Association between obesity and the severity of ambulatory hypertension in children and adolescents

The association of obesity and hyperuricemia with ambulatory blood pressure in children

BACKGROUND

Primary hypertension (HTN) in children is on the rise and linked to the childhood obesity epidemic. Recent studies support the role of hyperuricemia in the pathogenesis of HTN. With this study we intend to evaluate the effect of body mass index (BMI) and uric acid levels on daily blood pressure (BP) parameters/phenotypes and target organ damage (TOD).

METHODS

A mean ambulatory systolic and/or diastolic BP ≥ 95th percentile or above the adolescent cut points was defined as 'HTN'. Patients were grouped as group 1 normal weight, and group 2 overweight/obese.

RESULTS

Of the 140 children (89 male/51 female) with a mean age of 13.9 ± 2.6 years, 21 were overweight and 86 were obese. Mean 24-h systolic BP (SBP) and daytime SBP were higher in group 2 (p = 0.015, p = 0.011). BMI was positively correlated with 24-h SBP (r = 0.272, p = 0.001) and daytime SBP (r = 0.280, p = 0.001). Uric acid level showed a moderate correlation with daytime SBP (r = 0.311, p < 0.01). Logistical regression analysis showed that daytime SBP is independently associated with obesity (OR 7.44, 95%CI 2.7-20.6, p < 0.001) and male sex (OR 4.60, 95%CI 2.0-10.2, p < 0.001), but not uric acid. Left ventricular hypertrophy was more common in non-dippers (p = 0.044).

CONCLUSIONS

Male sex and BMI are independently associated risk factors for systolic BP. The association between non-dipping pattern and TOD suggests the widespread use of ambulatory blood pressure monitoring (ABPM) in childhood HT. In this paper, we could not demonstrate an independent association between uric acid and SBP. The effect of uric acid on SBP seems to be regulated by other metabolic factors in addition to uric acid.

Obesity and hypertension in children and adolescents

As childhood obesity rates increase worldwide, the prevalence of obesity-related hypertension is also on the rise. Obesity has been identified as a significant risk factor for hypertension in this age group. National Health Surveys and meta-analyses show increasing trends in obesity and pediatric hypertension in obese children. The diagnosis of hypertension in children involves percentiles relative to age, sex, and height, unlike in adults, where absolute values are considered. Elevated blood pressure (BP) in childhood is consistently associated with cardiovascular disease in adulthood, emphasizing the need for early detection and intervention. The pathogenesis of hypertension in obesity involves multiple factors, including increased sympathetic nervous system activity, activation of the renin-angiotensin-aldosterone system (RAAS), and renal compression due to fat accumulation. Obesity disrupts normal RAAS suppression and contributes to impaired pressure natriuresis and sodium retention, which are critical factors in the development of hypertension. Risk factors for hypertension in obesity include degree, duration, and distribution of obesity, patient age, hormonal changes during puberty, high-sodium diet, sedentary lifestyle, and socioeconomic status. Treatment involves lifestyle changes, with weight loss being crucial to lowering BP. Medications such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers may be considered first, and surgical approaches may be an option for severe obesity, requiring tailored antihypertensive medications that consider individual pathophysiology to avoid exacerbating insulin resistance and dyslipidemia.

Weight Loss and Glycemic Control After Bariatric Surgery in Adolescents With Severe Obesity: A Randomized Controlled Trial

PURPOSE

Bariatric surgery is regarded as a valuable treatment option for adolescents with severe obesity. However, high-quality evidence of its superiority over prolonged conservative treatment with multidisciplinary lifestyle intervention (MLI) is limited. This study investigated the efficacy and safety of bariatric surgery in adolescents without sufficient weight loss after MLI for severe obesity.

METHODS

A two-group randomized controlled trial was designed to assess one-year health effects of bariatric surgery in adolescents with severe obesity. The participants were referred by pediatricians after completing MLI without sufficient effects. Eligible for participation were adolescents aged 14-16 years with severe obesity (age- and sex-adjusted body mass index (BMI) using the International Obesity Task Force cutoffs: BMI ≥40 kg/m2, or ≥35 kg/m2 in combination with comorbidity). Participants were assigned to MLI combined with laparoscopic adjustable gastric banding (n = 29) versus only MLI (n = 30). Participants were included from 2011 to 2019. Main outcomes were weight change and sex- and age-specific BMI loss. Additionaly, glucose metabolism, blood pressure and lipid profile were analysed.

