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Costa-Santos C, Mattar GGCD, Fuziwara RA, de Araújo Peres JA, Queiroz MS. Screen Time and Hours of Sleep Influence the Estimate Risk of Diabetes Mellitus and Metabolic Syndrome in Healthy Young Males. Metab Syndr Relat Disord 2024. [PMID: 38848280 DOI: 10.1089/met.2024.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Objective: Screen time (ST) has shown negative effects on physical and mental health, with an increase in the prevalence of overweight, metabolic syndrome (MetS), and obesity. The time spent in front of the screens was also associated with higher odds of selecting indicators of cardiometabolic disease in adulthood. In view of this, the aim of this study was to identify the risk of MetS and type 2 diabetes mellitus (T2DM) in healthy young males and relate it to ST and sleep time. Methods: We evaluated physical and laboratory characteristics, dichotomous diagnosis criteria, and continuous scores to assess MetS and Finnish Diabetes Risk Score questionnaire to measure the T2DM risk. Results: The means of MetS dichotomous and continuous severity criteria, among individuals with <7 hr of sleep, were higher than those with adequate sleep. We did not observe a direct impact of ST on the risk of MetS; nevertheless, >8 hr of ST increased 1.22 points in the T2DM risk. Conclusion: Excessive ST increased the risk of T2DM, but not of MetS. Moreover, sleeping <7 hr was associated with a higher mean of dichotomous and continuous severity criteria for MetS.
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Affiliation(s)
- Carolina Costa-Santos
- Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro, São Paulo, Brazil
- Hospital de Força Aérea de São Paulo, São Paulo, Brazil
| | | | | | - Jorge Alexandre de Araújo Peres
- Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro, São Paulo, Brazil
- Hospital de Força Aérea de São Paulo, São Paulo, Brazil
| | - Márcia Silva Queiroz
- Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro, São Paulo, Brazil
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Tzvi-Behr S, Greenstein LB, Ben-Shalom E, Frishberg Y, Cohen SO. Associations Between Prematurity, Birthweight, and Adolescence Blood Pressure in a Nationwide Cohort. Kidney Int Rep 2024; 9:1228-1235. [PMID: 38707822 PMCID: PMC11068966 DOI: 10.1016/j.ekir.2024.02.1437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/24/2024] [Accepted: 02/26/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Prematurity is associated with incomplete nephrogenesis and an increased incidence of acute kidney injury, that may increase the risk of future kidney disease, including hypertension, proteinuria and reduced glomerular filtration rate. The aim of this study was to evaluate the risk of hypertension or proteinuria in adolescents born prematurely or small for gestational age, in a nationwide cohort. Methods The study cohort included potential recruits examined in the Israel Defense Forces (IDF) medical facilities, between November 2005 and October 2018. Clinical and anthropometric data, including blood pressure (BP) measurement, were retrieved from the IDF medical files. Adolescents born between January 1993 and December 2000 had additional data on gestational age at birth, retrieved from the Israeli Ministry of Health database. Results The study cohort included 513,802 participants, aged 17.3 ± 0.9 years, of whom 48,994 had gestational age data. Adolescents born as very preterm, as extremely preterm infants, those born with very low birthweight (VLBW), or with extremely low birthweight (ELBW) had higher incidence of hypertensive-range BP (55%, 47%, 19% and 12%, respectively). No significant association between birthweight (BW) adjusted to gestational age and hypertension was observed. Within the overweight and obese adolescents, those born with VLBW and ELBW, had further increased hypertensive-range BP rate. Proteinuria was diagnosed in 0.33% of the study cohort, with no significant difference between BW or gestational age categories. Conclusion Adolescents born with VLBW or as significant preterm were associated with high BP and should be monitored for hypertension development and its potential complications.
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Affiliation(s)
- Shimrit Tzvi-Behr
- Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Lucy B. Greenstein
- Medical corps, Israel Defense Forces, Jerusalem, Israel
- Department of Military Medicine, Hebrew University of Jerusalem, Israel
| | - Efrat Ben-Shalom
- Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Yaacov Frishberg
- Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Sharon O. Cohen
- Medical corps, Israel Defense Forces, Jerusalem, Israel
- Department of Military Medicine, Hebrew University of Jerusalem, Israel
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Urbina EM, Daniels SR, Sinaiko AR. Blood Pressure in Children in the 21st Century: What Do We Know and Where Do We Go From Here? Hypertension 2023; 80:1572-1579. [PMID: 37278234 PMCID: PMC10524445 DOI: 10.1161/hypertensionaha.122.19455] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The association between hypertension in adulthood and cardiovascular morbidity and death is well known. Based on that association, a diagnosis of elevated blood pressure in children has been clinically interpreted as early cardiovascular disease. The objective of this review is to discuss historical data and new research on the relationship between elevated blood pressure and early preclinical and later adult cardiovascular disease. After summarizing the evidence, we will address the gaps in knowledge around Pediatric hypertension in an effort to stimulate research into the important role that control of blood pressure in youth may play in preventing adult cardiovascular disease.
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Affiliation(s)
- Elaine M. Urbina
- Cincinnati Children’s Hospital Medical Center and the University of Cincinnati
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Antihypertensives in Children and Adolescents. Curr Hypertens Rep 2022; 24:581-587. [PMID: 36114998 DOI: 10.1007/s11906-022-01220-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW To review target organ outcomes and current pharmacologic treatment options for children and adolescents with hypertension. RECENT FINDINGS There is an increased prevalence of pediatric hypertension. Following the 2017 AAP clinical practice guidelines, there is a growing body of literature illustrating the association between pediatric hypertension and end organ damage, though few studies looking at long-term outcomes. There is also new data to support the use of n-of-1 trials to identify the best antihypertensive therapy for an individual. Pediatric hypertension is increasing in prevalence and is associated with end organ damage. Treatment of hypertensive children has been shown to reverse end organ damage. Due to the lack of large, randomized trials assessing antihypertensive classes against one another, n-of-1 studies may serve as a viable and safe option to optimize patient care.
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Abstract
Cardiovascular diseases caused by atherosclerosis do not typically manifest before middle age; however, the disease process begins early in life. Preclinical atherosclerosis can be quantified with imaging methods in healthy populations long before clinical manifestations present. Cohort studies have shown that childhood exposure to risk factors, such as dyslipidaemia, elevated blood pressure and tobacco smoking, are associated with adult preclinical atherosclerotic phenotypes. Importantly, these long-term effects are substantially reduced if the individual becomes free from the risk factor by adulthood. As participants in the cohorts continue to age and clinical end points accrue, the strongest evidence linking exposure to risk factors in early life with cardiovascular outcomes has begun to emerge. Although science has deciphered the natural course of atherosclerosis, discovered its causal risk factors and developed effective means to intervene, we are still faced with an ongoing global pandemic of atherosclerotic diseases. In general, atherosclerosis goes undetected for too long, and preventive measures, if initiated at all, are inadequate and/or come too late. In this Review, we give an overview of the available literature suggesting the importance of initiating the prevention of atherosclerosis in early life and provide a summary of the major paediatric programmes for the prevention of atherosclerotic disease. We also highlight the limitations of current knowledge and indicate areas for future research.
