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Tas V, Birisci E, Jones RA, Forbus JJ, Blaszak RT, Crawford B, Ilyas M, Magee JS, Sisterhen LL. Improving Pediatric Hypertension Screening in an Academic Primary Care Setting. Pediatr Qual Saf 2024; 9:e746. [PMID: 38993274 PMCID: PMC11236397 DOI: 10.1097/pq9.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/07/2024] [Indexed: 07/13/2024] Open
Abstract
Introduction Adherence to the American Academy of Pediatrics clinical practice guidelines for screening and managing high blood pressure (BP) is low. This team sought to improve recognition and documentation of relevant diagnoses in patients aged 13-20 years who presented to general pediatric clinics. Methods The primary outcome measure was the proportion of office visits for patients ages 13-20 with a BP ≥ 120/80 with a visit or problem list diagnosis of hypertension or elevated BP. Secondary measures included (1) the proportion of patients who had their BP measured in the right arm, (2) the proportion of patients who had a mid-arm circumference measurement recorded, and (3) the proportion of patients who had a second BP reading measured at the visit. Interventions addressed key drivers for evidence-based high BP screening: standard BP measurement, electronic health record clinical decision support, and clinical pathway adoption. Data were collected over a twenty-seven-month period and plotted using the Laney p' chart. Results Provider documentation of elevated BP or hypertension improved from a baseline mean of 24% in April 2020 through January 2022 to 41% in February 2021 through June 2022. All secondary outcome measures also demonstrated significant improvement. Conclusions This project demonstrates the feasibility of improving adherence to best practices of BP measurement in primary care clinics through education, acquisition of resources, and implementation of electronic health record flags for abnormal values.
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Affiliation(s)
- Vildan Tas
- From the Department of Pediatrics, University of Pittsburg Medical Center Children's Hospital of Pittsburgh, Little Rock, Penn
| | - Esma Birisci
- Department of Econometrics, Bursa Uludağ University, Bursa, Turkey
| | - Rachel Achor Jones
- Process Improvement and Population Health Departments, Arkansas Children's Hospital, Little Rock, Ark
| | - John J Forbus
- Process Improvement and Population Health Departments, Arkansas Children's Hospital, Little Rock, Ark
| | - Richard T Blaszak
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Brendan Crawford
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Mohammad Ilyas
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - James S Magee
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Laura L Sisterhen
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
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Ntretsiou E, Benas D, Trivilou P, Pavlidis G, Ikonomidis I, Attilakos A, Iliodromitis E, Triantafyllidi H. Evaluation of cardiovascular risk factors in children aged 6-16 years and their evolution in early adulthood in a 10-year follow-up study. Hellenic J Cardiol 2024:S1109-9666(24)00030-7. [PMID: 38369194 DOI: 10.1016/j.hjc.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 02/20/2024] Open
Abstract
OBJECTIVE Obesity and arterial hypertension (AH) in children represent well-recognized risk factors for cardiovascular (CV) events during adult life. We investigated any changes regarding several CV risk (CVR) factors in children after a 10-year follow-up period. METHODS A cohort of 143 healthy children, elementary/high school students, 6-16 years old, was initially evaluated in 2010-2011 regarding CVR factors [obesity, blood pressure (BP), aortic stiffness (PWV), lipid profile] plus food habits/sports activity. At 10-years follow-up (2020-2021), 63/143 (44%) young adults were re-evaluated. RESULTS Children with obesity (45%) had increased BP (p < 0.001) and a less favorable LDL-C/triglycerides profile (p = 0.001) compared to overweight/normoweight ones. In a 10-year follow-up, obesity and exercise improved (p < 0.001 and p = 0.005), systolic BP (SBP) (102 ± 13 vs. 118 ± 11 mmHg, p < 0.001) and PWV increased (6.1 ± 1 vs. 7.7 ± 1.1 m/sec, p < 0.001), LDL-C (96 ± 21 vs. 86 ± 24 mg/dl, p = 0.004) and HDL-C + (64 ± 18 vs. 55 ± 10 mg/dl, p < 0.001) decreased, triglycerides increased (62 ± 21 vs. 73 ± 34 mg/dl, p = 0.04), and food approached the western model of nutrition (less fish/fruits). In children/young adults, BMI was associated with age (Beta = 0.47, p < 0.001 and Beta = 0.36, p = 0.004), SBP (Beta = 0.46 and Beta = 0.52, p < 0.001), and LDL-C (Beta = 0.27 and Beta = 0.44, p < 0.001). CONCLUSIONS In children with obesity, increased BMI and waist circumference were related to SBP and a less favorable lipid profile. At the 10-year re-evaluation, obesity was partially improved, physical activity was increased, and SBP had reached the high-normal levels in a substantial number of young adults, while lipid profile was less favorable (for HDL-C/triglycerides) compared to baseline evaluation. Our results highlight the evolution of CVR factors from childhood to early adulthood.
