Pediatric hypertension: a growing problem

Pediatric Hypertension

Pediatric hypertension is becoming of increasing concern as the incidence rate increases alongside pediatric obesity. Practitioners need to be aware of the screening recommendations for early recognition and management of this disorder. Lifestyle modifications should be addressed early and specialty referral considered if the child is not improving. Further work-up to rule out secondary causes of pediatric hypertension should also be considered in any child with stage 2 hypertension and in those with persistently elevated blood pressures. Early recognition and management are key to not only preventing present complications but also future cardiovascular disease in adulthood.

Prevalence and Risk Factors of Hypertension Among Children Attending Out Patient Department of a Tertiary Care Hospital in Karachi

Introduction: The childhood obesity epidemic has caused the global prevalence of hypertension (HTN) in children to increase from 2% to 4%. However, there is limited data regarding this issue in Pakistan. Hence this cross-sectional study aims to document the prevalence of HTN and its risk factors among children visiting the out patient department (OPD) of a government hospital in Karachi, which is one of the largest cities in Pakistan. Methods: One thousand children aged between 4 and 12 years who visited the OPD in October 2019 were included. Blood pressures (BPs) for each child were measured manually and recorded. Their guardians were then interviewed to assess the risk factors present in each child. Data collected were analyzed using SPSS (Statistical Package for the Social Sciences). Results: Among all the children, those between 4 and 7 years of age had a higher prevalence of HTN (19.2%; 9.2% stage 1 and 10.0% stage 2) than children aged between 8 and 12 years (14.5%; 8.0% stage 1 and 6.5% stage 2). Obese children between the age of 4 and 7 years (OR = 3.11) were more likely to develop HTN. Moreover, children with a positive family history of HTN were 1.43 times more likely to have HTN and 1.32 times more likely to have pre-HTN. There was no significant association of gender, artificial feeding, low birth weight, and maternal smoking with HTN. Conclusion: The prevalence is particularly higher in children aged between 4 and 7 years (19.2%) and there is a strong association between high BMI (body mass index), family history of HTN, and high-fat diet intake with HTN in children. There was no significant variation of prevalence between both genders.

Pediatric hypertension: A guideline update

The prevalence of pediatric hypertension is growing. Hypertension during childhood remains a major risk factor for adverse cardiovascular events later in life. NPs should be aware of current guidelines on screening, diagnosis, and treatment of hypertension in children to improve care for this patient population.

Pediatric Obesity Algorithm: A Practical Approach to Obesity Diagnosis and Management

Childhood obesity is a growing global health problem. Despite the highest rates of childhood obesity in the United States and other developed countries over the last 30 years, there is still no clear treatment strategy. Practitioners often do not know where to turn to find guidance on managing the nearly one third of their population who present for medical care either with obesity that coexists with other medical problems or because of obesity. The Pediatric Obesity Algorithm is an evidence based roadmap for the diagnosis and management of children with obesity. In this article, we summarize topics from the Pediatric Obesity Algorithm pertaining to pediatric obesity diagnosis, evaluation, and management including assessment, differential diagnosis, review of systems, diagnostic work up, physical exam, age specific management, comorbidities, use of medications and surgery, and medication associated weight gain. Identifying and treating children with obesity as early as possible is important, as is identifying comorbid conditions. Earlier and more comprehensive management through resources such as the Pediatric Obesity Algorithm serve to help guide health care practitioners with a practical and evidence based approach to the diagnosis and management of children with obesity, and provide families with the tools needed for a healthy future.

Hypertension and correlates among Montenegrin schoolchildren-a cross-sectional study

OBJECTIVES

In one of the few national studies of children in a former Eastern bloc country emerging as a Western democracy and the first such study ever in Montenegro, this study establishes the prevalence and correlates of childhood hypertension (CH).

STUDY DESIGN

A cross-sectional national study.

METHODS

The study was conducted with 3254 children aged 7-13 years (50.3% male) from 39 elementary schools. We used a structured questionnaire to gather sociodemographic information as well as data on factors potentially related to CH. Children's nutritional status was assessed using the criteria of the International Obesity Task Force. Waist circumference was also measured. Blood pressure was measured in schools using an oscillometric monitor. CH was defined as an average systolic blood pressure and/or diastolic blood pressure greater than or equal to the 95th percentile for sex, age, and height.