RESULTS

53 patients completed the 12-months follow-up (89.8%). Mean (±standard deviation [SD]) weight loss in the surgery group was 11.2 ± 7.8% after 12 months, compared to a weight gain of 1.7 ± 8.1% in the control group. The fasting insulin, insulin resistance score and lipid profile improved significantly in the surgery group.

DISCUSSION

Bariatric surgery was associated with substantial weight loss and improvements in glucose and lipid metabolism after 12 months compared to conservative treatment in adolescents with severe obesity.

Does the Body Mass Index Category Influence Ambulatory Blood Pressure Parameters in Office Normotensive Obese Children?

The aim of our study was to investigate the influence of the degree of obesity on ambulatory blood pressure parameters in selected group of office normotensive obese children and adolescents. Our study involved 119 obese patients (55 males, 46.2%) aged 7-18 years divided into 3 groups based on their body mass index Z-score, who underwent ambulatory blood pressure monitoring. Our results show that obese patients, even when office normotensive, have alterations in blood pressure values obtained by ambulatory blood pressure monitoring. We found a positive correlation between systolic and diastolic blood pressure and body mass index in our patients (p [Formula: see text] 0.001). Daytime blood pressure load correlated with rising body mass index and was higher in groups II and III compared to group I (p < 0.001). Body mass index category did not influence the dipping pattern in our subjects although most of our subjects (66.4%) showed non-dipping pattern for systolic blood pressure. The difference in blood pressure variability was confirmed only for daytime systolic and diastolic values between groups I and II (p = 0.019 and p = 0.002, respectively). In conclusion, our study showed that in office normotensive obese children and adolescents, systolic and diastolic blood pressure values obtained by ambulatory blood pressure monitoring are higher in subjects with higher body mass index. Patients with increased body mass index also have higher percentage of blood pressure readings above 95^th percentile and increased daytime blood pressure variability. Obese patients show non-dipping pattern, independently of the rising body mass index category.

Estimation of Salt Intake in Normotensive and Hypertensive Children: The Role of Body Weight

OBJECTIVE

The connection between increased dietary salt intake and arterial hypertension has been recognized for a long time, even in children. This study aimed to investigate salt consumption in normotensive and hypertensive children and evaluate their dietary habits.

MATERIALS AND METHODS

A total of fifty participants were included in this cross-sectional study: twenty-five normotensive children and 25 children of both sexes with essential arterial hypertension from 12-17 years old. Subjects' body mass index, waist-to-hip ratio, body composition and arterial blood pressure were measured, and their daily salt intake was calculated from 24-h urine samples. Using the food frequency questionnaire (FFQ), the data on the average daily total energy and food intakes were collected and analyzed using a suitable program.

RESULTS

Estimated daily salt intake was significantly higher in hypertensive compared to normotensive children, and this is positively associated with blood pressure and body mass index (BMI). Hypertensive children had significantly higher BMIs, which also positively correlated with blood pressure. Consistently, resting metabolic rate (kcal) is higher in hypertensive children compared to normotensive, and this is also associated with blood pressure. Reported energy intake is also enlarged in hypertensive compared to normotensive children and for both groups, levels are significantly higher than the recommended values.

CONCLUSIONS

Our study results confirm the relationship between daily salt consumption, blood pressure and body weight. Sodium consumption related to blood pressure and body weight among children. Cardiovascular disease prevention should start in early childhood by reducing salt intake and preventing overweight/obesity since these are two of the most important modifiable risk factors for hypertension.

Hypertension in obese children is associated with vitamin D deficiency and serotonin dysregulation

Background

Obesity and hypertension represent serious health issues affecting the pediatric population with increasing prevalence. Hypovitaminosis D has been suggested to be associated with arterial hypertension. Serotonin by modulating nitric oxide synthase affect blood pressure regulation. The biological mechanism by which vitamin D specifically regulates serotonin synthesis was recently described. The aim of this paper is to determine the associations between vitamin D, serotonin, and blood pressure in obese children.

Methods

One hundred and seventy-one children were enrolled in the prospective cross-sectional study. Two groups of children divided according to body mass index status to obese (BMI ≥95th percentile; n = 120) and non-obese (n = 51) were set. All children underwent office and ambulatory blood pressure monitoring and biochemical analysis of vitamin D and serotonin. Data on fasting glucose, insulin, HOMA, uric acid, and complete lipid profile were obtained in obese children.