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Affiliation(s)
- Eleni Ntretsiou
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece
| | - Dimitris Benas
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece
| | - Paraskevi Trivilou
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece
| | - George Pavlidis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece
| | - Ignatios Ikonomidis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece
| | - Achilleas Attilakos
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece
| | - Efstathios Iliodromitis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece
| | - Helen Triantafyllidi
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece.
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Almahmoud OH, Arabiat DH, Saleh MY. Systematic review and meta-analysis: Prevalence of hypertension among adolescents in the Arab countries. J Pediatr Nurs 2022; 65:e72-e79. [PMID: 35305878 DOI: 10.1016/j.pedn.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
PROBLEM Hypertension (HTN) is one of the non-communicable diseases which prevalence is rising in both developed and developing countries. There is a scarcity of data on the prevalence of HTN in Arab countries. This review outlines what is currently known about prevalence and risk factors of HTN in adolescence in Arab world. ELIGIBILITY CRITERIA A systematic review and meta-analysis were conducted using PubMed, Cochrane Library, Scopus, CINAHL, Science Direct, and Google Scholar databases from 2011 to 2021. SAMPLE Fourteen studies from 9 Arab countries met inclusion criteria. Studies included a total of 777 adolescents with HTN and 2147 adolescents with pre-HTN. RESULTS The overall prevalence of HTN among adolescents in the Arab World was estimated at 12.6% (95CI 0.083-0.176), while pre-HTN was 13.9% (95CI 0.084-0205). Overweight and obesity resemble the higher risk of developing hypertension. Family history, high consumption of salt, smoking and low physical activity also increase the risk of HTN. The development of adolescent HTN can be predicted through anthropometric measurements such as Body Mass Index (BMI), wrist circumferences, and high waist circumference. CONCLUSION The prevalence of HTN among adolescents in the Arab world was significant, ranging from 4 to 26%. The heterogeneity between studies was high. IMPLICATION Local governments and policymakers must consider strengthening regulations to address environmental risk factors and improve public awareness about risk factors to HTN. A combined use of nurse- and patient targeted educational interventions could also help in reducing the burden of HTN in this population.
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Affiliation(s)
- Omar H Almahmoud
- Nursing Department, Pharmacy, Nursing and Health Professions College, Birzeit University, Palestine.
