Perceived stress and blood pressure in early adolescent children

A multisystem model for understanding stress and adaptation in ethnically and racially diverse youth

Contemporary biological and contextually based theoretical frameworks have conceptualized how stress exposure may influence adaptation in youth. However, nearly all of this scholarship neglects the role of specific contextual features and/or biological processes that are involved in ethnic-racial minority youth's responses and adaptation to sociocultural stressors. Drawing on the theoretical principles of the developmental psychopathology framework and contemporary models of stress and adaptation, this article proposes a new multisystem model that explains how multiple levels and systems within and outside of individual youth influence their sociocultural adaptation. We provide empirical evidence to support components of this multisystem model. We propose that research based on our new theoretical framework will capture the sociocultural experiences of ethnic-racial minority youth by centering processes that are relevant to their lived experiences, coping, and adjustment. In doing so, this model will inform psychosocial interventions focused on promoting healthy adaptation among ethnic and racial diverse youth. Finally, we offer recommendations to guide future research on stress and adaptation among ethnic and racial diverse youth, in particular, and developmental psychopathology more broadly.

Spot urinary sodium-to-potassium ratio is associated with blood pressure levels in healthy adolescents: the Wakayama Study

The spot urinary sodium-to-potassium (Na/K) ratio is a simple measure of salt loading and has been shown to be associated with elevated blood pressure (BP) in middle-aged and older adults. This study aimed to evaluate the association between the spot urinary Na/K ratio and BP in 457 healthy adolescents aged 12-15 years in a school-based setting. The mean urinary Na/K ratio was 4.99 ± 2.76, and no significant difference was found between the boys and girls. When the participants were stratified based on urinary Na/K ratio quartile, age- and sex-adjusted systolic and diastolic BP gradually increased as Na/K ratio increased (systolic BP: 106.1, 106.9, 108.2, and 111.5 mmHg, Ptrend < 0.001; diastolic BP: 62.0, 62.4, 63.1, 64.3 mmHg, Ptrend = 0.022). The systolic and diastolic BP were more closely associated with urinary Na/K ratio than with Na and K levels, as well as estimated daily salt intake. In the multiple regression analysis, the urinary Na/K ratio was significantly associated with systolic BP (β = 0.144, P < 0.001) and diastolic BP (β = 0.114, P = 0.015) independent of potential confounding factors. An additional subgroup analysis revealed that the BP of the group with both high salt intake (≥8.5 g/day) and high Na/K ratio (≥6.60) was significantly higher than that of the group with high salt intake alone (systolic BP, 115.0 vs. 109.1 mmHg, P < 0.001; diastolic BP, 66.0 vs. 62.5 mmHg, P = 0.017). These results suggest that the urinary Na/K ratio is associated with BP levels in healthy adolescents and may be useful for assessing salt loading and its effects on BP elevation.

Perceived Stress From Childhood to Adulthood and Cardiometabolic End Points in Young Adulthood: An 18-Year Prospective Study

BACKGROUND

We investigated how childhood-to-adulthood perceived stress patterns predict adult cardiometabolic risk.

METHODS AND RESULTS

This study included 276 participants from the Southern California Children's Health Study (2003-2014), and a follow-up assessment (2018-2021). Perceived stress (Perceived Stress Scale) was initially reported by participants' parents for themselves during early childhood (mean age, 6.3 years), and later self-reported during adolescence (13.3 years) and young adulthood (23.6 years). Participants were grouped into 4 stress patterns: consistently high, decreasing, increasing, and consistently low. Cardiometabolic risk was assessed in young adulthood by carotid artery intima-media thickness, systolic and diastolic blood pressure, obesity, percent body fat, android/gynoid ratio, and glycated hemoglobin. A cardiometabolic risk score was generated by summing the clinically abnormal markers. Multivariable linear and logistic regression models were used to (1) examine the associations between Perceived Stress Scale at 3 time points and adult cardiometabolic risk, and (2) assess the impact of stress pattern on adult cardiometabolic risk. Findings suggested that in adulthood, higher Perceived Stress Scale score was associated with increased overall cardiometabolic risk (β=0.12 [95% CI, 0.01-0.22]), carotid artery intima-media thickness (β=0.01 [95% CI, 0.0003-0.02]), systolic blood pressure (β=1.27 [95% CI, 0.09-2.45]), and diastolic blood pressure (β=0.94 [95% CI, 0.13-1.75]). Individuals with a consistently high adolescence-to-adulthood stress pattern had greater overall cardiometabolic risk (β=0.31 [95% CI, 0.02-0.60]), android/gynoid ratio (β=0.07 [95% CI, 0.02-0.13]), percent body fat (β=2.59 [95% CI, 0.01-5.17]), and greater odds of obesity (odds ratio, 5.57 [95% CI, 1.62-19.10]) in adulthood, compared with those with a consistently low Perceived Stress Scale score.

