Management of High Blood Pressure in Children and Adolescents

KidsTUMove-A Holistic Program for Children with Chronic Diseases, Increasing Physical Activity and Mental Health

The prevalence of chronic diseases in children and adolescents has risen alarmingly worldwide. Diseases such as asthma, diabetes, obesity, mental disorders, and congenital heart defects are increasingly affecting the lives of children and pose significant challenges for the healthcare system. Physical activity plays a crucial role in preventing and treating these diseases. Numerous studies have shown that regular exercise improves physical performance, increases well-being, and leads to better health in the long term. Specially tailored sports programs that meet the individual needs and abilities of the children and adolescents affected are particularly important. The KidsTUMove project addresses this by developing tailored exercise programs for children with chronic diseases' specific needs, medical conditions, and physical abilities. Therefore, it closes the gap in care provision and can thus sustainably improve the health prospects of these children and adolescents. KidsTUMove is positioned to make a significant impact on the lives of affected children across Europe. Promotion of such programs should therefore be an integral part of future health strategies.

Serum uric acid and risk of prehypertension: a dose-response meta-analysis of 17 observational studies of approximately 79 thousand participants

BACKGROUND

Studies examining the association between levels of serum uric acid (SUA) and risk of prehypertension still remained controversial conclusions. Also, a quantitative assessment of the dose-response association between them has not been reported. We aimed to quantitatively evaluate risk of prehypertension with levels of SUA based on observational study.

METHODS

We searched the PubMed, Embase, and Web of Science databases up to December 3, 2019 for relevant studies. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models. The possible linear or non-linear SUA-prehypertension association was modelled by restricted cubic splines.

RESULTS

We included 17 articles (17 studies) with a total of 79,358 participants and 34,591 cases of prehypertension. Compared with lowest levels of SUA, risk of prehypertension increased 46% (RR 1.46, 95% CI 1.28-1.66) for highest levels of SUA. For per 1 mg/dL increment in levels of SUA, risk of prehypertension increased by 12% (RR 1.12, 95% CI 1.08-1.17). Also, we found evidence of a linear SUA-prehypertension association (P_{non-linearity}=.368).

CONCLUSION

Elevated levels of SUA may be associated with increased risk of prehypertension. Present findings provide the evidence that lowering levels of SUA should be suggested in order to reduce the risk of prehypertension. More longitudinal and intervention studies are needed to clarify the optimal protective levels and whether reducing levels of SUA could prevent or control prehypertension and the progression of prehypertension to hypertension.

Antihypertensive agents: a long way to safe drug prescribing in children

Recently updated clinical guidelines have highlighted the gaps in our understanding and management of pediatric hypertension. With increased recognition and diagnosis of pediatric hypertension, the use of antihypertensive agents is also likely to increase. Drug selection to treat hypertension in the pediatric patient population remains challenging. This is primarily due to a lack of large, well-designed pediatric safety and efficacy trials, limited understanding of pharmacokinetics in children, and unknown risk of prolonged exposure to antihypertensive therapies. With newer legislation providing financial incentives for conducting clinical trials in children, along with publication of pediatric-focused guidelines, literature available for antihypertensive agents in pediatrics has increased over the last 20 years. The objective of this article is to review the literature for safety and efficacy of commonly prescribed antihypertensive agents in pediatrics. Thus far, the most data to support use in children was found for angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), and calcium channel blockers (CCB). Several gaps were noted in the literature, particularly for beta blockers, vasodilators, and the long-term safety profile of antihypertensive agents in children. Further clinical trials are needed to guide safe and effective prescribing in the pediatric population.

Determinants of childhood blood pressure using structure equation model: the CASPIAN-V study

BACKGROUND

Childhood hypertension is a predictor of later diseases, increases the risk for cardiovascular morbidity and mortality in adulthood and results in major economic burdens. The purpose of this study was to investigate the direct and indirect effect of anthropometric, socioeconomic and lifestyle factors on blood pressure (BP) in a large population-based sample of children and adolescents using a path analysis.

METHODS

This multi-centric nationwide study was performed on students aged 7-18 years. Anthropometric indices and blood pressure were measured by standard methods and demographic data, socioeconomic status, dietary habits and health related behaviors were obtained using validated questionnaires. Path analysis was applied to evaluate the relationships among the study variables and to implement the subsequent structural modeling.

RESULTS

Totally, 7235 students (50.6% boys; the mean age 12.3 ± 3.1 years) were assessed. Systolic and diastolic BP positively correlated with age (r = 0.35 and 0.26; respectively), BMI (r = 0.06 and 0.04; respectively) and WC (r = 0.05 and 0.03; respectively). According to path analysis, age had significant direct effect on BMI, WC, and BP (β = 0.035, 0.043 and 0.345; respectively), which was greater for BP. BMI and WC had the greatest direct effect on BP (β = 0.05 and 0.03; respectively). Education level, subjective health complaints, health-related behaviors and dietary habits had positive direct effects on BP (β = 0.036, 0.030, 0.018 and 0.017; respectively). Socioeconomic status and positive changes in diet had negative indirect effect on BP (β = - 0.001 for both).