Results

Hypertension was found only in the group of obese children. Compared to the control group, obese children had lower vitamin D and serotonin, especially in winter. The vitamin D seasonality and BMI-SDS were shown as the most significant predictors of systolic blood pressure changes, while diastolic blood pressure was predicted mostly by insulin and serotonin. The presence of hypertension and high-normal blood pressure in obese children was most significantly affected by vitamin D deficiency and increased BMI-SDS.

Conclusions

Dysregulation of vitamin D and serotonin can pose a risk of the onset and development of hypertension in obese children; therefore, their optimization together with reducing body weight may improve the long-term cardiovascular health of these children.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03337-8.

Association between physical activity level and blood pressure: varied and graded mediating effects of obesity indices in schoolchildren

OBJECTIVE

To explore the mediating effects of adiposity indices in the association between physical activity level and blood pressure in a Nigerian schoolchildren population.

MATERIALS AND METHODS

One thousand five hundred and seventeen schoolchildren (714 males and 803 females) from randomly selected primary schools participated. Physical activity level, sum of skinfold thickness at three sites, waist circumference, body mass index, and blood pressure were measured using standardised procedures. The statistical significance of the mediating effects of adiposity indices was determined using Sobel Test.

RESULTS

Some obesity indices mediated the association between physical activity level and systolic blood pressure in males [waist circumference (t = 5.31; p < 0.001), skin-fold thickness (t = 3.80; p < 0.001) and waist-circumference/height (t = 2.21; p < 0.001)] and in females [body mass index (t = 8.03; p < 0.001), waist circumference (t = 7.80; p < 0.001), and skin-fold thickness (t = 5.94; p < 0.001)]. Similarly, some obesity indices mediated the association of physical activity and diastolic blood pressure in males [body mass index (t = 1.95; p = 0.05), waist circumference (t = 2.65; p = 0.01), and skin-fold thickness (t = 1.97; p = 0.05)], and in females [body mass index (t = 6.49; p < 0.001), waist circumference (t = 6.29; p < 0.001), skin-fold thickness (t = 2.31; p = 0.02) and waist-circumference/Height (t = 2.59; p = 0.01)].

CONCLUSION

The obesity indices that mediate the association between physical activity level and blood pressure vary, and their mediating effects are graded. While waist circumference and skinfold thickness exert the greatest mediating effects on the association in males, body mass index and waist circumference do in females.

Predictive Model for Ambulatory Hypertension Based on Office Blood Pressure in Obese Children

Background: The epidemic of obesity, along with hypertension (HT) and cardiovascular disease, is a growing contributor to global disease burden. It is postulated that obese children are predisposed to hypertension and subsequent cardiovascular disease in adulthood. Early detection and management of hypertension in these children can significantly modify the course of the disease. However, there is a paucity of studies for the characterization of blood pressure in obese children through ambulatory blood pressure monitoring (ABPM), especially in the developing world. This study aims to characterize ambulatory blood pressure in obese children and to explore feasibility of using office BP that will predict ambulatory hypertension. Methods:In the present study, 55 children with a body mass index (BMI) in the ≥95th percentile for age and sex were enrolled in a tertiary care hospital and underwent 24 h of ABPM and detailed biochemical investigations. Results:Ambulatory hypertension was recorded in 14/55 (25.5%; white coat hypertension in 17/29 (58.6%) and masked hypertension in 2/26 (7.69%). For office SBP percentile the area under curve (AUC) was 0.773 (95% CI: 0.619-0.926, p = 0.005) and for office DBP percentile the AUC was 0.802 (95% CI: 0.638-0.966, p = 0.002). The estimated cut offs (Youden's index) for office blood pressure which predicts ambulatory hypertension in obese children were the 93rd percentile for systolic BP (sensitivity-67% and specificity-78%) and the 88th percentile for diastolic BP (sensitivity-83% and specificity-62%). Conclusion:Ambulatory blood pressure abnormalities are highly prevalent among children with obesity. Office blood pressure did not accurately predict ambulatory hypertension. More than half of the children labeled as "hypertension" on office blood pressure measurement in the study were diagnosed to have white coat hypertension (WCH), thus emphasizing the role of ABPM for evaluation of WCH before the child is subjected to detailed investigations or started on pharmacotherapy.