CONCLUSIONS

Consistently high perceived stress from adolescence to adulthood may contribute to greater cardiometabolic risk in young adulthood.

Accumulation of adverse childhood events and overweight in children: A systematic review and meta-analysis

OBJECTIVE

This study systematically summarizes the evidence of all observational studies investigating the relation between accumulation of adverse life events and measures of overweight in children <18 years.

METHODS

MEDLINE, Embase, PsycINFO, and CINAHL were systematically searched (last search date 18 February 2015). The Newcastle-Ottawa Scale was used for methodological quality assessment. Study estimates were pooled using a random-effects model, and sources of heterogeneity were explored (PROSPERO registration number CRD42014014927).

RESULTS

Eighteen articles were included, containing five longitudinal (n = 6,361) and fourteen cross-sectional and case-control study results (n = 52,318). The pooled estimate of the longitudinal studies showed that accumulation of adverse life events is positively related to childhood overweight measures (OR [95% CI] = 1.12 [1.01-1.25]). Cross-sectional and case-control study results were heterogeneous. Subgroup analyses showed that cross-sectional and case-control studies using a continuous adverse events measure, studies using a continuous overweight measure, and studies in children >6-12 years also generated positive pooled estimates, while the pooled estimate of studies assessing recent adverse events (past 2 years) was indicative of no relation with overweight.

CONCLUSIONS

Accumulation of adverse life events and childhood overweight measures are positively associated. However, increases in overweight measures in response to adverse childhood events do not seem to occur instantaneously.

Socioeconomic and Behavioral Characteristics Associated With Metabolic Syndrome Among Overweight/Obese School-age Children

BACKGROUND

Obesity in children comprises a significant public health concern in Korea. As with increased prevalence of overweight and obesity among children, risk factors for metabolic syndrome (MetS) have also increased in this population.

OBJECTIVE

The purpose was to examine behavioral and socioeconomic factors that were associated with biomarkers of MetS among overweight/obese school-age children.

METHODS

A cross-sectional study was conducted, and a convenience sample of 75 overweight/obese school-age children participated. Socioeconomic and behavioral characteristics, anthropometric measurements, and physiologic examinations were studied. The data were analyzed using an analysis of covariance and logistic regression.

RESULTS

Metabolic syndrome was diagnosed in 27.8% of our population. Severe stress was significantly associated with elevated systolic blood pressure (P < .05). Among the family characteristics, children's perception of family income (wealthy and very wealthy) and mother's education level (high school or less) were associated with diagnoses of MetS in children (P < .05).

CONCLUSIONS

The results indicated that certain socioeconomic and behavioral characteristics were associated with risk factors of MetS, and therefore, interventions to modify these risk factors are needed to promote the healthy development of overweight/obese school-age children.

Sodium-to-potassium ratio and blood pressure, hypertension, and related factors

The potential cost-effectiveness and feasibility of dietary interventions aimed at reducing hypertension risk are of considerable interest and significance in public health. In particular, the effectiveness of restricted sodium or increased potassium intake on mitigating hypertension risk has been demonstrated in clinical and observational research. The role that modified sodium or potassium intake plays in influencing the renin-angiotensin system, arterial stiffness, and endothelial dysfunction remains of interest in current research. Up to the present date, no known systematic review has examined whether the sodium-to-potassium ratio or either sodium or potassium alone is more strongly associated with blood pressure and related factors, including the renin-angiotensin system, arterial stiffness, the augmentation index, and endothelial dysfunction, in humans. This article presents a systematic review and synthesis of the randomized controlled trials and observational research related to this issue. The main findings show that, among the randomized controlled trials reviewed, the sodium-to-potassium ratio appears to be more strongly associated with blood pressure outcomes than either sodium or potassium alone in hypertensive adult populations. Recent data from the observational studies reviewed provide additional support for the sodium-to-potassium ratio as a superior metric to either sodium or potassium alone in the evaluation of blood pressure outcomes and incident hypertension. It remains unclear whether this is true in normotensive populations and in children and for related outcomes including the renin-angiotensin system, arterial stiffness, the augmentation index, and endothelial dysfunction. Future study in these populations is warranted.

Blood pressure and associated factors in a North African adolescent population. a national cross-sectional study in Tunisia

Background

In southern and eastern Mediterranean countries, changes in lifestyle and the increasing prevalence of excess weight in childhood are risk factors for high blood pressure (BP) during adolescence and adulthood. The aim of this study was to evaluate the BP status of Tunisian adolescents and to identify associated factors.

