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Astudillo Y, Kibrom S, Pereira T, Solomon S, Krishnan S, Samsonov D. Association between anxiety and elevated blood pressure in adolescent patients: a single-center cross-sectional study. J Hypertens 2024; 42:644-649. [PMID: 38230613 PMCID: PMC10906197 DOI: 10.1097/hjh.0000000000003652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Although anxiety is known to be associated with elevated blood pressure and hypertension in adults, this has not been studied in children. The aim of this study was to determine the association between anxiety and elevated blood pressures in adolescents. METHODS Adolescents, aged 12-18 years old, referred to the nephrology clinic were eligible to participate. Elevated blood pressure was defined as either SBP or DBP measurement above the 95th percentile for age, height, and sex. Participants were evaluated for anxiety using the validated Screen for Child Anxiety Related Disorders questionnaire filled independently by the child (SCARED-C) and parent (SCARED-P) evaluating the child. RESULTS Two hundred adolescents participated in this study. Thirty-one (53%) of SCARED-P-positive participants were found to have elevated blood pressure compared with 27 (19%) of SCARED-P negative, P 0.03. Twenty-five (43%) of SCARED-P positive had elevated DBP compared with 31 (28%) of SCARED-P negative ( P 0.003). In SCARED-P positive, mean DBP (78.4 ± 9.9) was higher compared with SCARED-P negative (74.9 ± 9.2) ( P 0.03). In a subgroup of adolescents (№ 130) not treated with blood pressure medications mean DBP was higher in both SCARED-P (79.0 ± 10.1) and SCARED-C (77.1 ± 10.4) positive groups compared with SCARED-P (73.6 ± 9.3) and SCARED-C (73 ± 8.9) negative, respectively. CONCLUSION Our study demonstrates an association between anxiety and elevated DBP in adolescent children. Screening adolescents for anxiety should be a part of the routine evaluation of adolescent children.
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Affiliation(s)
- Yaritzy Astudillo
- Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Sara Kibrom
- Stanford University School of Medicine, Stanford Children's Health, San Francisco, California, USA
| | - Tanya Pereira
- Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Sonia Solomon
- Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Sankaran Krishnan
- Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Dmitry Samsonov
- Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, New York
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Ding FL, Elias I, Wright R, De Mello A, Cojocaru D, Dionne J. Yield of diagnostic testing in evaluating etiology and end organ effects of pediatric hypertension. Pediatr Nephrol 2024; 39:513-519. [PMID: 37515741 DOI: 10.1007/s00467-023-06101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Current recommendations regarding the utility of diagnostic investigations for pediatric hypertension are based on limited evidence, leading to wide practice variation. The objective of this study was to characterize the cohort of children that may benefit from secondary hypertension workup, and determine the diagnostic yield of investigations. METHODS This was a single-center, retrospective cohort study of 169 children aged 1-18 years referred between 2000 and 2015, to a tertiary pediatric nephrology center in Canada, for evaluation of hypertension. The number of investigations completed, abnormal findings, and diagnostic findings that helped establish hypertension etiology was determined. RESULTS 56 children were diagnosed with primary and 72 children with secondary hypertension in the outpatient setting. Secondary hypertension was predominant at all ages except for obese adolescents ≥ 12 years. Half of children with traditional risk factors for primary hypertension, including obesity, were diagnosed with secondary hypertension. Kidney ultrasound had the highest yield of diagnostic results (19.8%), with no difference in yield between age groups (P = 0.19). Lipid profile had a high yield of abnormal results (25.4%) as part of cardiovascular risk assessment but was only abnormal in overweight/obese children. Echocardiogram had a high yield for identification of target-organ effects in hypertensive children (33.3%). CONCLUSION A simplified secondary hypertension workup should be considered for all hypertensive children and adolescents. High yield investigations include a kidney ultrasound, lipid profile for overweight/obese children, and echocardiograms for assessment of target-organ damage. Further testing could be considered based on results of initial investigations for the most cost-effective management. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- FangChao Linda Ding
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Isaac Elias
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca Wright
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alanna De Mello
