Management of Hypertension in Children and Adolescents

Association of dietary fatty acid intake with hypertension in children and adolescents: evidence from the NHANES 2005-2018

Aim

This study aims to evaluate the association between dietary fatty acid intake and hypertension in children and adolescents.

Methods

This cross-sectional study used data of children and adolescents aged 8-17 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Dietary intake of total fat and fatty acid was evaluated via two 24-h dietary recall interviews. Multivariate logistic regression models were used to assess the association between fatty acid intake and hypertension, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. A subgroup analysis was conducted according to gender, age, and body mass index Z-score.

Results

This study included 13,330 subjects, of which 11,614 were non-hypertensive and 1,716 were hypertensive. Higher intake of total polyunsaturated fatty acids (PUFAs) was associated with significantly lower odds of hypertension (OR = 0.85, 95% CI: 0.74-0.97, P = 0.018). No significant associations were found between the density of total saturated fatty acid, monounsaturated fatty acids, and PUFAs and the odds of hypertension (all P > 0.05). Increased intake of omega-3 (OR = 0.82, 95% CI: 0.72-0.93, P = 0.002) and omega-6 (OR = 0.86, 95% CI: 0.75-0.98, P = 0.025) PUFAs, octadecatrienoic acid (OR = 0.82, 95% CI: 0.72-0.93, P = 0.003), and octadecadienoic acid (OR = 0.86, 95% CI: 0.75-0.98, P = 0.025) was associated with significantly lower odds of hypertension, and individuals with higher omega-6/omega-3 ratio had significantly higher odds of hypertension (OR = 1.09, 95% CI: 1.02-1.17, P = 0.025). The density of omega-3 PUFAs (OR = 0.86, 95% CI: 0.78-0.95, P = 0.004) and octadecatrienoic acid (OR = 0.87, 95% CI: 0.78-0.96, P = 0.006) was inversely associated with the odds of hypertension, and the omega-6/omega-3 ratio was positively associated with the odds of hypertension (OR = 1.09, 95% CI: 1.02-1.17, P = 0.012).

Conclusion

Total PUFA intake was negatively associated with the odds of hypertension in children and adolescents. Higher intake of omega-3 and omega-6 PUFAs, octadecatrienoic acid, and octadecadienoic acid, as well as density of omega-3 PUFAs and octadecatrienoic acid, was associated with lower odds of hypertension.

Physiological and Lifestyle Factors Associated With Abnormal Blood Pressure in Adolescents Before and After a School-Based Wellness Program in Michigan: A Report From Project Healthy Schools

PURPOSE

Hypertension (HTN) is associated with increased cardiovascular risk and unhealthy lifestyles in adults. However, data on both physiological and lifestyle factors associated with abnormal blood pressure (BP) in adolescents, as well as the effectiveness of interventions in improving these factors among adolescents with abnormal BP, is scarce.

METHODS

Students enrolled in a middle-school-based wellness program, Project Healthy Schools (PHS), between 2005-2016 were eligible. Three systolic (SBP) and diastolic (DBP) BP measurements were taken pre-PHS and post-PHS; averages of the final two were analyzed. Students were grouped by baseline BP: abnormal BP (≥90th percentile for SBP and/or DBP, or ≥120/80 mmHg) or normal BP (<90th percentile for SBP and/or DBP, or <120/80 mmHg). Demographics, physiologic measures, and health behaviors were compared between groups pre- and post-PHS.

RESULTS

Of 2,865 students, 812 (28.3%) had abnormal BP. Median SBP was 119 mmHg in abnormal BP students and 103 mmHg in normal BP students (p < .001). Females were less likely to have abnormal BP than males (48.4% vs. 51.6%, p < .01). Pre-PHS, abnormal BP students were more likely to be overweight (62.3% vs. 28.2%, p < .001) or obese (38.9% vs. 11.3%, p < .001) than normal BP students. Their total cholesterol, triglycerides, random glucose, resting, and recovery heart rates were also higher, and they had worse dietary and sedentary habits. Post-PHS, abnormal BP students demonstrated greater reduction in SBP (-4.0 vs. 2.8 mmHg, p < .001) and DBP (-3.3 vs. .8 mmHg, p < .001) than normal BP students.

CONCLUSIONS

Abnormal BP was prevalent and associated with worse cardiometabolic health parameters and behaviors at baseline. Abnormal BP students demonstrated significant improvements in BP post-PHS, suggesting school-based programs may be effective as nonpharmacological lifestyle interventions in this population.