Methods

A cross-sectional study in 2005, based on a national, stratified, random cluster sample of 1294 boys and 1576 girls aged 15-19 surveyed in home visits. The socio-economic and behavioral characteristics of the adolescents were recorded. Overweight/obesity were assessed by Body Mass Index (BMI) from measured height and weight (WHO, 2007), abdominal obesity by waist circumference (WC). BP was measured twice during the same visit. Elevated BP was systolic (SBP) or diastolic blood pressure (DBP) ≥ 90th of the international reference or ≥ 120/80 mm Hg for 15-17 y., and SBP/DBP ≥ 120/80 mm Hg for 18-19 y.; hypertension was SBP/DBP ≥ 95th for 15-17 y. and ≥ 140/90 mm Hg for 18-19 y. Adjusted associations were assessed by logistic regression.

Results

The prevalence of elevated BP was 35.1%[32.9-37.4]: higher among boys (46.1% vs. 33.3%; P < 0.0001); 4.7%[3.8-5.9] of adolescents had hypertension. Associations adjusted for all covariates showed independent relationships with BMI and WC: - obesity vs. no excess weight increased elevated BP (boys OR = 2.1[1.0-4.2], girls OR = 2.3[1.3-3.9]) and hypertension (boys OR = 3.5[1.4-8.9], girls OR = 5.4[2.2-13.4]), - abdominal obesity (WC) was also associated with elevated BP in both genders (for boys: 2nd vs. 1st tertile OR = 1.7[1.3-2.3], 3rd vs.1st tertile OR = 2.8[1.9-4.2]; for girls: 2nd vs. 1st tertile OR = 1.6[1.2-2.1], 3rd vs.1st tertile OR = 2.1[1.5-3.0]) but only among boys for hypertension. Associations with other covariates were weaker: for boys, hypertension increased somewhat with sedentary lifestyle, while elevated BP was slightly more prevalent among urban girls and those not attending school.

Conclusion

Within the limits of BP measurement on one visit only, these results suggest that Tunisian adolescents of both genders are likely not spared from early elevated BP. Though further assessment is likely needed, the strong association with overweight/obesity observed suggests that interventions aimed at changing lifestyles to reduce this main risk factor may also be appropriate for the prevention of elevated BP.

Anger, stress and blood pressure in overweight children

Among adults, trait anger, patterns of anger expression, and stress have been associated with blood pressure (BP). Less apparent is the effect of these variables on BP in overweight and obese children. To characterize the relationships between these psychological variables and BP, the authors conducted a secondary analysis of data from 73 overweight and obese 9- to 11-year-old children. Findings indicate a positive correlation between trait anger and systolic BP (SBP). Regression results indicate that the overall model significantly predicted SBP by explaining 15.4% of the variance and that trait anger was a significant predictor of SBP.

Perceived stress and physiological dysregulation in older adults

We use a population-based representative sample of older Taiwanese to investigate links between respondents' perceived levels of stress and a broad set of biological measures. These biomarkers were collected at a single time (2000) and reflect sympathetic nervous system (SNS)-activity, hypothalamo-pituitary-adrenal (HPA)-activity, immune function, cardiovascular function, and metabolic pathways. We model the relationship between perceived stress and (1) extreme values for each of 16 individual biological indicators; and (2) a measure of cumulative physiological dysregulation based on the full set of biomarkers. We consider two measures of perceived stress, one derived from the 2000 interview and the second based on data from three interviews (1996-2000). Age and sex-adjusted models reveal significant associations between measures of perceived stress and extreme values of cortisol, triglycerides, interleukin-6 (IL-6), dehydroepiandrosterone sulphate (DHEAS) and fasting glucose. Examined individually, numerous biomarkers, including those pertaining to blood pressure and obesity, are not significantly related to perceived stress. Jointly, however, the measure of cumulative physiological dysregulation is associated with both the level of perceived stress at a given time and to a longitudinal measure of perceived stress. Some results suggest that the relationship between level of perceived stress and physiological response is stronger for women than men.

Pediatric hypertension: recent literature

This article reviews selected recent literature specifically concerning pediatric hypertension, much of which has focused on measurement and monitoring of blood pressure, as well as on evaluating antihypertensive medications. Normative data for blood pressure in children have been widely available for some time, based upon seated in-office measurements. In recent years, ambulatory blood pressure monitoring (ABPM), facilitated by user-friendly instrumentation, has become more commonplace, though norms are not based on large populations. However, ABPM has important uses in assessing blood pressure as well as in monitoring antihypertensive. This review discusses issues involved in determining blood pressure, as well as the utility of ABPM in several situations. Recent developments concerning pediatric antihypertensive therapy are considered, as well as new information relevant to the diagnosis, course and treatment of hypertension in children and adolescents.