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Pool LR, Krefman AE, Labarthe DR, Greenland P, Juonala M, Kähönen M, Lehtimäki T, Day RS, Bazzano LA, Van Horn L, Liu L, Fernandez-Alonso C, Webber LS, Pahkala K, Laitinen TT, Raitakari OT, Lloyd-Jones DM, Allen NB. The Timing and Sequence of Cardiovascular Health Decline. Am J Prev Med 2021; 61:545-553. [PMID: 34238623 DOI: 10.1016/j.amepre.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Childhood declines in cardiovascular health have been linked to the development of subclinical atherosclerosis; however, less is known about the timing and sequence of the decline of the specific cardiovascular health components. The study objective is to identify the patterns of decline and associations with adulthood subclinical atherosclerosis. METHODS Data were pooled from 5 cardiovascular cohorts. Clinical components of cardiovascular health (BMI, blood pressure, cholesterol, and blood glucose) were categorized as ideal or nonideal using American Heart Association definitions. Multitrajectory models simultaneously fitted the probability ideal for each factor. Adjusted associations between trajectory groups and carotid intima-media thickness were modeled. Data were pooled from December 1, 2015 to June 1, 2019; statistical analysis occurred between June 1, 2019 and June 1, 2020. RESULTS This study included 9,388 individuals (55% female, 66% White). A total of 5 distinct trajectory groups were created: 1 maintained the ideal levels of all the 4 health factors, 2 had risk onset of a single factor in childhood, 1 had risk onset of multiple factors in childhood, and 1 had risk onset in adulthood. Those with childhood multiple risk onset had 8.1% higher carotid intima-media thickness (95% CI=0.067, 0.095) than those in the ideal group, childhood cholesterol risk onset had 5.9% higher carotid intima-media thickness (95% CI=0.045, 0.072), childhood BMI risk onset had 5.5% higher carotid intima-media thickness (95% CI=0.041, 0.069), and early adulthood multiple risk onset had 2.7% higher carotid intima-media thickness (95% CI=0.013, 0.041). CONCLUSIONS Those who lost the ideal status of cardiovascular health in childhood and early adulthood had more subclinical atherosclerosis than those who retained the ideal cardiovascular health across the life course, underscoring the importance of preserving the ideal cardiovascular health beginning in childhood and continued into adulthood.
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Affiliation(s)
- Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Amy E Krefman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Darwin R Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland; Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland; Department of Clinical Chemistry, Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Rena Sue Day
- Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lei Liu
- Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Camilo Fernandez-Alonso
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Larry S Webber
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Health and Physical Activity, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku, Turku, Finland
| | - Tomi T Laitinen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Health and Physical Activity, University of Turku, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku, Finland
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Timing of procedural interventions in childhood renovascular hypertension. Pediatr Nephrol 2021; 36:3089-3096. [PMID: 34143295 DOI: 10.1007/s00467-021-05152-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/04/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Renovascular hypertension (RVHTN) is a rare, often complex condition due to multiple etiologies including congenital stenoses, vasculitides, and fibromuscular dysplasia. Among children with RVHTN who require multiple and escalating medications to control blood pressure, the optimal timing of a procedural intervention involves a balance of numerous factors. CASE-DIAGNOSIS/TREATMENT In this presentation of a 1-month-old girl with RVHTN, the treating medical team had to consider multiple factors in the initial management and timing of interventions to treat her underlying cause of RVHTN, including concerns for kidney health, degree of hypertension, age and size of the patient, and potential methods of procedural intervention. Initially, she was treated conservatively until concern for poor renal growth arose and a durable surgical intervention was thought feasible and safe. CONCLUSION The evidence regarding the timing of non-medical interventions in pediatric RVHTN is limited. Considerations should include patient age, size, disease severity, comorbid conditions, and degree of medical management required to maintain safe blood pressures that allow for growth and reverse cardiac damage. The optimal interventions have not been evaluated by controlled trials and should be decided on a case-by-case basis with consideration of center expertise and family preferences.
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Pool LR, Aguayo L, Brzezinski M, Perak AM, Davis MM, Greenland P, Hou L, Marino BS, Van Horn L, Wakschlag L, Labarthe D, Lloyd-Jones D, Allen NB. Childhood Risk Factors and Adulthood Cardiovascular Disease: A Systematic Review. J Pediatr 2021; 232:118-126.e23. [PMID: 33516680 DOI: 10.1016/j.jpeds.2021.01.053] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To conduct a comprehensive review of the literature on childhood risk factors and their associations with adulthood subclinical and clinical cardiovascular disease (CVD). STUDY DESIGN A systematic search was performed using the MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science databases to identify English-language articles published through June 2018. Articles were included if they were longitudinal studies in community-based populations, the primary exposure occurred during childhood, and the primary outcome was either a measure of subclinical CVD or a clinical CVD event occurring in adulthood. Two independent reviewers screened determined whether eligibility criteria were met. RESULTS There were 210 articles that met the predefined criteria. The greatest number of publications examined associations of clinical risk factors, including childhood adiposity, blood pressure, and cholesterol, with the development of adult CVD. Few studies examined childhood lifestyle factors including diet quality, physical activity, and tobacco exposure. Domains of risk beyond "traditional" cardiovascular risk factors, such as childhood psychosocial adversity, seemed to have strong published associations with the development of CVD. CONCLUSIONS Although the evidence was fairly consistent in direction and magnitude for exposures such as childhood adiposity, hypertension, and hyperlipidemia, significant gaps remain in the understanding of how childhood health and behaviors translate to the risk of adulthood CVD, particularly in lesser studied exposures like glycemic indicators, physical activity, diet quality, very early life course exposure, and population subgroups.
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Affiliation(s)
- Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Liliana Aguayo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Michal Brzezinski
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Amanda M Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew M Davis
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley S Marino
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren Wakschlag
- Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Darwin Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Kupferman JC, Lande MB, Stabouli S, Zafeiriou DI, Pavlakis SG. Hypertension and childhood stroke. Pediatr Nephrol 2021; 36:809-823. [PMID: 32350664 DOI: 10.1007/s00467-020-04550-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 01/09/2023]
Abstract
Cerebrovascular disease (stroke) is one of the ten leading causes of death in children and adolescents. Multiple etiologies, from arteriopathies to prothrombic states, can cause stroke in youth. In adult stroke, hypertension has been shown to be the single most important modifiable risk factor. Although hypertension has not been strongly identified as a risk factor in childhood stroke to date, there is preliminary evidence that suggests that hypertension may also be associated with stroke in children. In this review, we summarize the literature that may link hypertension to stroke in the young. We have identified a series of barriers and limitations in the fields of pediatric hypertension and pediatric neurology that might explain why hypertension has been overlooked in childhood stroke. We suggest that hypertension may be a relevant risk factor that, alone or in combination with other multiple factors, contributes to the development of stroke in children. Currently, there are no consensus guidelines for the management of post-stroke hypertension in children. Thus, we recommend that blood pressure be assessed carefully in every child presenting with acute stroke in order to better understand the effects of hypertension in the development and the outcome of childhood stroke. We suggest a treatment algorithm to help practitioners manage hypertension after a stroke.
