in adults and children. However, their relative importance as risk factors is unknown. We examined the relationships between weight status, CRF and HBP among Chinese primary school children. A cross-sectional study was conducted with 4926 school children aged 5-12 years. CRF was estimated from a modified Cooper test, body mass index z-scores and weight categories were calculated from objective height and weight measurements and BP was measured using an electronic sphygmomanometer. HBP was defined as >95th percentile based on reference cutoffs for Chinese boys and girls. Generalised Linear Mixed models, adjusting for age, pubertal status and height, were developed for boys and girls to explore the independent and combined associations between fitness, weight status and HBP. Seven hundred and fifty-two (15.3%) children had HBP, with a higher prevalence in obese (40.5% and 45.9% in boys and girls, respectively) and overweight (27.6% and 30.2% in boys and girls, respectively) compared with non-overweight (9.0% and 13.8% in boys and girls, respectively) children. HBP prevalence was lower in boys with higher CRF (odds ratio (OR) for the highest vs lowest CRF quartile in boys 0.64; 95% confidence interval (CI) 0.46-0.89). This association was not seen in girls. With weight status and CRF in the same model, weight status, but not CRF, remained significantly associated with HBP (obesity in boys: OR 4.19; 95% CI 2.63-6.67; in girls: OR 2.49; 95% CI 1.19-5.19). The interaction effect for CRF and weight status was non-significant. Overweight/obesity was significantly associated with HBP among children. There was no evidence of modification of this relationship by CRF.
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79
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Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140:peds.2017-1904. [PMID: 28827377 DOI: 10.1542/peds.2017-1904] [Citation(s) in RCA: 1889] [Impact Index Per Article: 269.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.
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Affiliation(s)
- Joseph T Flynn
- Dr. Robert O. Hickman Endowed Chair in Pediatric Nephrology, Division of Nephrology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington;
| | - David C Kaelber
- Departments of Pediatrics, Internal Medicine, Population and Quantitative Health Sciences, Center for Clinical Informatics Research and Education, Case Western Reserve University and MetroHealth System, Cleveland, Ohio
| | - Carissa M Baker-Smith
- Division of Pediatric Cardiology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Douglas Blowey
- Children's Mercy Hospital, University of Missouri-Kansas City and Children's Mercy Integrated Care Solutions, Kansas City, Missouri
| | - Aaron E Carroll
- Department of Pediatrics, School of Medicine, Indiana University, Bloomington, Indiana
| | - Stephen R Daniels
- Department of Pediatrics, School of Medicine, University of Colorado-Denver and Pediatrician in Chief, Children's Hospital Colorado, Aurora, Colorado
| | - Sarah D de Ferranti
- Director, Preventive Cardiology Clinic, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Janis M Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Bonita Falkner
- Departments of Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Susan K Flinn
- Consultant, American Academy of Pediatrics, Washington, District of Columbia
| | - Samuel S Gidding
- Cardiology Division Head, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Celeste Goodwin
- National Pediatric Blood Pressure Awareness Foundation, Prairieville, Louisiana
| | - Michael G Leu
- Departments of Pediatrics and Biomedical Informatics and Medical Education, University of Washington, University of Washington Medicine and Information Technology Services, and Seattle Children's Hospital, Seattle, Washington
| | - Makia E Powers
- Department of Pediatrics, School of Medicine, Morehouse College, Atlanta, Georgia
| | - Corinna Rea
- Associate Director, General Academic Pediatric Fellowship, Staff Physician, Boston's Children's Hospital Primary Care at Longwood, Instructor, Harvard Medical School, Boston, Massachusetts
| | - Joshua Samuels
- Departments of Pediatrics and Internal Medicine, McGovern Medical School, University of Texas, Houston, Texas
| | - Madeline Simasek
- Pediatric Education, University of Pittsburgh Medical Center Shadyside Family Medicine Residency, Clinical Associate Professor of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vidhu V Thaker
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York; and
| | - Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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80