RESULTS

The prevalence of CH was 10.4% with no differences between boys and girls. Multiple regression revealed that the odds for child hypertension were lowered by 10% for each year of age. On the other hand, rural environment and child obesity raised the odds of hypertension by 38% and 68%, respectively.

CONCLUSIONS

We found hypertension in one out of ten Montenegrin schoolchildren, with no gender differences. Obesity and rural areas may be unfriendly to children's blood pressure.

[Renovascular disease in children - a rare diagnosis with few symptoms]

BACKGROUND To estimate the prevalence, symptoms, causes and treatment of renovascular disease in children, and also to assess the degree of secondary organ damage to the heart, kidneys and eyes (end organ damage).MATERIAL AND METHOD Retrospective review of data for all children (0 - 16 years) who were examined for resistant hypertension in the period 1998 - 2013 at Oslo University Hospital Rikshospitalet.RESULTS A total of 21 children/adolescents (median age 8.5 years, 11 girls) were assessed and treated for resistant hypertension in the study period. Altogether had 38 % no symptoms at the time of diagnosis and 19 % had classical symptoms of hypertension. Fifteen patients received invasive treatment in the form of percutaneous transluminal renal angioplasty (PTRA) (n = 5), nephrectomy (n = 6), coiling (n = 1), autotransplantation (n = 1) or a combination of these (n = 2). Blood pressure improved following treatment in 10 of 14 patients for whom outcomes were recorded in the medical records. End organ damage to the heart and retina was observed in 60 % and 50 % of patients, respectively.INTERPRETATION Children with severely elevated blood pressure as a result of renovascular disease often have unspecific or no symptoms. Blood pressure improved following invasive treatment in 10 of 14 children and few complications were recorded. Invasive treatment may be considered in children and adolescents when standard treatment for hypertension is insufficient.

Postnatal height and adiposity gain, childhood blood pressure and prehypertension risk in an Asian birth cohort

OBJECTIVE

There have been hypotheses that early life adiposity gain may influence blood pressure (BP) later in life. We examined associations between timing of height, body mass index (BMI) and adiposity gains in early life with BP at 48 months in an Asian pregnancy-birth cohort.

METHODS

In 719 children, velocities for height, BMI and abdominal circumference (AC) were calculated at five intervals [0-3, 3-12, 12-24, 24-36 and 36-48 months]. Triceps (TS) and subscapular skinfold (SS) velocities were calculated between 0-18, 18-36 and 36-48 months. Systolic (SBP) and diastolic blood pressure (DBP) was measured at 48 months. Growth velocities at later periods were adjusted for growth velocities in preceding intervals, as well as measurements at birth.

RESULTS

After adjusting for confounders and child height at BP measurement, each unit z-score gain in BMI, AC, TS and SS velocities at 36-48 months were associated with 2.3 (95% CI:1.6, 3.1), 2.1 (1.3, 2.8), 1.4 (0.6, 2.2) and 1.8 (1, 2.6) mmHg higher SBP respectively, and 0.9 (0.4, 1.4), 0.9 (0.4, 1.3), 0.6 (0.1, 1.1) and 0.8 (0.3, 1.3) mmHg higher DBP respectively. BMI and adiposity velocities (AC, TS or SS) at various intervals in the first 36 months however, were not associated with BP. Faster BMI, AC, TS and SS velocities, but not height, at 36-48 months were associated with 0.22 (0.15, 0.29), 0.17 (0.10, 0.24), 0.11 (0.04, 0.19) and 0.15 (0.08, 0.23) units higher SBP z-score respectively, and OR=1.46 (95% CI: 1.13-1.90), 1.49 (1.17-1.92), 1.45 (1.09-1.92) and 1.43 (1.09, 1.88) times higher risk of prehypertension/hypertension respectively at 48 months.

