Patient-, provider-, and clinic-level predictors of unrecognized elevated blood pressure in children

Developmental origins of health and adult disease: what should neonatologists/paediatricians be considering about the long-term health of their patients?

The developmental origins of health and disease hypothesis is now strongly supported by both animal and human evidence, and as a consequence, obstetricians, neonatologists and paediatricians need to consider the impact that the in utero and early post-natal environment can have on later renal, cardiovascular and metabolic health. Four common clinical scenarios were provided along with animal and human evidence identifying long-term health implications. Suggestions as to how we should translate this growing body of evidence into practice are provided.

Prevalence of cardiovascular disease risk factors among US adolescents, 1999-2008

OBJECTIVE

Overweight and obesity during adolescence are associated with an increased risk for cardiovascular disease (CVD) risk factors. The objective of this study was to examine the recent trends in the prevalence of selected biological CVD risk factors and the prevalence of these risk factors by overweight/obesity status among US adolescents.

METHODS

The NHANES is a cross-sectional, stratified, multistage probability sample survey of the US civilian, noninstitutionalized population. The study sample included 3383 participants aged 12 to 19 years from the 1999 through 2008 NHANES.

RESULTS

Among the US adolescents aged 12 to 19 years, the overall prevalence was 14% for prehypertension/hypertension, 22% for borderline-high/high low-density lipoprotein cholesterol, 6% for low high-density lipoprotein cholesterol (<35 mg/dL), and 15% for prediabetes/diabetes during the survey period from 1999 to 2008. No significant change in the prevalence of prehypertension/hypertension (17% and 13%) and borderline-high/high low-density lipoprotein cholesterol (23% and 19%) was observed from 1999-2000 to 2007-2008, but the prevalence of prediabetes/diabetes increased from 9% to 23%. A consistent dose-response increase in the prevalence of each of these CVD risk factors was observed by weight categories: the estimated 37%, 49%, and 61% of the overweight, obese, and normal-weight adolescents, respectively, had at least 1 of these CVD risk factors during the 1999 through 2008 study period.

CONCLUSIONS

The results of this national study indicate that US adolescents carry a substantial burden of CVD risk factors, especially those youth who are overweight or obese.

Learning and attention problems among children with pediatric primary hypertension

OBJECTIVE

The objective was to determine whether children with sustained primary hypertension are at increased risk for learning disabilities (LDs), as a school-related manifestation of neurocognitive problems.

METHODS

A total of 201 children 10 to 18 years of age who were referred because of elevated blood pressure (BP) were included. Patients were categorized as having or not having hypertension, on the basis of BP evaluation at the initial hypertension clinic visit and subsequent confirmation of sustained elevated BP outside the clinic setting. Parents reported whether their child had a provider-confirmed LD or attention-deficit/hyperactivity disorder (ADHD).

RESULTS

A total of 101 children without hypertension and 100 children with hypertension were evaluated; 18% of the children (n = 37) had LDs. In comparison with children without hypertension, children with hypertension were significantly more likely to have LDs (18% vs 9%; P < .001), irrespective of comorbid ADHD. With adjustment for demographic variables and obesity, the odds of having LDs were elevated for subjects with hypertension, in comparison with subjects without hypertension (odds ratio: 4.1 [95% confidence interval: 1.8-9.4]).

CONCLUSIONS

The rate of LDs, with or without ADHD treatment, was significantly higher for children with sustained primary hypertension, compared with children without hypertension. These findings add to the growing evidence for an association between primary hypertension and cognitive function and may inform treatment and monitoring decisions for these children who may be at risk for learning problems.