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Di Bonito P, Valerio G, Pacifico L, Chiesa C, Invitti C, Morandi A, Maffeis C, Licenziati MR, Manco M, Miraglia Del Giudice E, Baroni MG, Loche S, Tornese G, Tomat M, de Simone G. A new index to simplify the screening of hypertension in overweight or obese youth. Nutr Metab Cardiovasc Dis 2017; 27:830-835. [PMID: 28755804 DOI: 10.1016/j.numecd.2017.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Hypertension (HTH) is a frequent complication in pediatric obesity. To simplify the screening of HTH in overweight/obese (Ow/Ob) youth, we compared the performance of a new index (High Blood Pressure index, HBPi) with respect to the standard criteria of the IV Report [systolic BP (SBP) and/or diastolic BP (DBP) ≥95th percentile for age, gender and height]. We also compared the performance of HBPi with other simplified indices such as the BP/height ratio and the absolute height-specific BP thresholds. Ten pediatrics' outpatient centers participating in the "CARdiometabolic risk factors in ITALY study" provided medical records of 4225 Ow/Ob children and adolescents (age 6-16 years). METHODS AND RESULTS Centers were divided into two groups: training set (TS) (n = 2204 participants) and validation set (VS) (n = 2021 participants). The simplified HBPi (mmHg) was: (SBP/2 + DBP/10) - age + (1 × female gender). In the TS, a HBPi value ≥57 mmHg in both children and adolescents had high sensitivity (0.89), specificity (0.97), positive (0.89) and negative (0.97) predictive values in classifying youth at high risk of HTN compared with the IV Report. In the VS, the HBPi showed a better performance than high levels of BP/height ratio and height-specific BP thresholds in classifying individuals at risk of HTN: area under curves 0.95 (0.93-0.96), 0.80 (0.78-0.82), 0.76 (0.74-0.79), respectively; specificities 0.95 (0.94-0.96), 0.69 (0.67-0.72), 0.60 (0.57-0.62), respectively. CONCLUSIONS HBPi, combining SBP and DBP, gender and age, may help pediatricians to implement HTN screening in Ow/Ob youth.
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Affiliation(s)
- P Di Bonito
- Department of Internal Medicine, "S. Maria delle Grazie", Pozzuoli Hospital, Naples, Italy
| | - G Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy.
| | - L Pacifico
- Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - C Chiesa
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - C Invitti
- IRCCS Istituto Auxologico Italiano, Department of Medical Sciences & Rehabilitation, Milan, Italy
| | - A Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona, Italy
| | - C Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - M R Licenziati
- Department of Pediatrics, AORN Santobono-Pausilipon, Naples, Italy
| | - M Manco
- IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - E Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M G Baroni
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy; Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Loche
- Pediatric Endocrine Unit, Pediatric Hospital for Microcitemia, AO Brotzu, Cagliari, Italy
| | - G Tornese
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - M Tomat
- Pediatric Unit, AOU Udine, Udine, Italy
| | - G de Simone
- Hypertension Research Center, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
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81
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Hu J, Shen H, Chu GP, Fu H, Huang FF, Zheng YM, Han D, Zhou YK, Wang Q, Wang B, Teng CG, Liu F, Yang HB. Association of elevated resting pulse rate with increased risk of hypertension development in children: A prospective study in Suzhou, China. Medicine (Baltimore) 2017; 96:e7696. [PMID: 28796052 PMCID: PMC5556218 DOI: 10.1097/md.0000000000007696] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Elevated resting heart rate (RHR) or resting pulse rate (RPR) is associated with increased risk of hypertension development. However, information is limited to adults. The purpose of this study is to analyze this association among Chinese children in a prospective design. METHODS A total of 4861 children who participated in the Blood Pressure Surveillance Program (2011-2017) were selected in this research. To investigate the association between RPR and hypertension development, children were divided into 4 groups according to the quartiles of RPR at baseline. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using logistic regression model. RESULTS Over a mean follow-up of 3.0 ± 0.1 years, there were 384 cases of incident hypertension. Compared to boys and girls in the 1st quartile, those in the 4th quartile were 1.73 (95% CI 1.13, 2.65), 2.22 (95% CI 1.43, 3.45) times more likely to have hypertension, respectively. Every 10 bpm increase in RPR was associated with a 26% greater risk of hypertension development in boys (OR: 1.26; 95% CI 1.10, 1.44), while this risk was 1.28 (95% CI 1.13, 1.44) in girls. Baseline blood pressure (BP) and body mass index (BMI) did not have significant interactions with RPR on risk of hypertension development. CONCLUSION This study confirms the relationship between elevated RPR and increased risk of hypertension development in children, independent of confounders including baseline BP and BMI. An elevated RPR could be considered as a risk factor for the assessment of hypertension, no matter from a clinical setting or a public health perspective.