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Affiliation(s)
- Juan C Kupferman
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY, USA.
| | - Marc B Lande
- Department of Pediatrics, University of Rochester, Rochester, NY, USA
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios I Zafeiriou
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Steven G Pavlakis
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY, USA
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Garvick S, Ballen E, Brasher D, St Amand E, Ray O, Vera N, Gregory T. Guidelines for screening and managing hypertension in children. JAAPA 2021; 34:14-20. [PMID: 33315729 DOI: 10.1097/01.jaa.0000723904.18671.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ABSTRACT Pediatric hypertension has risen to an overall prevalence of 16.3%. If left untreated, hypertension in children and adolescents can have significant implications for cardiovascular and renal health into adulthood, including stroke, coronary artery disease, kidney disease, and heart failure. In 2017, the American Academy of Pediatrics (AAP) released updated guidelines for the screening, evaluation, and management of pediatric hypertension. This article reviews the definition of pediatric hypertension, describes why the guidelines were updated, and defines treatment protocol. By familiarizing themselves with and applying these guidelines, clinicians will be able to appropriately screen and manage hypertension in children to prevent morbidity into adulthood.
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Affiliation(s)
- Sarah Garvick
- Sarah Garvick is associate program director of the PA program at Wake Forest University in Winston-Salem, N.C., and practices clinically in the Appalachian District Health Department. At the time this article was written, Eliza Ballen, Danielle Brasher, Elizabeth St. Amand, Olivia Ray, and Natalie Vera were students in the PA program at Wake Forest University. Tanya Gregory is an assistant professor and director of student services in the PA program at Wake Forest University. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Martinis O, Čoklo M, Aladrović J, Belavić A, Missoni S. ANTHROPOMETRIC MEASUREMENTS, DIETARY HABITS, SERUM LIPID AND GLUCOSE LEVELS IN RELATION TO HIGH BLOOD PRESSURE AMONG ADOLESCENT BOYS AND GIRLS IN CROATIA. Acta Clin Croat 2020; 59:672-685. [PMID: 34285438 PMCID: PMC8253067 DOI: 10.20471/acc.2020.59.04.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/16/2019] [Indexed: 11/24/2022] Open
Abstract
The aim was to determine differences in anthropometric measurements, dietary habits, serum lipid and glucose levels in relation to high blood pressure (BP) among adolescent boys and girls in Croatia. The specific aim was to determine the effect of dietary habits and lifestyle on high BP in adolescents according to sex. The study included 260 (68.2%) adolescent girls and 121 (31.8%) boys with anthropometric data obtained (without missing values) from 246 girls and 111 boys. Participants answered questions from the questionnaire and anthropometric BP and blood test values were obtained. Non-parametric tests were used in analyses of reference intervals of systolic and diastolic BP in adolescent boys and girls according to age. High BP was defined as ≥90th percentile for adolescent girls and boys, with a value of ≥135/87.5 mm Hg. Mann-Whitney U test was used to analyze differences in anthropometric and laboratory values between the groups of girls and boys with high (≤90th percentile) and normal BP. Increase in systolic and diastolic BP was noted in the adolescents. In girls, BP values showed a decreasing systolic and increasing diastolic BP trend with age. Girls with high BP had a significantly higher body mass index (BMI) (p=0.020), waist circumference (WC) (p=0.002), waist-to-height ratio (WHtR) (p=0.016), waist-to-hip ratio (WHR) (p=0.043), hip circumference (HC) (p=0.015), triglyceride (TG) levels (p=0.021), higher prevalence of unhealthy diet at school breakfast (p=0.008) and lower prevalence of eating fish (p=0.02). Boys with high BP had a significantly higher BMI (p=0.045), WC (p=0.004), WHtR (p=0.017), WHR (p=0.022) and higher prevalence of eating meat products (p=0.015). Effective health interventions are needed to reduce the risk of developing cardiovascular diseases and preventing age-related illness.
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Affiliation(s)
| | - Miran Čoklo
- 1Croatian Education and Teacher Training Agency, Zagreb, Croatia; 2Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, Croatia; 3University of Zagreb, Faculty of Veterinary Medicine, Zagreb, Croatia; 4Croatian Institute of Public Health, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6Institute for Anthropological Research, Zagreb, Croatia
| | - Jasna Aladrović
- 1Croatian Education and Teacher Training Agency, Zagreb, Croatia; 2Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, Croatia; 3University of Zagreb, Faculty of Veterinary Medicine, Zagreb, Croatia; 4Croatian Institute of Public Health, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6Institute for Anthropological Research, Zagreb, Croatia
| | - Anja Belavić
- 1Croatian Education and Teacher Training Agency, Zagreb, Croatia; 2Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, Croatia; 3University of Zagreb, Faculty of Veterinary Medicine, Zagreb, Croatia; 4Croatian Institute of Public Health, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6Institute for Anthropological Research, Zagreb, Croatia
| | - Saša Missoni
- 1Croatian Education and Teacher Training Agency, Zagreb, Croatia; 2Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, Croatia; 3University of Zagreb, Faculty of Veterinary Medicine, Zagreb, Croatia; 4Croatian Institute of Public Health, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6Institute for Anthropological Research, Zagreb, Croatia
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Abstract
PURPOSE OF REVIEW To review the haemodynamic characteristics of paediatric hypertension. RECENT FINDINGS Pulsatile components of blood pressure are determined by left ventricular dynamics, aortic stiffness, systemic vascular resistance and wave propagation phenomena. Recent studies delineating these factors have identified haemodynamic mechanisms contributing to primary hypertension in children. Studies to date suggest a role of cardiac over activity, characterized by increased heart rate and left ventricular ejection, and increased aortic stiffness as the main haemodynamic determinants of primary hypertension in children.
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Affiliation(s)
- Ye Li
- King's College London British Heart Foundation Centre, London, UK
- Department of Clinical Pharmacology, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
| | - Emily Haseler
- Department of Pediatric Nephrology, Evelina London Children's Hospital, London, UK
| | - Phil Chowienczyk
- King's College London British Heart Foundation Centre, London, UK.