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dan Cojocaru
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janis Dionne
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
- Division of Nephrology, BC Children's Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
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Chen Y, Ye P, Dong H, Xu X, Shi L, Li B, Dong J, Lv A, Su Z, Zhang Y, Zhou Y, Wang J, Feng G, Zeng Y, Ni X, Mi J. Clinical characteristics of pediatric hypertension: a multicenter study in China. J Hypertens 2023; 41:1753-1759. [PMID: 37602486 DOI: 10.1097/hjh.0000000000003533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
OBJECTIVES Hypertension in children has attracted increasing attention. However, clinical-based studies investigating characteristics and secular trends of pediatric hypertension remain limited. This study aimed to investigate the clinical characteristics and secular trends of different types of hypertension among hospitalized children in China. METHODS This retrospective analysis was based on medical records from nine tertiary children's hospitals in China during 2010∼2020. A total of 5847 pediatric inpatients (aged <18 years) with the diagnosis of hypertension were enrolled. Information on the clinical characteristics of each patient was obtained from their first admission records. RESULTS During the past decade, secondary hypertension sustained to be the dominant type of hypertension in children, with the proportion increased from 51.2% during 2010∼2015 to 59.8% during 2016∼2020. The main causes of secondary hypertension were neurologic disorders in children aged 0∼2 years, which changed to renal diseases after 3 years of age. Compared with primary hypertension, secondary hypertension was common in girls (43.1 vs. 23.3%) and children under 5 years of age (32.2 vs. 2.1%). Moreover, over four-fifths of primary hypertensive individuals had obesity and obesity-related comorbidities, and the proportion of clusters of one or more comorbidities increased in the past decade (79.7 → 85.2%). CONCLUSION Secondary hypertension sustained to be the dominant type of hypertension among children, especially in girls. Renal diseases were the most common causes of secondary hypertension in children, followed by rheumatic immune diseases. For primary hypertension, over four-fifths of inpatients had obesity and obesity-related diseases, and the proportion kept rising.
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Affiliation(s)
- Yijun Chen
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
- School of Physical Education and Health, Hunan University of Technology and Business, Hunan
| | - Peiyu Ye
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
| | - Hongbo Dong
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
| | - Xin Xu
- Department of Information Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health
| | - Lin Shi
- Capital Institution of Pediatrics, Beijing
| | - Bin Li
- Kunming Children's Hospital, Kunming
| | - Jie Dong
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha
| | - Aiting Lv
- Henan Children's Hospital, Zhengzhou
| | - Zhe Su
- Shenzhen Children's Hospital, Shenzhen
| | - Yong Zhang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan
| | - Yunguo Zhou
- Jiangxi Provincial Children's Hospital, Nanchang
| | | | | | - Yueping Zeng
- Department of Medical Record Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
| | - Jie Mi
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
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Riis JL, Dent AL, Silke O, Granger DA. Salivary uric acid across child development and associations with weight, height, and body mass index. Front Pediatr 2023; 11:1235143. [PMID: 38027287 PMCID: PMC10646470 DOI: 10.3389/fped.2023.1235143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Obesity during childhood is a serious and growing chronic disease with consequences for lifelong health. In an effort to advance research into the preclinical indicators of pediatric obesity, we examined longitudinal assessments of uric acid concentrations in saliva among a cohort of healthy children from age 6-months to 12-years (n's per assessment range from 294 to 727). Methods Using data from a subsample of participants from the Family Life Project (an Environmental influences on Child Health Outcomes Program cohort), we: (1) characterized salivary uric acid (sUA) concentrations from infancy to early adolescence by sex and race; (2) assessed changes in sUA levels across development; and (3) evaluated associations between sUA concentrations and measures of child weight, height, and body mass index (BMI). Across four assessments conducted at 6-, 24-, 90-, and 154-months of age, 2,000 saliva samples were assayed for UA from 781 participants (217 participants had sUA data at all assessments). Results There were no significant differences in sUA concentrations