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Affiliation(s)
- Jia Hu
- Suzhou Center for Disease Prevention and Control
| | - Hui Shen
- Suzhou Center for Disease Prevention and Control
| | - Guang-Ping Chu
- Health Center for Women and Children of Gusu District, Suzhou, Jiangsu
| | - Han Fu
- Xi’an Center for Disease Control and Prevention, Xi’an, Shaanxi Province
| | | | | | - Di Han
- Suzhou Center for Disease Prevention and Control
| | - Yi-Kai Zhou
- MOE Key Lab of Environment and Health, Institute of Environmental Medicine
| | - Qi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bo Wang
- Suzhou Center for Disease Prevention and Control
| | | | - Fang Liu
- Suzhou Center for Disease Prevention and Control
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82
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Daley MF, Reifler LM, Johnson ES, Sinaiko AR, Margolis KL, Parker ED, Greenspan LC, Lo JC, O’Connor PJ, Magid DJ. Predicting Hypertension Among Children With Incident Elevated Blood Pressure. Acad Pediatr 2017; 17:275-282. [PMID: 28254479 PMCID: PMC5384864 DOI: 10.1016/j.acap.2016.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/16/2016] [Accepted: 09/25/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To develop a model to predict hypertension risk among children with incident elevated blood pressure (BP); to test the external validity of the model. METHODS A retrospective cohort study was conducted in 3 organizations: Kaiser Permanente Colorado was the model derivation site; HealthPartners of Minnesota and Kaiser Permanente Northern California served as external validation sites. During study years 2006 through 2012, all children aged 3 through 17 years with incident elevated BP in an outpatient setting were identified. The predictor variables were demographic and clinical characteristics collected during routine care. Cox proportional hazards regression was used to predict subsequent hypertension, and diagnostic statistics were used to assess model performance. RESULTS Among 5598 subjects at the derivation site with incident elevated BP, 160 (2.9%) developed hypertension during the study period. Eight characteristics were used to predict hypertension risk: age, sex, race, BP preceding incident elevated BP, body mass index percentile, systolic BP percentile, diastolic BP percentile, and clinical setting of the incident elevated BP. At the derivation site, the model discriminated well between those at higher versus lower risk of hypertension (c-statistic = 0.77). At external validation sites, the observed risk of hypertension was higher than the predicted risk, and the model showed poor discrimination (c-statistic ranged from 0.64 to 0.67). CONCLUSIONS Among children with incident elevated BP, a risk model demonstrated good internal validity with respect to predicting subsequent hypertension. However, the risk model did not perform well at 2 external validation sites, which might limit transportability to other settings.
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Affiliation(s)
- Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Liza M. Reifler
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
| | - Eric S. Johnson
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Alan R. Sinaiko
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | | | | | - Joan C. Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - David J. Magid
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
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83
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Kuciene R, Dulskiene V, Medzioniene J. Associations between high birth weight, being large for gestational age, and high blood pressure among adolescents: a cross-sectional study. Eur J Nutr 2017; 57:373-381. [PMID: 28058464 PMCID: PMC5847040 DOI: 10.1007/s00394-016-1372-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 12/21/2016] [Indexed: 11/29/2022]
Abstract
Purpose Low birth weight and being small for gestational age are associated with increased risk of cardiometabolic diseases. However, the results from the studies examining the associations between high birth weight (HBW), being large for gestational age (LGA), and high blood pressure (HBP) are inconsistent. The aim of this study was to evaluate the associations between HBW and being LGA alone and in combinations with body mass index (BMI) categories in adolescence and HBP among Lithuanian adolescents aged 12–15 years. Methods The participants with HBP (≥90th percentile) were screened on two separate occasions. Data on the BMI, birth weight (BW), gestational age, and BP were analyzed in 4598 adolescents. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) for the associations were estimated using multivariate logistic regression models. Results The overall prevalence of HBW (>4000 g), being LGA, adolescent overweight/obesity, and HBP were 13.9, 10.4, 14.5, and 25.6%, respectively. After adjustment for age, sex, and BMI, significant positive associations were found between HBW and being LGA and HBP (HBW: aOR 1.34; 95% CI, 1.11–1.63; LGA: aOR 1.44; 95% CI, 1.16–1.79). After adjustment for age and sex and compared to BW 2500–4000 g and being AGA (appropriate for gestational age) with normal weight in adolescence, the combinations that included both risk factors—HBW with overweight/obesity and being LGA with overweight/obesity—showed higher aORs (aOR 4.36; 95% CI, 3.04–6.26; and aOR 5.03; 95% CI, 3.33–7.60, respectively) than those with either of these risk factors alone did. Conclusions HBW and being LGA were positively associated with HBP in Lithuanian adolescents aged 12–15 years. The highest odds of having HBP were observed for subjects with both risk factors—neonatal HBW or being LGA and overweight/obesity in adolescence.