- Department of Clinical Pharmacology, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
| | - Manish D Sinha
- King's College London British Heart Foundation Centre, London, UK
- Department of Pediatric Nephrology, Evelina London Children's Hospital, London, UK
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Silberstein J, Gwynn L, Mathew MS, Arheart KL, Messiah SE. Evidence to Support Universal Blood Pressure Screening in School-Based Clinical Settings. THE JOURNAL OF SCHOOL HEALTH 2020; 90:474-481. [PMID: 32236966 DOI: 10.1111/josh.12893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 05/28/2019] [Accepted: 07/04/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Most pediatric elevated blood pressure (BP) remains undiagnosed. The American Academy of Pediatrics states "there is limited evidence to support school-based measurement of children's BP." We explored the utility school-based BP screening. METHODS A cross-sectional sample of 4096 students ages 6 to 17 from Title 1 Miami-Dade Public Schools (50% female, 71% non-Hispanic black, 26% Hispanic) had their systolic/diastolic BP (SBP/DBP) and body mass index (BMI) collected over the 2016 to 2017 or 2017 to 2018 school years. Relative risks (RRs) ratios were calculated to estimate normal/elevated SBP/DBP by BMI percentile, ethnicity, and sex. RESULTS Overall, 26.4% had at least one elevated BP measurement, of which 59% were not obese. RR for obese status was significant for all categories of elevated BP (RRs > 1.88, p < .0001). Being either female (RR = 1.34, p = .009) or Hispanic (RR = 1.31, p = .014) was significantly associated with elevated DBP. BMI accounted for <10% of the variation in BP (SBP: F(1, 4095) = 367.6, adjusted R2 = .08, p < .0001; DBP: F(1, 4095) = 93.3, adjusted R2 = .02, p < .0001). CONCLUSION These findings support providing BP screenings in school settings. Low-income and minority students often have limited access to health care, higher obesity rates, and unhealthy behaviors. Our findings support universal school-based BP screening regardless of weight status, particularly among ethnically diverse populations.
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Affiliation(s)
- Juliet Silberstein
- University of Miami Miller School of Medicine, 1601 NW 12th Ave. #403, Miami, FL 33136., USA
| | - Lisa Gwynn
- Clinical Pediatrics and Public Health Sciences, University of Miami Miller School of Medicine, 1601 NW 12th Ave., Miami, FL 33136., USA
| | - M Sunil Mathew
- Department of Pediatrics, University of Miami Miller School of Medicine, 1601 NW 12th Ave., Miami, FL 33136., USA
| | - Kristopher L Arheart
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1601 NW 12th Ave., Miami, FL 33136., USA
| | - Sarah E Messiah
- Department of Pediatrics and Department Public Health Sciences, University of Miami Miller School of Medicine, 1601 NW 12th Ave., Miaxsmi, FL 33136., USA
- University of Texas Health, School of Public Health, Dallas Campus, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health and Children's Health System of Texas, Dallas, TX, USA
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14
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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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15
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Simplified blood pressure tables based on different height percentiles for screening elevated blood pressure in children. J Hypertens 2020; 37:292-296. [PMID: 30067249 DOI: 10.1097/hjh.0000000000001880] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In 2017, the American Academy of Pediatrics (AAP) updated its clinical practice guideline for screening and management of high blood pressure (BP) in children. In addition, the AAP guideline also recommended a simplified BP table for screening purposes in children aged 1-12 years, which was based on the fifth height percentile. The aim of this study was to assess the performance of the simplified AAP table and six other simplified tables across different height percentiles in predicting elevated BP in US children. METHODS We included 6816 children aged 8-12 years in the National Health and Nutrition Examination Survey (NHANES) in 1999-2016 and 3145 children aged 5-12 years in the NHANES III in 1988-1994. Apart from the AAP simplified table at fifth height percentile, we generated sex and age-specific BP tables to predict elevated BP at the 10th, 25th, 50th, 75th, 90th and 95th percentiles of height, respectively, based on the reference AAP guideline. RESULTS In NHANES 1999-2016, with the height percentile increasing (5th-95th), positive predictive value (PPV) substantially increased (46.9 to 94.0%), while negative predictive value (NPV) slightly decreased (100 to 96.7%); specificity increased (84.4 to 99.3%) while sensitivity decreased (99.9 to 75.7%). The results were similar in NHANES III. CONCLUSION The simplified AAP table could be necessary in clinical practice to avoid omitting any true positive case, but a simplified and more efficient table at a higher height percentile could be more suitable in settings such as school screening programs by nonpaediatricians.
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16
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Yang L, Magnussen CG, Yang L, Bovet P, Xi B. Elevated Blood Pressure in Childhood or Adolescence and Cardiovascular Outcomes in Adulthood: A Systematic Review. Hypertension 2020; 75:948-955. [PMID: 32114851 DOI: 10.1161/hypertensionaha.119.14168] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There remains some uncertainty about the magnitude of the associations between elevated blood pressure (BP) in childhood or adolescence and cardiovascular morbidity and mortality in adulthood. We summarized evidence on the long-term impact of elevated BP in childhood or adolescence on cardiovascular morbidity and mortality in adulthood. PubMed and Embase databases were searched up to August 1, 2019, and retrieved studies were reviewed manually. Our systematic review included all eligible prospective cohort studies on the associations between BP status in childhood or adolescence and intermediate markers or hard outcomes of cardiovascular disease in adults, including high pulse wave velocity, high carotid intima-media thickness, left ventricular hypertrophy, and cardiovascular disease (fatal and nonfatal) and total mortality. A total of 19 articles were finally included, and 12 could be synthesized by meta-analysis. Elevated BP in childhood or adolescence was significantly associated, in adulthood, with high pulse wave velocity (3 articles, N=3725; pooled odds ratio [OR], 1.83 [95% CI, 1.39-2.40]); high carotid intima-media thickness (2 articles, N=4152; OR, 1.60 [95% CI, 1.29-2.00]); and left ventricular hypertrophy (2 articles, N=3019; OR, 1.40 [95% CI, 1.20-1.64]). Additionally, our systematic review also shows evidence of associations of elevated BP in youth with cardiovascular disease and mortality in adulthood. In conclusion, our systematic review and meta-analysis confirms that elevated BP in childhood or adolescence is associated with several intermediate markers and hard outcomes of cardiovascular disease in adulthood. These findings emphasize the importance for children and adolescents to have their BP within normal values.
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Affiliation(s)
- Lili Yang
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (Lili Yang, Liu Yang, B.X.)
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.)
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland (C.G.M.)
| | - Liu Yang
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (Lili Yang, Liu Yang, B.X.)
| | - Pascal Bovet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland (P.B.)
| | - Bo Xi
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (Lili Yang, Liu Yang, B.X.)
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17
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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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18
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Yang L, Kelishadi R, Hong YM, Khadilkar A, Nawarycz T, Krzywińska-Wiewiorowska M, Aounallah-Skhiri H, Motlagh ME, Kim HS, Khadilkar V, Krzyżaniak A, Ben Romdhane H, Heshmat R, Chiplonkar S, Stawińska-Witoszyńska B, El Ati J, Qorbani M, Kajale N, Traissac P, Ostrowska-Nawarycz L, Ardalan G, Ekbote V, Zhao M, Heiland EG, Liang Y, Xi B. Impact of the 2017 American Academy of Pediatrics Guideline on Hypertension Prevalence Compared With the Fourth Report in an International Cohort. Hypertension 2019; 74:1343-1348. [PMID: 31630571 DOI: 10.1161/hypertensionaha.119.13807] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk.
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Affiliation(s)
- Liu Yang
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (L.Y., B.X.)
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.)