CONCLUSION

Our findings strengthen the importance of weight and body composition in BP control. It is suggested to improve diet and health related behaviors especially in families with low socioeconomic position.

Waist circumference as high blood pressure predictor in school age children

Childhood hypertension is becoming more common with the increasing numbers of child obesity, which has encouraged new studies to identify a good anthropometric marker for high blood pressure levels. The objective this study was to identify the best anthropometric predictor of risk of hypertension in children between 8-10 years of age. The Children were evaluated for socioeconomic status and their blood pressure (BP), weight, height, waist circumference (WC) and percentage of body fat (PBF) were measured. The study included 445 children, of which 50.1% were females. The prevalence of obesity defined by body mass index (BMI) was 14.6%. Increased BP was found in 3.4% and 2.2% of the children, considering the pre-hypertension and hypertension classifications respectively. The arithmetic mean of BP value correlated significantly with BMI, WC and PBF. After height control, the correlations that were maintained significant were between WC and systolic blood pressure (SBP) and between WC and diastolic blood pressure (DBP). The variable with the highest predictive power of the occurrence of hypertension was WC. The results indicate that, in this population of children between 8 and 10 years old, WC is a measurement of higher value in predicting increased BP.

Sonographic evaluation of renovascular hypertension in the pediatric population: State-of-the-art

Hypertension in children affects 2-5% of the pediatric population. Identifying secondary causes of hypertension is crucial, as some of these entities may be treatable. Renovascular hypertension accounts for 5-10% of the secondary causes of hypertension in children and is mainly related to fibromuscular dysplasia and neurofibromatosis type 1. Ultrasonographic evaluation of the kidneys, including Doppler interrogation, is the recommended primary screening tool. A comprehensive study of the upper abdomen and retroperitoneum allows for identification of additional underlying etiologies. The purpose of this review is to emphasize the different causes of renovascular hypertension in children one can diagnose during the initial ultrasonographic evaluation. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:282-292, 2017.

Determinação dos teores de sódio e potássio em refeições servidas em um restaurante universitário da região sul do Brasil

Resumo O objetivo do trabalho foi determinar os teores de sódio (Na) e potássio (K) em refeições servidas em um restaurante universitário da região sul do Brasil, utilizando espectrometria de emissão atômica como método analítico. Foram coletadas 30 amostras de refeições do almoço e do jantar de um restaurante universitário, referentes a 131 diferentes cardápios no período de um semestre (4 meses), levando-se em conta o consumo de todos os alimentos oferecidos no cardápio, inclusive o suco e a salada temperada. Os resultados indicaram que o teor médio de Na em uma refeição ultrapassou o limite diário recomendado pela Organização Mundial da Saúde (OMS) em 25 das 30 amostras analisadas. Observaram-se teores maiores em refeições compostas por algum tipo de alimento industrializado, como linguiças e batata palha, ou com pratos tradicionalmente temperados, como barreado. Os menores teores de Na estavam presentes em cardápios nos quais havia batata frita ou ovo. Os teores de K encontrados em 19 refeições poderiam ser considerados satisfatórios segundo a recomendação da OMS, no entanto, levando-se em conta que o consumo de K deve ser 1,75 vezes maior que o de Na em uma mesma refeição, a oferta de K foi baixa em todas as amostras analisadas.

Metabolic Syndrome: Bridging the Gap from Childhood to Adulthood

Childhood and adolescence are particularly vulnerable periods of life to the effects of cardiometabolic risk and later development of atherosclerosis, hypertension, and diabetes mellitus. Developing countries with limited resources suffer most heavily from the consequences of cardiometabolic risk in children and its future implications to the global health burden. A better understanding of mechanisms leading to cardiometabolic risk in early life may lead to more effective prevention and intervention strategies to reduce metabolic stress in children and later disease. Longitudinal "tracking" studies of cardiometabolic risk in children provide a tremendous global resource to direct prevention strategies for cardiovascular disease. In this review, we will summarize the pathophysiology, existing definitions for cardiometabolic risk components in children. Screening and identifying children and adolescents of high cardiometabolic risk and encouraging them and their families through healthy lifestyle changes should be implemented to as a global public health strategy.

Factors Associated With Musculoskeletal Injuries in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

BACKGROUND

Musculoskeletal injuries may be associated with attention-deficit/hyperactivity disorder (ADHD) symptom severity, comorbid psychiatric or medical conditions, and the prescribed psychostimulant.