| | - Diana H Arabiat
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia; The Centre for Evidence Informed Nursing, Midwifery and Healthcare Practice, Joondalup, WA, Australia; Maternal and Child Nursing Department, Faculty of Nursing, The University of Jordan, Amman, Jordan
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Candelino M, Tagi VM, Chiarelli F. Cardiovascular risk in children: a burden for future generations. Ital J Pediatr 2022; 48:57. [PMID: 35410281 PMCID: PMC8996670 DOI: 10.1186/s13052-022-01250-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 03/27/2022] [Indexed: 11/30/2022] Open
Abstract
Cardiovascular diseases are the main causes of death and health costs in developed countries. Although cardiovascular diseases are thought to affect only adulthood, the underlying process of atherosclerosis begins in the first decade of life. Epidemiological studies show that severity of atherosclerosis depends both on the number and intensity of risk factors. Early detection of cardiovascular risk in childhood is the most powerful tool to prevent cardiovascular accidents in adulthood and possibly reduce its consequent burden for the future. A large amount of cardiovascular risk factors is already detectable in childhood and include non-modifiable elements, among which genetic factors and congenital heart diseases, and modifiable elements, which depend on environmental effects (e.g. lifestyle and nutrition). Regardless of the possibility to intervene on these factors, an early diagnosis is fundamental to ensure an optimal life expectancy in adulthood. The most important cardiovascular risk factors in the paediatric age and adolescence are excess weight, arterial hypertension, glucose metabolism and lipid metabolism alterations. In this review we will discuss the main risk factors strictly correlated with cardiac and vessels diseases, focusing on their pathogenesis, diagnosis, and treatments.
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Dawson AE, Kallash M, Spencer JD, Wilson CS. The pressure's on: understanding neurocognitive and psychological associations with pediatric hypertension to inform comprehensive care. Pediatr Nephrol 2021; 36:3869-3883. [PMID: 33890179 DOI: 10.1007/s00467-021-05077-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/15/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
The prevalence of hypertension is increasing in pediatric populations. While clinical data and practice guidelines identify the impact of hypertension on organ dysfunction and emphasize the importance for end-organ damage screening, the bidirectional effects of pediatric hypertension on neurocognitive and psychological outcomes are understudied. The objective of this review is to highlight the association between hypertension and cognition, attention, learning, and mental health in children and adolescents. In doing so, this review provides a framework and toolkit to integrate neuropsychology and psychology into the screening and management stages of pediatric hypertension. By recognizing the effects of hypertension on cognition, behavior, and mental health, screenings and interventions can be implemented to proactively and comprehensively improve the health outcomes for children with blood pressure concerns.
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Affiliation(s)
- Anne E Dawson
- Department of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Mahmoud Kallash
- Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children's, Columbus, OH, USA
| | - John D Spencer
- Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children's, Columbus, OH, USA
| | - Camille S Wilson
- Department of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's, 700 Children's Drive, Columbus, OH, 43205, USA
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Redjala O, Sari-Ahmed M, Cherifi M, Smati L, Benhassine F, Baghriche M, Chibane A, Lopez-Sublet M, Monsuez JJ, Benkhedda S. Children hypertension in Northern Africa. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:222-230. [PMID: 34084657 PMCID: PMC8166588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To assess factors associated with prehypertension and hypertension among children in North Africa. METHODS An epidemiological observational, school- and college-based study among 3562 healthy children and adolescents to assess factors associated with blood pressure categories (normal, prehypertensive, hypertensive), including perinatal (gestational age, birth weight, breastfeeding) and current lifestyle characteristics (body mass index, time spent watching a screen and time spent exercising). RESULTS Prevalence of hypertension increased with age from 8.7% between 6-10 years to 14.7% between 11-15 years, and 15.6% above 15 years. Prevalence of prehypertension and hypertension increased with body mass index from 9.9% and 11.5% among children not overweight to 15.6% (RR 1.58, 95% CI 1.24-2.02, P<0.001) and 17.2% (RR 1.50, 95% CI 1.22-1.85, P<0.001) among those overweight and to 26.8% (RR 2.72, 95% CI 2.04-3.64, P<0.01) and 32.3% (RR 2.82, 95% CI 2.27-3.50, P<0.01) among obese children. There was a trend of association of prehypertension with the time spent watching Television, internet and electronic games. Children whose mother or father had a history of hypertension had a trend to be prehypertensive or hypertensive. A parental hypertension was found in 33.6% of normotensive, 38.2% of prehypertensive, and 42.6% of hypertensive children (P=0.05). Children with prehypertension or hypertension were more likely to have a diabetic father or mother (22.8% and 22.6% vs 15.8%, respectively, P=0.01). Also, prehypertension and hypertension were associated with shorter gestational age, early birth, reduced birth weight, and shorter breastfeeding. CONCLUSION Prehypertension and hypertension have a high prevalence among children in North Africa. They are associated with overweight, obesity, diabetes, a shorter gestational age, a lower birth weight and a shorter breastfeeding.