Steroid withdrawal improves blood pressure control and nocturnal dipping in pediatric renal transplant recipients: analysis of a prospective, randomized, controlled trial

BACKGROUND

Variable effects of steroid minimization strategies on blood pressure in pediatric renal transplant recipients have been reported, but data on the effect of steroid withdrawal on ambulatory blood pressure and circadian blood pressure rhythm have not been published so far.

METHODS

In a prospective, randomized, multicenter study on steroid withdrawal in pediatric renal transplant recipients (n = 42) on cyclosporine, mycophenolate mofetil, and methylprednisolone, we performed a substudy in 28 patients, aged 11.2 ± 3.8 years, for whom ambulatory blood pressure monitoring (ABPM) data were available.

RESULTS

In the steroid-withdrawal group, the percentage of patients with arterial hypertension, defined as systolic and/or diastolic blood pressure values recorded by ABPM > 1.64 SDS and/or antihypertensive medication, at month 15 was significantly lower (35.7%, p = 0.002) than in controls (92.9%). The need of antihypertensive medication dropped significantly by 61.2% (p < 0.000 vs. control), while in controls, it even rose by 69.3%. One year after steroid withdrawal, no patient exhibited hypertensive blood pressure values above the 95th percentile, compared to 35.7% at baseline (p = 0.014) and to 14.3% of control (p = 0.142). The beneficial impact of steroid withdrawal was especially pronounced for nocturnal blood pressure, leading to a recovered circadian rhythm in 71.4% of patients vs. 14.3% at baseline (p = 0.002), while the percentage of controls with an abnormal circadian rhythm (35.7%) did not change.

CONCLUSIONS

Steroid withdrawal in pediatric renal transplant recipients with well-preserved allograft function is associated with less arterial hypertension recorded by ABPM and recovery of circadian blood pressure rhythm by restoration of nocturnal blood pressure dipping.

Comparison of ambulatory blood pressure monitoring and office blood pressure measurements in obese children and adolescents

BACKGROUND

Obesity in adults has been related to hypertension and abnormal nocturnal dipping of blood pressure, which are associated with poor cardiovascular and renal outcomes. Here, we aimed to resolve the relationship between the degree of obesity, the severity of hypertension and dipping status on ambulatory blood pressure in obese children.

METHODS

A total 72 patients with primary obesity aged 7 to 18 years (mean: 13.48 ± 3.25) were selected. Patients were divided into three groups based on body mass index (BMİ) Z-score. Diagnosis and staging of ambulatory hypertension based on 24-h blood pressure measurements, obtained from ambulatory blood pressure monitoring.

RESULTS

Based on our ambulatory blood pressure data, 35 patients (48.6%) had hypertension, 7 (20%) had ambulatory prehypertension, 21 (60%) had hypertension, and 7 patients (20%) had severe ambulatory hypertension. There was a significant relationship between severity of hypertension and the degree of obesity (p < 0.05). Thirty-one patients (88.6%) had isolated nighttime hypertension, and 53 patients (73.6%) were non-dippers. All systolic blood pressure results and loads were similar between groups. Diastolic and mean arterial blood pressure levels during the night, diastolic blood pressure loads, and heart rate during the day were significantly higher in Group 3 (p < 0.05). Nocturnal non-dipping was not associated with severity of obesity.

CONCLUSION

Obesity was associated with severity of hypertension, higher diastolic blood pressure at night, mean arterial pressure at night, diastolic blood pressure loads and heart rate at day. Increase in BMI Z-score does not a significant impact on daytime blood pressure and nocturnal dipping status.

Prevalence of hypertension determined by ambulatory blood pressure monitoring (ABPM) and body composition in long-term survivors of childhood cancer

AIM

In recent years, survival rates of childhood cancers have significantly increased, and occurrence of long-term adverse late effects (eg, insulin resistance, diabetes mellitus, metabolic syndrome, hypertension) has become increasingly important. Early diagnosis of obesity/hypertension in childhood is essential to avoid morbidity in the adulthood. Therefore, this study was aimed to determine the blood pressure (BP) profile by ambulatory BP monitoring (ABPM) method, and prevalence of hypertension, obesity, abdominal obesity among childhood cancer survivors.