METHODS

A population-based, retrospective cohort design was employed using South Carolina's Medicaid claims data set covering outpatient and inpatient medical services and medication prescriptions over an 11-year period (January 1, 1996, through December 31, 2006) for patients ≤ 17 years of age with ≥ 2 visits for ICD-9-CM diagnostic codes for ADHD. A cohort of 7,725 cases was identified and analyzed using logistic regression to compare risk factors for those who sustained focal musculoskeletal injuries and those who did not.

RESULTS

The risk of sustaining sprains, arthropathy and connective tissue disorders, or muscle and joint disorders was significantly related to being diagnosed with comorbid hypertension (adjusted odds ratios [aORs] = 1.60, 2.09, and 1.46, respectively) and a substance use disorder (aORs = 1.58, 1.38, and 1.28). Having a substance use disorder was also related to incident fractures and dorso/spinal injuries (aORs = 1.42 and 1.21). Diagnosed hypertension was related to incident concussions (aOR = 2.00), a diagnosed thyroid disorder was related to an increased risk of sprain and concussion (aORs = 1.44 and 2.05), a diagnosed anxiety disorder was related to an increased risk of dorso/spinal disorders (aOR = 1.71), and diagnosed diabetes was related to incident bone and cartilage disorders (aOR = 1.61).

CONCLUSIONS

Comorbid hypertension, substance use disorders, and thyroid disorders deserve increased clinical surveillance in children and adolescents with ADHD because they may be associated with an increased risk of more than one musculoskeletal injury.

Management of hypertension in children and adolescents

Hypertension has been recognized as an important health issue in the pediatric population over the past years. This emphasizes the need for an organized and effective plan for diagnosis and management. This review provides information to guide physicians through a structured approach to (1) screen children for hypertension during routine visits; (2) use normative blood pressure tables for diagnosis and classification; (3) perform a clinical evaluation to identify the presence of risk factors, comorbidities and/or target organ damage; and (4) initiate an individualized plan of care that includes follow-up blood pressure measurement, therapeutic lifestyle changes and - if necessary - pharmacological therapies.

Association between anthropometry and high blood pressure in a representative sample of preschoolers in madrid

INTRODUCTION AND OBJECTIVES

Program SI! is a multi-level, school-based intervention for the promotion of cardiovascular health from early childhood. The aim of this paper is to characterize the prevalence of obesity and high blood pressure in the preschoolers enrolled in the study, and to compare various criteria for classifying obesity.

METHODS

The study was a cluster-randomized controlled intervention trial including 24 state schools in Madrid (Spain). Weight, height, triceps and subscapular skinfold thicknesses, waist circumference, and systolic and diastolic blood pressure were measured in 2011 children (1009 boys and 1002 girls) aged 3 to 5 years (3.7 [0.9]). Body mass index and blood pressure were classified by corresponding task force criteria. Obesity was studied by 6 different criteria. Associations of body mass index, body weight, body fat, and waist circumference on blood pressure were examined, and the risk of high blood pressure in relation to tertiles of body mass index was calculated.

RESULTS

The prevalence of obesity according to the International Obesity Task Force varied from 2% at age 3 to 8% at age 5, and the overall prevalence of high blood pressure (≥ 90th percentile) was 20%. Sex- and age-specific criteria for obesity showed better agreement with the reference than a single generalized cutoff. The risk of high blood pressure was higher for the highest tertile of body mass index distribution.

CONCLUSIONS

The highest prevalence of obesity and high blood pressure was found among older children. The classification of obesity in children was more accurate using sex- and age-specific cutoffs.

Hypertension in the teenager

Over the last two decades, essential hypertension has become common in adolescents, yet remains under-diagnosed in absence of symptoms. Diagnosis is based on normative percentiles that factor in age, sex and height. Evaluation is more similar to adult essential hypertension than childhood secondary hypertension. Modifiable risk factors such as obesity, sodium consumption and low exercise should be addressed first. Many anti-hypertensive medications now have specific regulatory approval for children. Sports participation need not be limited in mild or well-controlled cases. Primary care physicians play an important role in reduction of cardiovascular mortality by early detection and referral when needed.

The use of the RESPeRATE device to lower blood pressure in inner city obese adolescents and children: a pilot feasibility study

The RESPeRATE device was tested for feasibility of use in a population of overweight and obese children and adolescents (n = 10) in San Francisco, CA. After a 2-week and then a 2-month period, participants were interviewed on their frequency of use and attitudes towards the device. A high percentage stated that they enjoyed using the device at 2 months (90%) and 80% stated that they would recommend use to a friend or relative. Future studies are needed to assess the efficacy of the RESPeRATE device in lowering blood pressure and helping with weight loss/weight management in obese and overweight children.