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Affiliation(s)
- Ouzna Redjala
- COCRG, Cardiology Oncology Research Collaborative Group (CORCG), Faculty of Medicine BENYOUCEF BENKHEDDA UniversityAlgiers
- Department of Pediatrics, CHU BainemAlgiers
| | - Mahfoud Sari-Ahmed
- COCRG, Cardiology Oncology Research Collaborative Group (CORCG), Faculty of Medicine BENYOUCEF BENKHEDDA UniversityAlgiers
- Department of Pediatrics, CHU BainemAlgiers
| | - Mehdi Cherifi
- COCRG, Cardiology Oncology Research Collaborative Group (CORCG), Faculty of Medicine BENYOUCEF BENKHEDDA UniversityAlgiers
- Pathologie Moléculaire, Université Paul Sabatier, Toulouse IIIFrance
- Ancient DNA Genomics and Biological Anthropology, Department of Evolutionary Anthropology, University of ViennaAustria
| | | | | | | | - Ahcene Chibane
- COCRG, Cardiology Oncology Research Collaborative Group (CORCG), Faculty of Medicine BENYOUCEF BENKHEDDA UniversityAlgiers
| | | | | | - Salim Benkhedda
- COCRG, Cardiology Oncology Research Collaborative Group (CORCG), Faculty of Medicine BENYOUCEF BENKHEDDA UniversityAlgiers
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Abstract
Although relatively rare in childhood, primary hypertension (PH) is thought to have originated in childhood and may be even determined perinatally. PH prevalence increases in school-age children and affects 11% of 18-year-old adolescents. Associated with metabolic risk factors, elevated blood pressure in childhood is carried into adulthood. Analysis of the phenotype of hypertensive children has revealed that PH is a complex of anthropometric and neuro-immuno-metabolic abnormalities, typically found in hypertensive adults. Children with elevated blood pressure have shown signs of accelerated biological development, which are closely associated with further development of PH, metabolic syndrome, and cardiovascular disease in adulthood. At the time of diagnosis, hypertensive children were reported to have significant arterial remodelling expressed as significantly increased carotid intima-media thickness, increased stiffness of large arteries, lower area of microcirculation, and decreased endothelial function. These changes indicate that their biological age is 4 to 5 years older than their normotensive peers. All these abnormalities are typical features of early vascular aging described in adults with PH. However, as these early vascular changes in hypertensive children are closely associated with features of accelerated biological development and neuro-immuno-metabolic abnormalities observed in older subjects, it seems that PH in childhood is not only an early vascular aging event, but also an early biological maturation phenomenon.
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8
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Kolesnikova LR, Darenskaya MA, Pogodina AV, Grebenkina LA, Natyaganova LV, Kolesnikova LI, Kolesnikov SI. [The relationship of hemodynamic parameters of periodontal microvascular bed and lipid peroxidation products in adolescents with arterial hypertension]. STOMATOLOGII︠A︡ 2020; 99:9-14. [PMID: 32692513 DOI: 10.17116/stomat2020990419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
THE AIM Of the study was to establish the relationship of hemodynamic parameters of periodontal tissues and lipid peroxidation products in adolescents with arterial hypertension (AH). METHODS The study included 132 adolescents (average age 14.51±1.91 years), from which 2 clinical groups (1 - the group with AH without periodontal disease (n=19, average age - 15±1.53 years) and 2 - the group with AH with periodontal diseases (n=57, average age - 14.7±1.89 years)) and 2 comparison groups (3 - the comparison group without AH and periodontal diseases (n=19, average age - 13.82±1.89 years) and 4 - comparison group without AH and with periodontal diseases (n=37, mean age - 14.57±2.01 years)) were formed. Hemodynamic analysis of the periodontal microcirculatory bed using the Doppler ultrasound method and the level of lipid peroxidation products using spectrophotometric and fluorometric methods was performed. RESULTS In adolescents with hypertension without and with inflammatory periodontal diseases as a whole, unidirectional changes in the hemodynamics of the vascular bed of the periodontium were observed in the form of increased values of the maximum blood