MATERIAL AND METHOD

The study was carried out with 52 cancer survivors. The ABPM measurement was performed during 24 hours. The anthropometric measurements of patients were performed using standardized protocols. The body composition analysis was performed with bioelectrical impedance analysis (BIA) method. Statistical significance was considered at p < 0.05.

RESULTS

The mean age of patients was 12.84 ± 3.88 years. Time off therapy ranged 24-125 month. The prevalence of prehypertension and hypertension were 57.7% and 9.6%, respectively. There was no statistically significant relationship between diagnosis and BP status (p = 0.59). The prevalence of obesity, and abdominal obesity were 1.9% and 30.4%, respectively. There was a positive correlation between waist circumference (WC) and time off therapy (p = 0.046). The WC was found to be higher in patients who received cranial irradiation (p = 0.048). Weight/WC were higher in patients who used corticosteroids in the treatment (p = 0.019).

CONCLUSION

Careful follow up of BP, weight and WC is necessary for long-term cancer survivors to prevent complications. Especially patients who receive cranial radiotherapy and use corticosteroid are at increased risk of abdominal obesity.

Prevalence, risk factors and consequences of overweight and obesity among schoolchildren: a cross-sectional study in Kashmir, India

BACKGROUND

Obesity among children and adolescents is a growing public health problem. The objective of this study was to evaluate the prevalence, risk factors and metabolic consequences of obesity among schoolchildren from Kashmir, India.

METHODS

The study subjects (n=2024) included 870 boys and 1154 girls, aged between 6 and 18 years. Data were collected by interviewer-administered questionnaires. Information was obtained about different lifestyles, anthropometric parameters and dietary habits. Obesity was defined as body mass index (BMI) percentile as per the guidelines of Centers for Disease Control, 2000. For the evaluation of different clinical parameters, blood samples were collected from the subjects in the fasting state at 8 to 9 am after an overnight (10-12 h) fast.

RESULTS

The highest representation of subjects was from fee-paying private schools. Out of the total subjects, 6.69% were overweight and 4.64% were obese. The hip circumference, abdominal circumference, BMI, blood pressure (BP), use of ready-made foods as well as the clinical parameters like glucose, phosphorous, cholesterol and triglycerides were found significantly higher among girls than boys (p<0.05). Boys were taller and were physically more active than girls (p<0.01). Compared to the boys (3.33%), the girls were found to be more obese (5.63%). Rural dwelling subjects (4.22%) exhibited a lower percentage of obesity than urban population (5.00%). The difference in obesity among the different age groups was found statistically significant (p<0.05). Additionally, children with active lives in the form of vigorous (10.59%) or moderate (10.34%) exercise decreased their chances of gaining weight substantially.

CONCLUSIONS

Results from the present study have shown that prevalence of obesity among children was high in our population.

Effect of plasma NOx values on cardiac function in obese hypertensive and normotensive pediatric patients

BACKGROUND

Hypertension (HT) is a major comorbidity of obesity that is associated with an increased risk of cardiovascular disease and higher mortality. The aim of our study was to evaluate cardiac function in obese hypertensive (OHT) and obese normotensive (ONT) pediatric patients and determine the effects of plasma nitric oxide (NOx) values on cardiac function, while demonstrating the role of plasma NOx in HT in obese pediatric patients.

METHODS

The study population consisted of 62 patients (27 boys, 35 girls), aged 13-18 years and 21 age-matched healthy controls. All subjects enrolled in the study underwent echocardiography (Echo) evaluation and ambulatory blood pressure monitoring for HT. Plasma NOx and biochemical values were studied in both patient groups separately.

RESULTS

Plasma NOx levels were found to be lower in the OHT group than in the ONT and control groups (p < 0.001) and to be negatively correlated with left ventricular mass index values (p < 0.05). Both the OHT and ONT groups had concentric hypertrophy of the heart.

CONCLUSIONS

Plasma NOx plays an essential role in obesity-induced HT. Concentric hypertrophy of the left ventricle was found in both the OHT and ONT groups, indicating structural deformation of the heart.

Physical Examination Findings Among Children and Adolescents With Obesity: An Evidence-Based Review

Overweight and obesity affects 1 in 3 US children and adolescents. Clinical recommendations have largely focused on screening guidelines and counseling strategies. However, the physical examination of the child or adolescent with obesity can provide the clinician with additional information to guide management decisions. This expert-based review focuses on physical examination findings specific to children and adolescents with obesity. For each physical examination element, the authors define the finding and its prevalence among pediatric patients with obesity, discuss the importance and relevance of the finding, describe known techniques to assess severity, and review evidence regarding the need for additional evaluation. The recommendations presented represent a comprehensive review of current evidence as well as expert opinion. The goal of this review is to highlight the importance of conducting a targeted physical examination during pediatric weight management visits.