by sex at any assessment, and differences in sUA concentrations between White and non-White children varied by age. At the 90- and 154-month assessments, sUA concentrations were positively correlated with measures of child weight, height, and BMI (90-month: weight- ρ(610) = 0.13, p < 0.01; height- ρ(607) = 0.10, p < 0.05; BMI- ρ(604) = 0.13, p < 0.01; 154-month: weight- ρ(723) = 0.18, p < 0.0001; height- ρ(721) = 0.10, p < 0.01; BMI- ρ(721) = 0.17, p < 0.0001). Group based trajectory modeling identified two groups of children in our sample with distinct patterns of sUA developmental change. The majority (72%) of participants showed no significant changes in sUA across time ("Stable" group), while 28% showed increases in sUA across childhood with steep increases from the 90- to 154-month assessments ("Increasing" group). Children in the Increasing group exhibited higher sUA concentrations at all assessments (6-month: t(215) = -5.71, p < 0.001; 24-month: t(215) = -2.89, p < 0.01; 90-month: t(215) = -3.89, p < 0.001; 154-month: t(215) = -19.28, p < 0.001) and higher weight at the 24- and 90-month assessments (24-month: t(214) = -2.37, p < 0.05; 90-month: t(214) = -2.73, p < 0.01). Discussion Our findings support the potential utility of sUA as a novel, minimally-invasive biomarker that may help advance understanding of the mechanisms underlying obesity as well as further surveillance and monitoring efforts for pediatric obesity on a large-scale.
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Affiliation(s)
- J. L. Riis
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, CA, United States
| | - A. L. Dent
- Department of Psychological Science, University of California, Irvine, CA, United States
| | - O. Silke
- Department of Psychological Science, University of California, Irvine, CA, United States
| | - D. A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, CA, United States
- Department of Psychological Science, University of California, Irvine, CA, United States
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Nugent JT, Young C, Funaro MC, Jiang K, Saran I, Ghazi L, Wilson FP, Greenberg JH. Prevalence of Secondary Hypertension in Otherwise Healthy Youths with a New Diagnosis of Hypertension: A Meta-Analysis. J Pediatr 2022; 244:30-37.e10. [PMID: 35120981 PMCID: PMC9086113 DOI: 10.1016/j.jpeds.2022.01.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/26/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the prevalence of secondary hypertension among otherwise healthy children with hypertension diagnosed in the outpatient setting. STUDY DESIGN The MEDLINE, PubMed Central, Embase, Web of Science, and Cochrane Library databases were systematically searched for observational studies reporting the prevalence of secondary hypertension in children who underwent evaluation for hypertension and had no known comorbidities associated with hypertension at the time of diagnosis. Two authors independently extracted the study-specific prevalence of secondary hypertension in children evaluated for hypertension. Prevalence estimates for secondary hypertension were pooled in a random-effects meta-analysis. RESULTS Nineteen prospective studies and 7 retrospective studies including 2575 children with hypertension were analyzed, with a median of 65 participants (range, 9-486) in each study. Studies conducted in primary care or school settings reported a lower prevalence of secondary hypertension (3.7%; 95% CI, 1.2%-7.2%) compared with studies conducted in referral clinics (20.1%; 95% CI, 11.5%-30.3%). When stratified by study setting, there were no significant subgroup differences according to study design, country, participant age range, hypertension definition, blood pressure device, or study quality. Although the studies applied different approaches to diagnosing secondary hypertension, diagnostic evaluations were at least as involved as the limited testing recommended by current guidelines. CONCLUSIONS The low prevalence of secondary hypertension among children with a new diagnosis of hypertension identified on screening reinforces clinical practice guidelines to avoid extensive testing in the primary care setting for secondary causes in most children with hypertension.
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Affiliation(s)
- James T Nugent
- Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT.
| | - Chelsea Young
- Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University School of Medicine, New Haven, CT
| | - Kuan Jiang
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Ishan Saran
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Lama Ghazi
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - F Perry Wilson
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT; Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Jason H Greenberg
- Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT
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