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.)
| | - Anuradha Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Tadeusz Nawarycz
- Department of Biophysics, Medical University of Lodz, Poland (T.N., L.O.-N.)
| | | | - Hajer Aounallah-Skhiri
- National Institute of Public Health, Nutrition Surveillance and Epidemiology in Tunisia Research Laboratory, Tunis, Tunisia (H.A.-S.)
| | | | - Hae Soon Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.)
| | - Vaman Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Alicja Krzyżaniak
- Department of Epidemiology and Hygiene, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W., A.K., B.S.-W.)
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia (H.B.R.)
| | - Ramin Heshmat
- Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.)
| | - Shashi Chiplonkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Barbara Stawińska-Witoszyńska
- Department of Epidemiology and Hygiene, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W., A.K., B.S.-W.)
| | - Jalila El Ati
- Nutrition Surveillance and Epidemiology Unit, National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.)
| | - Mostafa Qorbani
- Department of Epidemiology, Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran (M.Q.)
| | - Neha Kajale
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Pierre Traissac
- Institut de Recherche pour le Développement, UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.)
| | | | - Gelayol Ardalan
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.)
| | - Veena Ekbote
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Emerald G Heiland
- Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden (E.G.H.)
| | - Yajun Liang
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden (Y.L.)
| | - Bo Xi
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (L.Y., B.X.)
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19
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Blowey DL, Flynn JT, Warady BA. Are There Consequences of Adolescent Blood Pressure on Kidney Function in Adulthood? Am J Kidney Dis 2019; 74:567-569. [PMID: 31257050 DOI: 10.1053/j.ajkd.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/13/2019] [Indexed: 11/11/2022]
Affiliation(s)
| | - Joseph T Flynn
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA
| | - Bradley A Warady
- Division of Nephrology, Children's Mercy Hospital, Kansas City, MO.
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20
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Younes N, Atallah M, Alam R, Chehade NH, Gannagé-Yared MH. HbA1c AND BLOOD PRESSURE MEASUREMENTS: RELATION WITH GENDER, BODY MASS INDEX, STUDY FIELD, AND LIFESTYLE IN LEBANESE STUDENTS. Endocr Pract 2019; 25:1101-1108. [PMID: 31241365 DOI: 10.4158/ep-2019-0163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: The purpose of this study is to determine the prevalence of prediabetes/diabetes in Lebanese university students and to examine the relationship between both hemoglobin A1c (HbA1c) and blood pressure (BP) and gender, body mass index (BMI), study field, and lifestyle factors. Methods: This cross-sectional study was carried out at the Saint-Joseph University of Beirut. A total of 603 students aged 18 to 25 years were recruited from both the medical science campus (MSC) and the social science campus (SSC) between January, 2016, and May, 2018. Waist circumference (WC), BMI, and BP were determined for each student and HbA1c was measured using the Siemens vintage DCA device. Participants completed a self-administered questionnaire about their eating habits and level of physical activity. Results: The mean age of the population was 20.31 ± 1.76 years. The percentage of participants recruited from the MSC was 59.2%. The prevalence of prediabetes was 2.5%. Lower BMI, WC, and HbA1c values, and higher diastolic BP (DBP) were found in MSC students compared to SSC ones. HbA1c, systolic BP (SBP), and DBP were correlated with BMI (P = .02, P<.0001, and P = .017, respectively). HbA1c was not associated with eating habits or physical activity. DBP was inversely associated with physical activity (P = .002), while SBP was positively associated with fast food consumption (P = .003). Conclusion: The present study shows a low prevalence of prediabetes in Lebanese students. BMI and the study field are the main factors predicting HbA1c and BP. Further studies are needed to extrapolate our results to the overall young Lebanese population. Abbreviations: ADA = American Diabetes Association; BMI = body mass index; BP = blood pressure; DBP = diastolic blood pressure; HbA1c = hemoglobin A1c; HTN = hypertension; MSC = medical science campus; SBP = systolic blood pressure; SSC = social science campus; T2D = type 2 diabetes; US = United States; USJ = Saint-Joseph University; WC = waist circumference.
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21
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Park C, Fraser A, Howe LD, Jones S, Davey Smith G, Lawlor DA, Chaturvedi N, Hughes AD. Elevated Blood Pressure in Adolescence Is Attributable to a Combination of Elevated Cardiac Output and Total Peripheral Resistance. Hypertension 2019; 72:1103-1108. [PMID: 30354820 PMCID: PMC6181289 DOI: 10.1161/hypertensionaha.118.11925] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Unlike in older people, it has been suggested that elevated blood pressure (BP) in young people is because of high cardiac output accompanied by normal total peripheral resistance (TPR)-a hyperkinetic/hyperdynamic circulation. We investigated this in a large, United Kingdom-based birth cohort of adolescents. The study was conducted on 2091 17-year-old participants in the ALSPAC (Avon Longitudinal Study of Parents and Children)-a prospective population-based birth cohort study. BP measurement and echocardiography were performed, and heart rate (HR), stroke volume (SV), and TPR were calculated. Data are means (SD). Higher quintiles of systolic BP were associated with higher SV, higher HR, and higher TPR. The proportional contribution made by SV, HR, and TPR to mean arterial pressure differed little by systolic BP quintile (SV [32%-34%], HR [25%-29%], and TPR [39%-41%]). Higher BP is attributable to a combination of higher cardiac output (ie, SV×HR) and higher TPR in a population-based sample of adolescents. There is no evidence of a disproportionate contribution from elevated cardiac output at higher BP levels.
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Affiliation(s)
- Chloe Park
- From the Department of Population Science and Experimental Medicine, Institute of Cardiovascular Sciences, University College London, United Kingdom (C.P., S.J., N.C., A.D.H.)
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom (A.F., L.D.H., G.D.S., D.A.L.).,MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (A.F., L.D.H., G.D.S., D.A.L.)
| | - Laura D Howe
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom (A.F., L.D.H., G.D.S., D.A.L.).,MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (A.F., L.D.H., G.D.S., D.A.L.)
| | - Siana Jones
- From the Department of Population Science and Experimental Medicine, Institute of Cardiovascular Sciences, University College London, United Kingdom (C.P., S.J., N.C., A.D.H.)
| | - George Davey Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom (A.F., L.D.H., G.D.S., D.A.L.).,MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (A.F., L.D.H., G.D.S., D.A.L.)
| | - Debbie A Lawlor
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom (A.F., L.D.H., G.D.S., D.A.L.).,MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (A.F., L.D.H., G.D.S., D.A.L.)
| | - Nish Chaturvedi
- From the Department of Population Science and Experimental Medicine, Institute of Cardiovascular Sciences, University College London, United Kingdom (C.P., S.J., N.C., A.D.H.).,MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom (N.C., A.D.H.)
| | - Alun D Hughes
- From the Department of Population Science and Experimental Medicine, Institute of Cardiovascular Sciences, University College London, United Kingdom (C.P., S.J., N.C., A.D.H.).,MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom (N.C., A.D.H.)