Body Mass Index Trajectory and Incident Hypertension: Results From a Longitudinal Cohort of Chinese Children and Adolescents, 2006-2016

Objectives. To identify body mass index (BMI) trajectories in Chinese children and to compare the risk of incident high blood pressure (HBP) across trajectory groups.Methods. A total of 9286 children were included. The mean age at baseline was 8.9 years; age at endpoint ranged between 16 and 18 years. At least 8 measurements were obtained from each involved child. We used group-based trajectory modeling to identify BMI trajectory groups in each sex. We used blood pressure from each measurement to define HBP.Results. We identified 4 BMI trajectories for each sex. Compared with the low trajectory group, the hazard ratios of HBP in the higher trajectory groups ranged from 1.17 (95% confidence interval [CI] = 1.11, 1.23) to 2.00 (95% CI = 1.78, 2.27) during follow-up, and HBP risk at late adolescence ranged from 1.36 (95% CI = 1.22, 1.52) to 3.63 (95% CI = 3.12, 4.21). All trend P values across trajectories were less than .001. In terms of population level, overweight started 3 years earlier than HBP.Conclusions. Children of higher BMI trajectories had a higher risk of HBP during adolescence. The transition period from overweight to HBP onset could be critical for HBP prevention.

Subjetividades de los adolescentes con respecto a la promoción de la salud: contribuciones a la enfermería

Introducción: Los adolescentes representan una parte importante de la población con particularidades relacionadas con el estilo de vida, por lo que es necesario promover acciones que fomenten hábitos saludables. En esta perspectiva, comprender las subjetividades que influencian los comportamientos de salud típicos de la adolescencia se vuelve esencial para la salud y la atención de enfermería, ya que las opciones de autocuidado están marcadas de singularidades. Objetivo: Exponer las subjetividades de los adolescentes sobre el autocuidado en el contexto de la promoción de la salud y la enfermería. Materiales y Métodos: Enfoque de investigación fenomenológica heideggeriana con 17 adolescentes de una escuela pública en Minas Gerais realizada entre octubre y diciembre de 2016. El movimiento analítico hermenéutico permitió la aparición del fenómeno en estudio. Resultados: Sobre el autocuidado, los adolescentes expresaron que van al médico sólo cuando se necesita; saben que tienen que cuidar su salud, pero no hacer ejercicio o comer de forma saludable y cuidar su salud ahora, sino porque en el futuro puede convertirse en un problema. De los participantes, el 68% reportó haber desarrollado actividad física durante las clases de educación física y el 30% informó haber consumido alcohol. Discusión y Conclusiones: Al comprender las subjetividades de los adolescentes sobre el autocuidado, las enfermeras encuentran mayores elementos para realizar acciones de salud dirigidas a estimular comportamientos saludables que resultarán una mejor calidad de vida en el presente y a futuro. Como citar este artigo: Paula JA, Melo MCSC, Amorim TV, Salimena AMO, Paiva ACPC, Nascimento RCN. Subjetividades de adolescentes face à promoção da saúde: contribuições para a enfermagem. Rev Cuid. 2020; 11(1): e895. http://dx.doi.org/10.15649/cuidarte.895

Association between sleep duration and high blood pressure in adolescents: a systematic review and meta-analysis

CONTEXT

Sleep has been assessed as a risk factor for health consequences. Among adults, excessively longer and shorter sleep durations are associated with high blood pressure (BP), but knowledge of the association between sleep duration and high BP among adolescents is limited.

OBJECTIVES

To estimate the associations between sleep duration and high BP in adolescents.

METHODS

PubMed, Web of Science, and Cochrane databases were searched for eligible publications up until 20 November 2017. This study reviewed the reference lists from retrieved articles to search for relevant studies. Pooled odds ratios (ORs) were calculated using a random-effects meta-analysis. Sub-group and sensitivity analyses were conducted to identify heterogeneity. Publication bias was evaluated using Egger's test.

RESULTS

Seven studies involving 21,150 participants were included, with ages ranging from 10-18 years. For primary analysis, compared with the reference sleep duration, the pooled OR for high BP was 1.51 (95% confidence interval [CI] = 1.04-2.19) for the short sleep duration overall. For long sleep duration, the pooled OR was 1.04 (95% CI = 0.78-1.38). Further sub-group analysis showed that short sleep duration had a higher risk of incident high BP in males (OR = 1.55, 95% CI = 1.24-1.93) than in females (OR = 1.23, 95% CI = 0.47-3.22).

CONCLUSIONS

Among adolescents, and particularly male adolescents, short sleep duration may be a risk factor for high BP. More attention should be given to this lifestyle factor.

Independent and combined effects of handgrip strength and adherence to a Mediterranean diet on blood pressure in Chilean children

OBJECTIVE

The aim of the study was to examine the combined associations between handgrip strength (HGS) and adherence to a Mediterranean diet with blood pressure (BP) in Chilean children.