Obstructive sleep apnea and periodic limb movement disorder in a population of children with hypertension and/or nocturnal nondipping blood pressures

There is a reported association between hypertension (HTN) and sleep disorders. The American Academy of Pediatrics recommends screening children with HTN for sleep disorders because sleep disorders increase the risk for cardiovascular disease. We quantified the frequency and severity of sleep disorders within our institution's hypertensive pediatric population and evaluated the effectiveness of performing nocturnal polysomnography (NPSG). In the hypertensive pediatric population referred for NPSG at our institution, 64% were diagnosed with obstructive sleep apnea (OSA) and/or periodic limb movement disorder. Thirty-three percent of those children with HTN had moderate to severe OSA, whereas only 20% of all children evaluated by NPSG had moderate to severe OSA. Those children with HTN were also two times more likely to be diagnosed with periodic limb movement disorder. Screening for sleep disorders and obtaining NPSG in children with HTN increase the identification of comorbid sleep disorders and reduce the risk for cardiovascular disease.

Is Daytime Systolic Load an Important Risk Factor for Target Organ Damage in Pediatric Hypertension?

The aim of this study was to compare ambulatory blood pressure (BP) monitoring (ABPM) data and determine which hypertension type is a risk factor in target organ damage. A total of 82 children (47 boys) with suspected hypertension based on office BP measurements and considered hypertensive by ABPM were studied. Target organ damage included the following: 35.3% hypertensive retinopathy, 25.6% microalbuminuria, 15.8% increased left ventricular mass index, 29.2% increased carotid intima-media thickness (cIMT), 24.3% high augmentation index (AIx), and 19.5% high pulse wave velocity (PWV). The association between BP load, PWV, and cIMT was statistically significant. There were significant correlations between daytime systolic BP load, PWV, AIx, and cIMT. A statistically significant difference was also detected between nighttime systolic BP load, PWV, and cIMT values and nighttime diastolic BP load levels and values of AIx and cIMT. There was also a statistically significant difference between the high level of nighttime diastolic BP load and cIMT. The authors found that target organ damage was seen more often in children with primary hypertension who had systolic loads.

Fast foods and physical inactivity are risk factors for obesity and hypertension among adolescent school children in east district of Sikkim, India

Background:

Obesity and hypertension among school children have a huge impact on public health. Hence, we estimated the prevalence and sociodemographic correlates of childhood obesity and elevated blood pressure (BP) among adolescent schoolchildren (11-19 years) in urban areas of Gangtok, Sikkim, India.

Materials and Methods:

A population based cross-sectional study was conducted on 979 school children, during November 1, 2009 - April 30, 2010 in Gangtok, East Sikkim India. Anthropometric measurements and BP were recorded among the study population. Obesity and hypertension prevalent among adolescent school children and their correlates were analyzed.

Results and Conclusion:

Prevalence of obesity, overweight, and hypertension was 2.04%, 14.5% and 5.62%, respectively. The average fast food intake, screen time and limited outdoor activities were significantly associated with obesity. Increase in abdominal height positively correlated with increase in body mass index and body fat; however waist — hip ratio was not a reliable index. The burden of overweight/obesity as well as hypertension with all its associated risk was found to high among our study population, which necessitates framing of policies and actions at national level to address the risk associated with these noncommunicable diseases.

Sleep disordered breathing as measured by SRBD-PSQ and neurocognition in children with hypertension

BACKGROUND

Cognitive test performance is decreased in hypertensive adults and children, a finding postulated to represent early target-organ damage to the brain. Hypertensive children are often obese, a comorbidity associated with sleep disordered breathing (SDB), itself associated with cognitive problems; potentially confounding the relation between hypertension (HTN) and neurocognition. Our objective was to determine the association between SDB as measured by a scale and questionnaire score and neurocognition among participants enrolled in an ongoing multicenter study of cognition in children with HTN.

METHODS

Subjects completed laboratory-based neurocognitive tests. Parents and subjects completed rating scales of executive function, mood, and behavior problems. Parents completed the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (SRBD-PSQ).