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22
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23
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Leiba A, Fishman B, Twig G, Gilad D, Derazne E, Shamiss A, Shohat T, Ron O, Grossman E. Association of Adolescent Hypertension With Future End-stage Renal Disease. JAMA Intern Med 2019; 179:517-523. [PMID: 30801616 PMCID: PMC6450304 DOI: 10.1001/jamainternmed.2018.7632] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IMPORTANCE Hypertension is a leading risk factor of cardiovascular morbidity and mortality. The role of nonmalignant hypertension as the sole initiating factor of end-stage renal disease (ESRD) in non-African American populations has recently been questioned. OBJECTIVE To investigate the association between hypertension and future ESRD in otherwise healthy adolescents. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined the data of 16- to 19-year-old healthy candidates for military service in the Israel Defense Forces between January 1, 1967, and December 31, 2013. Data were obtained from the central conscription registry of the Israel Defense Forces and the ESRD registry of the Israel Ministry of Health. Participants underwent a comprehensive medical assessment prior to their military service. Individuals with evidence of renal damage or kidney-related risk factors were excluded. The data analysis was conducted from February 12, 2017, to October 16, 2018. MAIN OUTCOMES AND MEASURES End-stage renal disease as recorded by the Israeli ESRD registry, including hemodialysis, peritoneal dialysis, renal transplant diagnosed between January 1, 1990, and December 31, 2014. RESULTS The cohort included 2 658 238 adolescents (1 596 709 [60.1%] male with a mean [SD] age of 17.4 [0.5] years), of whom 7997 (0.3%) had an established hypertension diagnosis. Half of the individuals in the hypertensive group were overweight (1559 [20.1%]) or obese (2243 [28.9%]), and most (7235 [90.5%]) were male. During a median follow-up of 19.6 years (52 287 945 person-years), 2189 individuals developed ESRD, with an incidence rate of 3.9 per 100 000 person-years. Adolescent hypertension was found to be associated with future ESRD (crude hazard ratio [HR], 5.07; 95% CI, 3.73-6.88). In a multivariable model adjusted for sex, age, years of education, body mass index, and other sociodemographic variables, the HR was 1.98 (95% CI, 1.42-2.77). When excluding participants with severe hypertension, the association with ESRD remained statistically significant (HR, 1.93; 95% CI, 1.37-2.70). In the subanalysis of nonoverweight adolescents, the association between hypertension and ESRD was statistically significant as well (HR, 2.11; 95% CI, 1.05-4.24). CONCLUSIONS AND RELEVANCE Hypertension appears to be associated with a doubling of the risk of future ESRD in an otherwise healthy adolescent population.
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Affiliation(s)
- Adi Leiba
- Division of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ben Gurion University, Beer Sheva, Israel.,IDF Medical Corps, Tel Hashomer, Ramat Gan, Israel.,Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Boston, Massachusetts
| | - Boris Fishman
- IDF Medical Corps, Tel Hashomer, Ramat Gan, Israel.,Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Twig
- IDF Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - David Gilad
- IDF Medical Corps, Tel Hashomer, Ramat Gan, Israel.,Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tamar Shohat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israel Center for Disease Control, Israel Ministry of Health, Tel Hashomer, Israel
| | - Ofir Ron
- IDF Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Ehud Grossman
- Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Peled A, Gordon B, Twig G, Grossman E, Matani D, Derazne E, Afek A. Hypertension and childhood migration: a nationwide study of 2.7 million adolescents. J Hypertens 2019; 37:702-709. [PMID: 30817450 DOI: 10.1097/hjh.0000000000001957] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Immigration studies can shed light on hypertension development and reveal high-risk populations. To this end, we investigated the association between age at immigration and hypertension occurrence at adolescence among immigrants to Israel. METHODS We analyzed cross-sectional data on 2 681 294 adolescents assessed for mandatory military service at approximately 17 years of age between 1967 and 2016. The study population constituted of 410 488 immigrants with origins in Ethiopia, Middle East and North Africa, Former USSR and Western Countries. Age at immigration was categorized into 0-5, 6-11 and 12-19 years. Odds ratios (ORs) for hypertension were calculated according to age at immigration with Israel-born participants as controls. Models were made to account for possible confounders. Additionally, the study population was stratified by country of origin and each immigrant group referenced to Israel-born participants of the same origin. RESULTS In the fully-adjusted model, immigrants arriving until age 11 years had comparable ORs for hypertension to the Israeli-born reference group, whereas recent immigrants, arriving at age 12-19 years had a marked lower OR of 0.30 (95% CI 0.27-0.33; P < 0.001). The lower hypertension odds among recent immigrants persisted in all models and when the study sample was stratified by sex and origin, with all but those of Western origin showing a graded decrease with increasing age at migration categories. CONCLUSION Immigrants arriving earlier in childhood lose their protection against hypertension at adolescence relative to the Israeli-born, likely because of lifestyle acculturation. Prevention programs are needed, beginning upon arrival and placing emphasis on nutritional and physical activity habits.
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Affiliation(s)
- Alon Peled
- Sackler Faculty of Medicine, Tel Aviv University
| | - Barak Gordon
- Sackler Faculty of Medicine, Tel Aviv University
- Medical Corps, Israeli Defense Forces
| | - Gilad Twig
- Sackler Faculty of Medicine, Tel Aviv University
- Medical Corps, Israeli Defense Forces
- Department of Medicine
- Talpiot Medical Leadership Program, Sheba Medical Center
| | - Ehud Grossman
- Sackler Faculty of Medicine, Tel Aviv University
- Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center
| | | | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University
- Medical Corps, Israeli Defense Forces
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University
- Central Management, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Mirzaeipour F, Seyedmazhari M, Pishgooie AH, Hazaryan M. Assessment of risk factors for coronary artery disease in military personnel: A study from Iran. J Family Med Prim Care 2019; 8:1347-1351. [PMID: 31143719 PMCID: PMC6510073 DOI: 10.4103/jfmpc.jfmpc_109_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction: Cardiovascular diseases are the most significant cause of mortality. Although the risk factors of this disease are well known, the strength of these factors varies in different populations and needs to be investigated. Aim: The aim of this study is to estimate the amount of the effect of each classic risk factor on CAD (coronary artery disease) among Aja personnel. Materials and Methods: This matched case-control study was conducted on 1000 male Aja personnel admitted selecting Aja hospitals in Tehran in 2017. The samples were selected using purposive-graded sampling method. The 250 military patients hospitalized for CAD were considered as a case group. Each case was individually matched for age and service force with tree military patients without CAD. Data were gathered using standard demographic information and history of risk factors questionnaire and analyzed using SPSS 23 and statistical tests. Odds ratio measured trough Cochran–Mantel–Haenszel test and used to estimate the amount of the effect of each classic risk factors on CAD. Results: Data analysis indicated that the risk factors including diabetes, hyperlipidemia, smoking, hypertension, and positive family history of CAD enhance the probability of CAD as much as 79.2%, 77.3%, 67.7%, 64.1%, and 56.6%, respectively. Conclusion: Diabetes and other modifiable risk factors have the greatest impact on CAD among the concerned Aja personnel. Hence, the authorities can consider the independent amount of the effect of each risk factor and modify them in order to prevent the disease more effectively and purposefully among the personnel.