Gender-specific prevalence and associated risk factors of prehypertension among rural children and adolescents in Northeast China: a cross-sectional study

Little is known about the prevalence and risk profile of prehypertension among Chinese children and adolescents. The aim of the present study was to investigate the prehypertensive status and its associated risk factors among rural Chinese children and adolescents. We conducted a cross-sectional study including 5,245 children and adolescents (2,732 boys and 2,513 girls) aged 5-18 years in Northeast China. Main anthropometric data and related information were collected. The overall prevalence of prehypertension and hypertension was 15 % and 20.2 %, respectively. The prevalence of prehypertension among boys was 15.7 %, compared to that of 14.2 % among girls (P = 0.256). After adjusting for age, race, weight status, waist circumference, triceps skinfold, family income, smoking and drinking status, boys aged 12-14 and 15-18 years had a 2.86- and 5.97-fold risk of prehypertension, respectively, compared to those aged 5-8 years. Overweight and obese boys had an increased risk of prehypertension in comparison to those with normal weight (overweight: odds ratio [OR] = 1.837, 95 % confidence interval [CI] 1.321-2.556; obese: OR = 2.941, 95 % CI 1.783-4.851). A larger triceps skinfold (≥90th percentile) was significantly related to increased odds of prehypertension (OR = 2.32; 95 % CI, 1.516-3.55) among boys. For girls, only older age was found to be a risk factor for prehypertension.

CONCLUSION

Pediatric prehypertension is highly prevalent in rural Northeast China. The risk factors for prehypertension differed among boys and girls. A more comprehensive risk profile of prehypertension among children and adolescents needs to be established for early prevention.

Association between adiposity and blood pressure levels between the ages of 6 and 16 years. Analysis in a student population from Madrid, Spain

INTRODUCTION AND OBJECTIVES

The increase in the incidence of hypertension in children can be attributed to the rising prevalence of obesity. The objective is to analyze the impact of overweight and the degree or distribution of adiposity on blood pressure levels in a population of Spanish schoolchildren.

METHODS

A cross-sectional study was carried out in 1511 schoolchildren between 6 years and 16 years of age. We measured weight, height, waist circumference, subcutaneous skinfolds, and blood pressure. Nutritional categories were established on the basis of body mass index, waist-to-height ratio, and percent body fat. According to the National High Blood Pressure Education Program Working Group, subjects whose blood pressure was above the 90th percentile of the standard normal distribution were considered to have high blood pressure.

RESULTS

In all, 3.17% of the boys and 3.05% of the girls had high blood pressure. According to odds ratio analysis, the risk of high blood pressure increased in individuals with a body mass index indicative of obesity (7.87-fold in boys, 12.32-fold in girls), with a percent body fat>97th percentile (6.98-fold in boys, 18.51-fold in girls), or with a waist-to-height ratio ≥0.5 (10.56-fold in boys, 7.82-fold in girls).

CONCLUSIONS

Overweight and obesity increase the risk of high blood pressure in children between 6 years and 16 years of age, although the risk level varies depending on the amount and distribution of adipose tissue. Anthropometric indicators of relative adiposity and fat distribution are especially useful in the identification of children and adolescents with high blood pressure.

Therapeutic options for the treatment of hypertension in children and adolescents

Primary hypertension in children is increasing in prevalence with many cases likely going undiagnosed. The prevalence is currently estimated at between 3%-5% in the United States and may be higher in certain ethnic groups. Primary hypertension, once felt to be rare in children, is now considered to be about five times more common than secondary hypertension. This review provides information to guide physicians through an organized approach to: 1) screening children and adolescents for hypertension during routine visits; 2) using normative percentile data for diagnosis and classification; 3) performing a clinical evaluation to identify the presence of co-morbidities; 4) initiating a plan of care including subsequent follow-up blood pressure measurements, therapeutic lifestyle changes and pharmacologic therapies.

Fatores de risco para hipertensão arterial entre estudantes do ensino médio

OBJETIVO: Identificar os valores pressóricos e estimar a frequência de fatores de risco para a hipertensão arterial entre estudantes do ensino médio. MÉTODOS: Estudo descritivo de corte transversal, desenvolvido em escolas da Região Sudeste brasileira. Fizeram parte da amostra 184 adolescentes matriculados na segunda série do ensino médio, em 2009. Além da mensuração das variáveis clínicas, foram aplicados instrumentos para identificação de fatores de risco associados à doença hipertensiva. RESULTADOS: A alteração pressórica foi um parâmetro detectado em 22,3% da amostra. Dentre os fatores de risco investigados, o histórico familiar de doenças cardiovasculares e o consumo de álcool foram os mais prevalentes. CONCLUSÃO: Há necessidade de valorizar as medidas de prevenção primária e detecção precoce da hipertensão arterial entre adolescentes, com especial atenção para a avaliação dos antecedentes familiares e adoção de hábitos de risco.