flow velocity in systole and an increase in the peripheral resistance index. At the same time, the group with hypertension and periodontal disease was distinguished by lower values of these indicators. In the system of lipid peroxidation, increased values of ketodienes and conjugated trienes occurred in patients with hypertension without periodontal disease and end products that actively reacting with thiobarbituric acid in patients with hypertension and periodontal disease. Correlation analysis showed the presence of intersystem relationships between the hemodynamic parameters of the vascular bed of periodontal adolescents with hypertension without periodontal disease. In the group of adolescents with arterial hypertension and periodontal disease, there was a decrease in the correlation coefficients between intersystem parameters by almost two times, as well as the appearance of pathological dependencies between toxic metabolites of the lipid peroxidation process - products that actively reacting with thiobarbituric acid and vascular blood flow indicators. CONCLUSION It has been noted that in adolescent patients with hypertension and periodontal diseases on the background of lower vascular blood flow and accumulation of end toxic metabolites, pathological dependencies occur between them, which may contribute to more intense damage to the tissues of the periodontal complex in the presence of hypertension.
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Affiliation(s)
- L R Kolesnikova
- Federal State Public Scientific Institution «Scientific Centre for Family Health and Human Reproduction Problems», Irkutsk, Russia.,Federal State Public Educational Institution of Higher Education «Irkutsk State Medical University» of the Ministry of Health of the Russian Federation, Irkutsk, Russia
| | - M A Darenskaya
- Federal State Public Scientific Institution «Scientific Centre for Family Health and Human Reproduction Problems», Irkutsk, Russia
| | - A V Pogodina
- Federal State Public Scientific Institution «Scientific Centre for Family Health and Human Reproduction Problems», Irkutsk, Russia
| | - L A Grebenkina
- Federal State Public Scientific Institution «Scientific Centre for Family Health and Human Reproduction Problems», Irkutsk, Russia
| | - L V Natyaganova
- Federal State Public Scientific Institution «Scientific Centre for Family Health and Human Reproduction Problems», Irkutsk, Russia
| | - L I Kolesnikova
- Federal State Public Scientific Institution «Scientific Centre for Family Health and Human Reproduction Problems», Irkutsk, Russia.,Federal State Public Educational Institution of Higher Education «Irkutsk State University»
| | - S I Kolesnikov
- Federal State Public Scientific Institution «Scientific Centre for Family Health and Human Reproduction Problems», Irkutsk, Russia.,Moscow State University Lomonosov M.V., Moscow, Russia.,Moscow State Regional University, Moscow, Russia
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Impact of updated pediatric hypertension criteria on prevalence estimates of hypertension among Chinese children. J Hum Hypertens 2020; 35:530-536. [PMID: 32572274 DOI: 10.1038/s41371-020-0370-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/21/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
This study aimed to evaluate the impact of updated pediatric hypertension (HTN) criteria (the 2017 AAP Guidelines) on prevalence estimates of HTN and prehypertension among Chinese children compared to the 2004 Fourth Report. A total of 2093 children aged 7-15 years from five schools in Tianjin, China were selected using a multistage random cluster sampling method. The prevalence of HTN per the 2017 AAP Guidelines (10.1%) was significantly higher than that per the Fourth Report (6.6%), whereas the prevalence of prehypertension per the 2017 AAP Guidelines (6.3%) was significantly lower than that per the Fourth Report (8.8%). From the 2004 Fourth Report to the 2017 AAP Guidelines, a total of 117 (5.6%) children were reclassified to have higher blood pressure. The two criteria had better consistency in the diagnosis of systolic abnormalities than in the diagnosis of diastolic abnormalities. The updated definitions for pediatric HTN have a substantive impact on the prevalence estimation among Chinese children, especially among boys, overweight children, and older children.