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Affiliation(s)
- Farshid Mirzaeipour
- Department of Critical Care Nursing, Aja University of Medical Sciences, Tehran, Iran
| | - Marjan Seyedmazhari
- Department of Medical-Surgical Nursing, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | - Amir Hosein Pishgooie
- Department of Critical Care Nursing, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | - Mahsa Hazaryan
- Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Prehypertension among 2.19 million adolescents and future risk for end-stage renal disease. J Hypertens 2017; 35:1290-1296. [PMID: 28169886 DOI: 10.1097/hjh.0000000000001295] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Persistent hypertension in adulthood is a leading cause of end-stage renal disease (ESRD). Whether lower blood pressure (BP) values, in the range of prehypertension, are also associated with future occurrence of ESRD is unclear. Even less clear is the potential risk of early prehypertension appearing in adolescence. To address this question, we examined whether BP measurements in the prehypertensive range at age 16-19 years predict adult ESRD. METHODS Medical data on 2194 635 16-19-year-old adolescents examined for medical fitness prior to military service from 1977 to 2013 were linked to the Israeli ESRD registry in this nationwide population-based cohort study. Incident cases of ESRD were recorded. Survival models were applied. RESULTS During 35 007 506 person-years of follow-up (median follow-up 16.8 years), there were 690 ESRD cases, with an overall incidence rate of 1.97 cases per 100 000 person-years. Examinees with elevated BP readings in the prehypertensive range (BP between the 90th and 95th percentiles or between 120 and 139/80-89 mmHg) had increased incidence of ESRD with a hazard ratio of 1.32 (95% confidence interval, 1.11-1.58) adjusted for year of birth, age at examination, sex, BMI, education, socioeconomic status, and country of origin. Hypertension (BP above the 95th percentile or above 140/90 mmHg) was associated with a hazard ratio of 1.44 (95% confidence interval, 1.17-1.79). A spline model demonstrated a nadir of risk at SBP values as low as 94 mmHg. CONCLUSION Asymptomatic, healthy adolescents with prehypertension have a 32% increased risk for subsequent ESRD, compared with adolescents with optimal BP.
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Alfandary H, Haskin O, Davidovits M, Pleniceanu O, Leiba A, Dagan A. Increasing Prevalence of Nephrolithiasis in Association with Increased Body Mass Index in Children: A Population Based Study. J Urol 2017; 199:1044-1049. [PMID: 29061537 DOI: 10.1016/j.juro.2017.10.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2017] [Indexed: 01/29/2023]
Abstract
PURPOSE Epidemiological studies demonstrate an association of increased body mass index and risk of kidney stone formation in adults. We conducted a population based pediatric study to examine the epidemiology of nephrolithiasis in Israeli children during a 30-year period, and to determine body mass index distribution during the same period. MATERIALS AND METHODS We accessed data from the compulsory medical evaluations of 17-year-old military service candidates in Israel before their enlistment during 1980 to 2013. Candidates for the army with a history of stone disease were compared to those without such a history. RESULTS Of 1,908,893 candidates 1,691 reported a history of nephrolithiasis, yielding an average prevalence rate of 88.6 per 100,000. During 1980 to 1995 the average reported prevalence of nephrolithiasis was 69 cases per 100,000. From 1995 onward the reported prevalence increased by an average of 6% yearly, reaching 120 per 100,000 during 2010 to 2012. This increased prevalence was observed for males and females but was more prominent among males. Mean ± SD body mass index of stone formers was higher than that of controls (22.7 ± 3.5 vs 22.1 ± 3.9 kg/m2, p <0.001). The trend of increasing body mass index among male candidates during 1995 to 2012 parallels the trend of increasing nephrolithiasis during these years. The odds ratio for nephrolithiasis in candidates with body mass index 30 or greater kg/m2 was 1.7 (range 1.4 to 2.1) compared to candidates with a body mass index of 18.5 to 24.9 kg/m2. CONCLUSIONS This large, population based study documents an increasing prevalence of nephrolithiasis in children. The possible association of this finding with the increase in body mass index during the same period warrants further investigation.
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Affiliation(s)
- Hadas Alfandary
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Orly Haskin
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Davidovits
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Pleniceanu
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Adi Leiba
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Amit Dagan
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zheng R, Mao Y. Triglyceride and glucose (TyG) index as a predictor of incident hypertension: a 9-year longitudinal population-based study. Lipids Health Dis 2017; 16:175. [PMID: 28903774 PMCID: PMC5598027 DOI: 10.1186/s12944-017-0562-y] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/04/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hypertension and the triglyceride and glucose index both have been associated with insulin resistance; however, the longitudinal association remains unclear. This study was designed to investigate the longitudinal association between the triglyceride and glucose index and incident hypertension among the Chinese population. METHODS We studied 4686 subjects (3177 males and 1509 females) and followed up for 9 years. The subjects were divided into four groups based on the triglyceride and glucose index. Univariate and multivariate Cox regression models were used to analyse the risk factors of hypertension. RESULTS After 9 years of follow-up, 2047 subjects developed hypertension. The overall 9-year cumulative incidence of hypertension was 43.7%, ranging from 28.5% in quartile 1 to 36.9% in quartile 2, 49.2% in quartile 3 and 59.8% in quartile 4 (p for trend < 0.001). Cox regression analyses indicated that higher triglyceride and glucose index was associated with an increased risk of subsequent incident hypertension. CONCLUSION The triglyceride and glucose index can predict the incident hypertension among the Chinese population.
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Affiliation(s)
- Rongjiong Zheng
- Department of Endocrinology, the Affiliated Hospital of Ningbo University School of Medicine, 247 Renmin Road, Ningbo, 315020, China. .,Ningbo University, Ningbo, China.
| | - Yushan Mao
- Department of Endocrinology, the Affiliated Hospital of Ningbo University School of Medicine, 247 Renmin Road, Ningbo, 315020, China. .,Ningbo University, Ningbo, China.
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Associated Factors and Standard Percentiles of Blood Pressure among the Adolescents of Jahrom City of Iran, 2014. Int J Pediatr 2017; 2017:3804353. [PMID: 28191019 PMCID: PMC5278187 DOI: 10.1155/2017/3804353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/20/2016] [Accepted: 12/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background. High blood pressure in adults is directly correlated with increased risk of cardiovascular diseases. Hypertension in childhood and adolescence could be considered among the major causes of this problem in adults. This study aimed to investigate the factors associated with hypertension among the adolescents of Jahrom city in Iran and also standard percentiles of blood pressure were estimated for this group. Methods. In this community-based cross-sectional study 983 high school students from different areas of the city were included using a multistage random cluster sampling method in 2014. Blood pressure, weight, and height of each student measured using standard methods. Data were analyzed by statistical software SPSS 16. Results. In total, 498 male and 454 female students were included in this study. Average systolic blood pressure of students was 110.27 mmHg with a variation range of 80.6–151.3. Average diastolic blood pressure was 71.76 mmHg with the variation range of 49.3–105. Results of this study indicated that there was a significant relationship between gender, body mass index, and parental education level with systolic and diastolic blood pressure of the students (P < 0.05). Conclusions. Body mass index was one of the most important changeable factors associated with blood pressure in adolescents. Paying attention to this factor in adolescence could be effective in prevention of cardiovascular diseases in adulthood.