RESULTS

To date, 38 HTN subjects and 34 control subjects have completed neurocognitive testing and the SRBD-PSQ. Median SRBD-PSQ scores were similar between groups but the HTN group had a higher percentage of subjects with SRBD-PSQ scores in the range suggestive of obstructive sleep apnea (26% vs. 6%, P = 0.03). Overall, higher SRBD-PSQ scores were not significantly associated with worse performance on laboratory-based measures of executive function and other cognitive domains but were significantly associated with worse scores on rating scales of executive function as well as mood and behavior problems.

CONCLUSIONS

A larger proportion of children with HTN had scores suggestive of SDB. The results underscore the importance of using a multi-method approach in the assessment of cognition and adjusting for potential confounding effects of SDB in studies of cognition in hypertensive children.

Sleep characteristics, body mass index, and risk for hypertension in young adolescents

Inadequate sleep has been identified as a risk factor for a variety of health consequences. For example, short sleep durations and daytime sleepiness, an indicator of insufficient sleep and/or poor sleep quality, have been identified as risk factors for hypertension in the adult population. However, less evidence exists regarding whether these relationships hold within child and early adolescent samples and what factors mediate the relationship between sleep and risk for hypertension. Using data from the Study of Early Child Care and Youth Development, the present study examined body mass index (BMI) as a possible mediator for the effects of school-night sleep duration, weekend night sleep duration, and daytime sleepiness on risk for hypertension in a sample of sixth graders. The results demonstrated gender-specific patterns. Among boys, all three sleep characteristics predicted BMI and yielded significant indirect effects on risk for hypertension. Oppositely, only daytime sleepiness predicted BMI among girls and yielded a significant indirect effect on risk for hypertension. The findings provide clarification for the influence of sleep on the risk for hypertension during early adolescence and suggest a potential need for gender-specific designs in future research and application endeavors.

Impact of Gender on the Association of Epicardial Fat Thickness, Obesity, and Circadian Blood Pressure Pattern in Hypertensive Patients

This study aimed to investigate the effects of gender on the association between epicardial fat thickness (EFT) and circadian blood pressure (BP) changes in patients with recently diagnosed essential hypertension (EH). A total of 441 patients with EH (male/female: 236/205, mean age: 50.7 ± 13.8) and 83 control patients underwent 24-hour ambulatory BP monitoring and echocardiography. Obese EH patients had higher circadian BP profile with BP variability, wall thickness, and left ventricular mass than nonobese EH patients and controls (all p's <0.05) without gender differences. EFT was higher in female than in male patients (7.0 ± 2.5 versus 5.9 ± 2.2 mm, p < 0.001) and higher in the obese female EH group (7.5 ± 2.6 mm) than in the control (6.4 ± 2.8 mm) or nonobese EH group (6.7 ± 2.8 mm) among women, whereas EFT did not vary among males (5.9 ± 1.9 versus 6.0 ± 2.7 versus 5.9 ± 2.4 mm, p = 0.937). Multivariate logistic regression analysis demonstrated that the 24-hour mean BP variability was associated with SBP (p = 0.018) and EFT (p = 0.016) in female patients, but not in male patients. The relationships among circadian BP variability, obesity, and EFT were affected by gender in different manners. EFT may be a more valuable parameter in the evaluation of BP severity and obesity in women than in men.

Primary hypertension in childhood

There is growing concern about elevated blood pressure in children and adolescents, because of its association with the obesity epidemic. Moreover, cardiovascular function and blood pressure level are determined in childhood and track into adulthood. Primary hypertension in childhood is defined by persistent blood pressure values ≥ the 95th percentile and without a secondary cause. Preventable risk factors for elevated blood pressure in childhood are overweight, dietary habits, salt intake, sedentary lifestyle, poor sleep quality and passive smoking, whereas non-preventable risk factors include race, gender, genetic background, low birth weight, prematurity, and socioeconomic inequalities. Several different pathways are implicated in the development of primary hypertension, including obesity, insulin resistance, activation of the sympathetic nervous system, alterations in sodium homeostasis, renin-angiotensin system and altered vascular function. Prevention of adult cardiovascular disease should begin in childhood by regularly screening for high blood pressure, counseling for healthy lifestyle and avoiding preventable risk factors.