CONCLUSIONS

Our results indicated that faster BMI and adiposity (AC, TS or SS) velocities only at the preceding interval before 48 months (36-48 months), but not at earlier intervals in the first 36 months, are predictive of BP and prehypertension/hypertension at 48 months.

Change in Metabolic Profile after 1-Year Nutritional-Behavioral Intervention in Obese Children

Research findings are inconsistent about improvement of specific cardio-metabolic variables after lifestyle intervention in obese children. The aim of this trial was to evaluate the effect of a 1-year intervention, based on normocaloric diet and physical activity, on body mass index (BMI), blood lipid profile, glucose metabolism and metabolic syndrome. Eighty-five obese children aged ≥6 years were analyzed. The BMI z-score was calculated. Fasting blood samples were analyzed for lipids, insulin and glucose. The homeostatic model assessment of insulin resistance (HOMA-IR) was calculated and insulin resistance was defined as HOMA-IR >3.16. HOMA-β%, quantitative insulin sensitivity check index and triglyceride glucose index were calculated. The metabolic syndrome was defined in accordance with the International Diabetes Federation criteria. At the end of intervention children showed a reduction (mean (95% CI)) in BMI z-score (-0.58 (-0.66; -0.50)), triglycerides (-0.35 (-0.45; -0.25) mmol/L) and triglyceride glucose index (-0.29 (-0.37; -0.21)), and an increase in HDL cholesterol (0.06 (0.01; 0.11) mmol/L). Prevalence of insulin resistance declined from 51.8% to 36.5% and prevalence of metabolic syndrome from 17.1% to 4.9%. Nutritional-behavioral interventions can improve the blood lipid profile and insulin sensitivity in obese children, and possibly provide benefits in terms of metabolic syndrome.

Epidemiology of elevated blood pressure and associated risk factors in Chinese children: the SNEC study

Despite the association of childhood blood pressure (BP) with hypertension later in the life course, there remains dearth of information regarding the prevalence and emergence of hypertension in children, especially in China. To investigate the current status of BP, prevalence of elevated BP and related factors in Chinese children, a cross-sectional survey in a representative sample of 9354 Chinese children 5-17 years old was conducted in seven cities in Northeastern China during 2011 and 2012. BP measurements were taken by mercury sphygmomanometer. Elevated BP in children was defined as an average diastolic BP or systolic BP that is in the 95th percentile or higher for their gender, age and height. Overall, total prevalence of elevated BP was 13.8%, and no significant difference between males and females was identified. Multivariate analyses revealed that children having a higher area of residence had a lower of elevated BP. Increased odds for elevated BP were found for individuals who were lean (odds ratio (OR)=2.12; 95% confidence interval (CI): 1.67-2.69), overweight (OR=2.05; 95% CI: 1.74-2.42), obese (OR=3.15; 95% CI: 2.70-3.68), were born with low birth weight (OR=1.26; 95%CI: 1.01-1.63), premature birth (OR=1.46; 95%CI: 1.13-1.88), and were with home coal use (OR=1.24; 95%CI: 1.02-1.52). In conclusion, elevated BP was found to be prevalent in children in urban areas of Northeast China. These results underscore the importance of implementing a package of measures aimed at reducing malleable risk for this cardiovascular condition in school-aged children in Northeast China.

Docosahexaenoic Acid Levels in Blood and Metabolic Syndrome in Obese Children: Is There a Link?

Prevalence of metabolic syndrome is increasing in the pediatric population. Considering the different existing criteria to define metabolic syndrome, the use of the International Diabetes Federation (IDF) criteria has been suggested in children. Docosahexaenoic acid (DHA) has been associated with beneficial effects on health. The evidence about the relationship of DHA status in blood and components of the metabolic syndrome is unclear. This review discusses the possible association between DHA content in plasma and erythrocytes and components of the metabolic syndrome included in the IDF criteria (obesity, alteration of glucose metabolism, blood lipid profile, and blood pressure) and non-alcoholic fatty liver disease in obese children. The current evidence is inconsistent and no definitive conclusion can be drawn in the pediatric population. Well-designed longitudinal and powered trials need to clarify the possible association between blood DHA status and metabolic syndrome.