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Dratva J. One Step Further Toward a Targeted Screening Program. Hypertension 2017; 69:409-410. [PMID: 28093468 DOI: 10.1161/hypertensionaha.116.08390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julia Dratva
- From the Zurich University of Applied Sciences, School of Health Professions, Institute of Health Sciences, Research Unit for Health Sciences, Switzerland.
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Kaelber DC, Liu W, Ross M, Localio AR, Leon JB, Pace WD, Wasserman RC, Fiks AG. Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study. Pediatrics 2016; 138:peds.2016-2195. [PMID: 27940711 PMCID: PMC5127074 DOI: 10.1542/peds.2016-2195] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric hypertension predisposes children to adult hypertension and early markers of cardiovascular disease. No large-scale studies have examined diagnosis and initial medication management of pediatric hypertension and prehypertension. The objective of this study was to evaluate diagnosis and initial medication management of pediatric hypertension and prehypertension in primary care. METHODS Retrospective cohort study aggregating electronic health record data on >1.2 million pediatric patients from 196 ambulatory clinics across 27 states. Demographic, diagnosis, blood pressure (BP), height, weight, and medication prescription data extracted. Main outcome measures include proportion of pediatric patients with ≥3 visits with abnormal BPs, documented hypertension and prehypertension diagnoses, and prescribed antihypertensive medications. Marginal standardization via logistic regression produced adjusted diagnosis rates. RESULTS Three hundred ninety-eight thousand seventy-nine patients, ages 3 to 18, had ≥3 visits with BP measurements (48.9% girls, 58.6% <10 years old). Of these, 3.3% met criteria for hypertension and 10.1% for prehypertension. Among practices with ≥50 eligible patients, 2813 of 12 138 patients with hypertension (23.2%; 95% confidence interval, 18.2%-28.2%) and 3990 of 38 874 prehypertensive patients (10.2%; 95% confidence interval, 8.2%-12.2%) were diagnosed. Age, weight, height, sex, and number and magnitude of abnormal BPs were associated with diagnosis rates. Of 2813 diagnosed, persistently hypertensive patients, 158 (5.6%) were prescribed antihypertensive medication within 12 months of diagnosis (angiotensin-converting enzyme inhibitors/angiotensin receptive blockers [35%], diuretics [22%], calcium channel blockers [17%], and β-blockers [10%]). CONCLUSIONS Hypertension and prehypertension were infrequently diagnosed among pediatric patients. Guidelines for diagnosis and initial medication management of abnormal BP in pediatric patients are not routinely followed.
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Affiliation(s)
- David C. Kaelber
- Comparative Effectiveness Research Through Collaborative Electronic Reporting (CER) Consortium Research Team, Elk Grove Village; Illinois;,Departments of Internal Medicine, Pediatrics, Epidemiology, and Biostatistics, Case Western Reserve University, Cleveland Ohio;,Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - Weiwei Liu
- Comparative Effectiveness Research Through Collaborative Electronic Reporting (CER) Consortium Research Team, Elk Grove Village; Illinois;,Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Michelle Ross
- Comparative Effectiveness Research Through Collaborative Electronic Reporting (CER) Consortium Research Team, Elk Grove Village; Illinois;,Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - A. Russell Localio
- Comparative Effectiveness Research Through Collaborative Electronic Reporting (CER) Consortium Research Team, Elk Grove Village; Illinois;,Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Janeen B. Leon
- Comparative Effectiveness Research Through Collaborative Electronic Reporting (CER) Consortium Research Team, Elk Grove Village; Illinois;,Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - Wilson D. Pace
- Comparative Effectiveness Research Through Collaborative Electronic Reporting (CER) Consortium Research Team, Elk Grove Village; Illinois;,American Academy of Family Physicians National Research Network, Leawood, Kansas
| | - Richard C. Wasserman
- Comparative Effectiveness Research Through Collaborative Electronic Reporting (CER) Consortium Research Team, Elk Grove Village; Illinois;,Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois;,Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont; and
| | - Alexander G. Fiks
- Comparative Effectiveness Research Through Collaborative Electronic Reporting (CER) Consortium Research Team, Elk Grove Village; Illinois;,Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois;,The Pediatric Research Consortium,,Department of Biomedical and Health Informatics,,Center for Pediatric Clinical Effectiveness, and,PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Bloetzer C, Chiolero A. Cardiovascular risk among hypertensive adolescents and the potential benefit of a screen-and-treat strategy. Pediatr Nephrol 2016; 31:349-51. [PMID: 26630880 DOI: 10.1007/s00467-015-3270-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/04/2015] [Indexed: 11/30/2022]
Abstract
To evaluate whether screening for hypertension should start early in life, information on the risk of diseases associated with the level of blood pressure in childhood or adolescence is needed. The study by Leiba et al. that is reported in the current issue of Pediatric Nephrology demonstrates convincingly that hypertensive adolescents are at higher risk of cardiovascular death than normotensive adolescents. Nevertheless, it can be shown that this excess risk is not sufficient to justify a screen-and-treat strategy. Since the large majority of cardiovascular deaths occur among normotensive adolescents, measures for primordial prevention of cardiovascular diseases could have a much larger impact at the population level.
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Affiliation(s)
- Clemens Bloetzer
- Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Route de la Corniche 10, 1010, Lausanne, Switzerland. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
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Vascular Aging: Lessons From Pediatric Hypertension. Can J Cardiol 2016; 32:642-9. [PMID: 27040097 DOI: 10.1016/j.cjca.2016.02.064] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/05/2016] [Accepted: 02/23/2016] [Indexed: 12/31/2022] Open
Abstract
Hypertension (HTN) in children is associated with early vascular aging (EVA) and underlying immunologic-metabolic abnormalities and accelerated biological maturation. Morphologic and functional vascular changes underlying EVA and HTN in children resemble those seen in the elderly including but not limited to an increase in intima-media thickness (IMT) and arterial stiffness and endothelial dysfunction. Although progeria syndrome leading to EVA and the development of clinically manifested cardiovascular (CV) disease in the second decade of life is a rare hereditary disorder, primary HTN, which is also associated with EVA, is much more common (reported in up to 10% in adolescents). EVA associated with HTN in children leads to the premature development of target organ injury in childhood and CV events in early adulthood. Limited evidence from prospective observational studies in children and adolescents indicates that early lifestyle measures (low salt/low sugar intake and exercise) or pharmacologic treatment of HTN, or both, partially reverses morphologic and functional changes underlying EVA such as an increase in carotid IMT and pulse wave velocity, a decrease in flow-mediated dilation of the brachial artery, and an increase in oxidative stress and visceral fat. Future mechanistic and therapeutic clinical trials are desirable to assess the mechanisms and treatment strategies of EVA in the context of HTN in children and their effect on CV events in early adulthood.
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