Serum uric acid level in newly diagnosed essential hypertension in a Nepalese population: a hospital based cross sectional study

OBJECTIVE

To develop the missing link between hyperuricemia and hypertension.

METHODS

The study was conducted in Department of Biochemistry in collaboration with Nephrology Unit of Internal Medicine Department. Hypertension was defined according to blood pressure readings by definitions of the Seventh Report of the Joint National Committee. Totally 205 newly diagnosed and untreated essential hypertensive cases and age-sex matched normotensive controls were enrolled in the study. The potential confounding factors of hyperuricemia and hypertension in both cases and controls were controlled. Uric acid levels in all participants were analyzed.

RESULTS

Renal function between newly diagnosed hypertensive cases and normotensive healthy controls were adjusted. The mean serum uric acid observed in newly diagnosed hypertensive cases and in normotensive healthy controls were (290.05±87.05) μmol/L and (245.24±99.38) μmol/L respectively. A total of 59 (28.8%) participants of cases and 28 (13.7%) participants of controls had hyperuricemia (odds ratio 2.555 (95% CI: 1.549-4.213), P<0.001).

CONCLUSIONS

The mean serum uric acid levels and number of hyperuricemic subjects were found to be significantly higher in cases when compared to controls.

Ambulatory blood pressure parameters in office normotensive obese and non-obese children: relationship with insulin resistance and atherosclerotic markers

OBJECTIVES

To determine differences in ambulatory blood pressure (ABP) parameters between office normotensive obese and non-obese children and to evaluate correlations of ABP parameters with insulin resistance and the lipid profile.

SUBJECTS AND METHODS

Thirty-eight obese [body mass index (BMI) above the 95th percentile] and 38 non-obese children aged 9-17 years were recruited. All subjects who were normotensive during office visits and who underwent 24-hour ABP monitoring were evaluated. Insulin resistance and the lipid profile were also evaluated.

RESULTS

The mean daytime, night-time and 24-hour systolic blood pressure (SBP) and the daytime and 24-hour diastolic blood pressure (DBP) in normotensive obese children were significantly higher compared to the values in non-obese children (p < 0.05). There was no difference in the frequency of nocturnal non-dippers and nocturnal hypertension (night-time SBP at or above the 95th percentile) between the two groups (p > 0.05). Children with night-time SBP at or above the 95th percentile and non-dippers had higher atherosclerotic markers than children with night-time SBP below the 95th percentile and dippers (p < 0.05). In logistic regression analysis, the low-density lipoprotein cholesterol (LDL-C):high-density lipoprotein cholesterol (HDL-C) ratio and night-time SBP had significantly positive associations with being obese in adolescents (OR 6.54, 95% CI 1.15-37.07, p = 0.03, and OR 1.1, 95% CI 1.01-1.19, p = 0.02, respectively).

CONCLUSION

Normotensive obese children had higher ABP parameters. A high LDL-C:HDL-C ratio and night-time SBP were associated with an increased risk of being obese. High LDL-C:HDL-C ratios and total cholesterol:HDL-C levels in children and adolescents may be risk factors for night-time hypertension.

Does low birth weight predict hypertension and obesity in schoolchildren?

BACKGROUND

Birth weight appears to play a role in determining high blood pressure (BP) and obesity during childhood. The purpose of this study is to investigate the association between birth weight and later obesity and hypertension among 10- to 13-year-old schoolchildren.

METHODS

A total of 1,184 primary school students were selected from 20 randomized schools between 2011 and 2012 in Iran. Height, weight, waist circumference and BP were measured using standard instruments. Data were analyzed using stepwise regression and logistic regression models.

RESULTS

13.5% of children had a history of low birth weight. First-degree family history of obesity, excessive gestational weight gain and birth weight were significantly correlated with overweight/obesity and abdominal obesity (p = 0.001), whereas only birth weight was associated with high BP (p = 0.001). An inverse correlation was found between waist circumference and systolic/diastolic BP. The duration of breastfeeding in children with low birth weight was inversely correlated with obesity/overweight, abdominal obesity and hypertension.

CONCLUSION

The results suggests that birth weight is inversely associated with BP and more so with obesity and abdominal obesity. The duration of having been breastfed could have an influence on later hypertension, obesity and abdominal obesity. Further results are needed to test these correlations as well as diagnosing early life factors to prevent young adult overweight/obesity or hypertension.