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Affiliation(s)
- Renata Kuciene
- Laboratory of Population Studies, Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu 15, 50009, Kaunas, Lithuania.
| | - Virginija Dulskiene
- Laboratory of Population Studies, Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu 15, 50009, Kaunas, Lithuania
| | - Jurate Medzioniene
- Laboratory of Population Studies, Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu 15, 50009, Kaunas, Lithuania
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Hu J, Chu GP, Huang FF, Zhou YK, Teng CG, Yang HB, Shen H. Relation of body mass index (BMI) to the prevalence of hypertension in children: A 3years' school-based prospective study in Suzhou, China. Int J Cardiol 2016; 222:270-274. [PMID: 27497109 DOI: 10.1016/j.ijcard.2016.07.217] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/28/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The prevalence of hypertension has been increasing in children and adolescents in China, which is considered to be accompanied with the epidemic of childhood overweight and obesity, but limited prospective studies have investigated the effect of body mass index (BMI) change on blood pressure among children, especially in China. METHODS This school-based prospective study compared the blood pressure and prevalence of hypertension in students with different patterns of change in BMI between two periods (childhood and adolescence). 5465 children were followed-up since 2011(childhood) in Suzhou, China and had weight, height and blood pressure measured in 2011(childhood) and 2014(adolescence). RESULTS Those who changed from being overweight in childhood to having normal BMI in adolescence had similar mean blood pressures to those who had a normal BMI at both two periods. In contrast, those who were overweight at both two periods or who had a normal BMI in childhood and were overweight in adolescence had higher blood pressure in adolescence than those who had a normal BMI at both two periods. Compared with students who had a normal BMI at both periods, those with combination of abnormal BMI in childhood and adolescence have higher ORs of hypertension (4.83 in boys, 3.44 in girls and 3.73 in total). CONCLUSION These results suggest that obesity is a key determinant of blood pressure during childhood, and weight reduction may have important beneficial effects on blood pressure.
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Affiliation(s)
- Jia Hu
- Suzhou Center for Disease Prevention and Control, Suzhou, Jiangsu, China
| | - Guang-Ping Chu
- Health Center for Women and Children of Gusu District, Suzhou, Jiangsu, China
| | - Fei-Fei Huang
- Suzhou Center for Disease Prevention and Control, Suzhou, Jiangsu, China
| | - Yi-Kai Zhou
- MOE Key Lab of Environment and Health, Institute of Environmental Medicine, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Chen-Gang Teng
- Suzhou Center for Disease Prevention and Control, Suzhou, Jiangsu, China
| | - Hai-Bing Yang
- Suzhou Center for Disease Prevention and Control, Suzhou, Jiangsu, China
| | - Hui Shen
- Suzhou Center for Disease Prevention and Control, Suzhou, Jiangsu, China.
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85
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Magnussen CG, Smith KJ. Pediatric Blood Pressure and Adult Preclinical Markers of Cardiovascular Disease. Clin Med Insights Blood Disord 2016; 9:1-8. [PMID: 27168729 PMCID: PMC4857790 DOI: 10.4137/cmbd.s18887] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 01/27/2023]
Abstract
A high blood pressure level in adults is considered the single most important modifiable risk factor for global disease burden, especially those of cardiovascular (CV) origin such as stroke and ischemic heart disease. Because blood pressure levels have been shown to persist from childhood to adulthood, elevations in pediatric levels have been hypothesized to lead to increased CV burden in adulthood and, as such, might provide a window in the life course where primordial and primary prevention could be focused. In the absence of substantive data directly linking childhood blood pressure levels to overt adult CV disease, this review outlines the available literature that examines the association between pediatric blood pressure and adult preclinical markers of CV disease.
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Affiliation(s)
- Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Kylie J Smith
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Gidding SS. Translating Epidemiologic Studies on Blood Pressure into Clinical Practice. J Pediatr 2015; 167:1188-9. [PMID: 26409310 DOI: 10.1016/j.jpeds.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/01/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Samuel S Gidding
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware.
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