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Kuciene R, Dulskiene V. Associations between body mass index, waist circumference, waist-to-height ratio, and high blood pressure among adolescents: a cross-sectional study. Sci Rep 2019; 9:9493. [PMID: 31263167 PMCID: PMC6602926 DOI: 10.1038/s41598-019-45956-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/17/2019] [Indexed: 02/06/2023] Open
Abstract
The purpose of the present study was to examine the associations between body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and high blood pressure (HBP), and to determine which anthropometric parameters can best predict HBP among Lithuanian adolescents aged 12–15 years. Data from the survey of “Prevalence and Risk Factors of HBP in 12–15-Year-Old Lithuanian Children and Adolescents (Study 1, 2010–2012)” were used; a total of 7,457 respondents (3,494 boys and 3,963 girls) were included in this analysis. Adolescents with BP above the 90th percentile were measured on two different occasions. Logistic regression analysis was used to assess the associations and to calculate odds ratios. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of the three anthropometric parameters to predict HBP. The adjusted odds ratios (aOR) in the highest quartiles of BMI, WC, and WHtR were statistically significant for both sexes separately (reference group – the first quartile): in boys, prehypertension – 4.91, 4.09, and 1.59; hypertension – 7.96, 6.44, and 2.81; and prehypertension/hypertension – 6.85, 5.65, and 2.37, respectively; and in girls, prehypertension – 3.42, 2.70, and 1.66; hypertension – 5.71, 3.54, and 2.90; and prehypertension/hypertension – 4.62, 3.17, and 2.31, respectively). According to the analyses of the ROC curve, BMI z-score provided the largest area under the curve (AUC) value, followed by WC z-score, while WHtR z-score showed the lowest AUC value in predicting elevated BP in both sexes separately. Among Lithuanian adolescents aged 12–15 years, both anthropometric indices – BMI and WC (but particularly BMI) – showed stronger associations with HBP and were better for the prediction of HBP, compared to WHtR.
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Affiliation(s)
- Renata Kuciene
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu 15, LT-50161, Kaunas, Lithuania.
| | - Virginija Dulskiene
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu 15, LT-50161, Kaunas, Lithuania
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Abstract
BACKGROUND White-coat hypertension (WCH) is a debatable risk factor of cardio-cerebrovascular diseases and the current study results on the association between WCH and arterial stiffness are inconsistent. The aim was to investigate the effect of WCH on arterial stiffness using meta-analysis. METHODS Based on prespecified search strategies and inclusion criteria, Medline, Embase, Web Of Science, Cochrane Library, and BioSciences Information Service Preview databases were reviewed. A total of 20 studies involving 1538 WCH patients and 3582 normotensives (NT) were included. Literatures were screened for data extraction and quality assessment. Overall analysis and subgroup analysis were conducted in RevMan version 5.3 and Stata version 14.0 software. RESULTS Overall analysis showed that carotid-femoral pulse wave velocity (cf-PWV) was significantly higher in WCH group than in the NT group (P < .00001, 95% CI: 0.79-3.26). Subgroup analysis showed that in adults, cf-PWV was significantly higher in the WCH patients than in the NT subjects (P<.001, 95% CI: 0.46-0.87), while in juveniles, cf-PWV was comparable between the WCH group and the NT group (P = .25, 95% CI: -0.39 to 0.61). CONCLUSION This meta-analysis showed that WCH may increase arterial stiffness in adult population.
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Affiliation(s)
- Peng Cai
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Third Military Medical University, Chongqing
| | - Yan Peng
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Third Military Medical University, Chongqing
| | - Yan Wang
- Key Laboratory of Basic Pharmacology of Ministry of Education Joint International Research Laboratory of Ministry Education, Zunyi Medical University, Zunyi, China
| | - Xukai Wang
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Third Military Medical University, Chongqing
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12
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To screen or not to screen: for high blood pressure. Pediatr Nephrol 2018; 33:81-82. [PMID: 28971255 DOI: 10.1007/s00467-017-3808-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
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