METHODS

This cross-sectional study enrolled 1140 children (794 boys and 346 girls) 8 to 12 y of age. HGS was measured using a hand dynamometer with an adjustable grip. Adherence to a Mediterranean diet was assessed with the Kidmed score. Resting BP was measured by an automated monitor using an appropriately sized cuff. Elevated BP was defined as ≥90th percentile, and high HGS was defined as sex- and age-specific normative ≥80th percentile for the HGS.

RESULTS

The prevalence of elevated systolic BP, diastolic BP, and overall BP were 16.6%, 12.9%, and 8.1%, respectively. HGS was negatively associated with BP parameters in an unadjusted and adjusted model after considering potential confounders (age, sex, body mass index z-score, and HGS). Regarding diet adherence, the unadjusted model reveals that children with high adherence to the Mediterranean diet showed lower BP levels (systolic, diastolic, and mean arterial pressure) compared with children with low-medium adherence; however, these differences disappear after considering potential confounders. The combination of high HGS and optimal adherence to a Mediterranean diet was negatively associated with BP.

CONCLUSIONS

Children with a high HGS levels (i.e., ≥80th percentile) may somewhat overcome the deleterious effects of low adherence to a Mediterranean diet. Therefore, these findings suggest that the combination of these two components of a healthy lifestyle, especially HGS may be beneficial to children's BP.

Waist circumference percentile curves as a screening tool to predict cardiovascular risk factors and metabolic syndrome risk in Brazilian children

The goals of this study were to develop reference values for waist circumference (WC) in Brazilian children between 6-10 years old and to evaluate the WC performance in predicting cardiovascular risk factors and metabolic syndrome (MetS) in children. This is a population-based epidemiological cross-sectional study, in which 1,397 children participated, with a 6-10 years old probability sampling and from public and private schools in the city of Uberaba, Minas Gerais State, Brazil. WC was measured at the waist narrowest point (WC1) and at the umbilicus level (WC2). Blood samples and blood pressure were collected to determine the MetS diagnosis. There was a significant effect of age (p = 0.001), anatomical point (WC1 vs. WC2, p = 0.001) and sex-anatomical point interaction (p = 0.016) for WC. Smoothed sex- and age-specific 5th, 10th, 25th, 50th, 75th, 90th and 95th percentile curves of WC1 and WC2 were designed by the LMS method. WC was accurate to predict MetS, for all ages [area under the ROC curve (AUC) > 0.79 and p < 0.05], regardless of sex. This study presented percentile curves for WC at two anatomical points in a representative sample of Brazilian children. Furthermore, WC was shown to be a strong predictor of cardiovascular risk factors and MetS in children.

The relationship between hyperthyrotropinemia and metabolic and cardiovascular risk factors in a large group of overweight and obese children and adolescents

PURPOSE

Mild TSH elevations are frequently observed in obese patients, in the absence of any detectable thyroid disease. Our objective is to evaluate the relationship between the raised TSH levels and the biochemical and clinical consequences of obesity.

METHODS

This is a retrospective cross-sectional study of a large population of obese children and adolescents. We evaluated 833 subjects (340 m, 493 f), aged 14.4 ± 2.5 (range 5.2-18.5) years, height SDS 0.27 ± 1.04 (-3.49-4.35), and BMI SDS 2.94 ± 0.59 (1.60-4.68). Body composition, free T4, TSH, anti-TPO antibodies, anti-TG antibodies, inflammation markers (total WBC and the subtypes, ultrasensitive C-reactive protein), and metabolic parameters [AST, ALT, γGT, ALP, glycaemia, insulin, total cholesterol (TC), HDL-cholesterol (HDL-C), and LDL-cholesterol (LDL-C), triglycerides (TG)] were measured, and oral disposition index (ODI) and cardiovascular risk factors (TC/HDL-C and TG/HDL-C) were calculated. After exclusion of the subjects showing anti-thyroid antibodies, the remaining 779 (325 m, 454 f) were then subdivided into two subgroups according to a TSH value below (group A) or above (group B) 4.5 mU/L.

RESULTS

Clinical characteristics and hematological markers of patients with and without positive anti-thyroid antibodies were similar, with the exception of higher TSH levels in the latter group. Using analysis of covariance, the subjects of group B had significantly higher values of TC (170.3 ± 28.7 vs 163.3 ± 32.9 mg/dL; p < 0.05), systolic (125.8 ± 13.5 vs 124.5 ± 13.1 mm/Hg), and diastolic blood pressure (79.2 ± 8.0 vs 77.9 ± 8.2 mm/Hg) than subjects of group A. No difference was observed in body composition, ODI, and the cardiovascular risk factors between these two groups.

CONCLUSION

TSH elevation in overweight and obese children and adolescents, being associated with a higher TC and blood pressure, might negatively influence the cardiac status. Longitudinal studies are requested, however, to confirm this hypothesis and, therefore, to conclude whether a substitutive treatment with l-thyroxine is really needed in these patients.