Blood pressure in youth from four ethnic groups: the Pasadena Prevention Project

Establishment of blood pressure nomograms representative for Egyptian children and adolescents: a cross-sectional study

OBJECTIVE

To define nomograms for blood pressure in Egyptian children and adolescents.

METHODS AND STUDY DESIGN

A total of 60 025 Egyptian children from birth to 19 years were enrolled in this cross-sectional randomised study from December 2015 to March 2017. They were selected from diverse geographical districts in Egypt. Healthy children who fulfilled the inclusion criteria, which included good nutritional history, absence of fever or documented underlying disease at the time of examination, no evidence of haemodynamically significant illness, and no antihypertensive drugs or other chronic drug administration, were included in the study. Body weight, recumbent length (for less than 24 months) and height (from 2 years to 19 years), and blood pressure were measured using standard mercury sphygmomanometers.

RESULTS

Blood pressure increases with age in both boys and girls. The 90th percentile of systolic and diastolic blood pressure among Egyptian children was different from other ethnic populations (American and Turkish children) in both sexes. Systolic and diastolic blood pressure showed a positive correlation with weight and height in both sexes (p<0.001).

CONCLUSION

We assumed that normal blood pressure curves should be used cautiously during childhood, and it is recommended that every population have its own normal standard curve to define measured blood pressure levels in children. These centiles increased our knowledge and awareness of normal blood pressure among Egyptian children and adolescents. The percentiles will distinguish children and young adolescents with increased blood pressure and will be of value to both medical practice and scientific research.

Association of Chronic Kidney Disease With Small Vessel Disease in Patients With Hypertensive Intracerebral Hemorrhage

Background

Chronic kidney disease (CKD) has been closely associated with hypertension and stroke. Although studies have reported the relationship between CKD and cerebral small vessel disease (SVD), the link between CKD, hypertension, and SVD is uncertain. The aim of this study was to investigate the association between CKD and SVD in patients with strictly hypertensive intracerebral hemorrhage (ICH).

Methods

142 patients with acute hypertensive ICH were enrolled in this study. Magnetic resonance imaging was performed to assess imaging markers for SVD. Patients were categorized into three CKD groups based on the degree of kidney dysfunction [glomerular filtration rate (GFR) in milliliters per minute per 1.73 m²]: normal kidney function (GFR ≥ 90), mild kidney disease (60 ≤ GFR < 90), and moderate to severe kidney disease (GFR < 60).

Results

The prevalence rate of mild and moderate to severe CKD was 50 and 14.8%, respectively. The stage of CKD was associated with history of chronic hypertension (p = 0.046) as well as the prevalence rate of overall and deep cerebral microbleed (CMB) (p = 0.001 and p = 0.002, respectively). The stage of CKD was a significant risk factor for deep white matter hyperintensity (WMH) (OR 1.848; 95% CI 1.022–3.343, p = 0.042), overall CMB (OR 2.628; 95% CI 1.462–4.724, p = 0.001), lobar CMB (OR 2.106; 95% CI 1.119–3.963, p = 0.021), and deep CMB (OR 2.237; 95% CI 1.263–3.960, p = 0.006), even after adjustment for confounders.

Conclusion

In patients with hypertensive ICH, the prevalence of CKD is high even at the early stage of renal function impairment and is associated with the prevalence of CMB and deep WMH. These results reinforce the notion of a link between hypertensive vasculopathy, renal function impairment, and cerebral SVD.

Prevalence of hypertension and prehypertension in adolescence in Ahvaz, Iran

BACKGROUND

High blood pressure is a risk factor for some disease like stroke, coronary heart disease, and renal failure. High blood pressure in children is an increasing health problem.

OBJECTIVES

The aim of this study was to determine prevalence of hypertension and pre-hypertension age between 10 to 17 years old.

PATIENTS AND METHODS

This descriptive analytic study was conducted using multiphase sampling method in Ahvaz (Southwest of Iran). A questionnaire include: height, weight, and body mass index, systolic and diastolic blood pressures filled for each participant. Blood pressure was measured twice for each person. For the diagnosis of hypertension, the fourth report of the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents of the National Health Institute of United States was used.

RESULTS

Total participants of the study were 1707children and adolescents including 922 boys (54%) and 785 girls (46%). The prevalence of high blood pressure was 1.7% (2.5% in boys and 0.8%). The prevalence of pre-hypertension was 9%(7.6% in boys, 10.6% in girls). The mean systolic and diastolic blood pressures increased with increasing body mass index.

CONCLUSIONS

The prevalence of high blood pressure was found to be lower than other studies in our country. The prevalence of the high blood pressure in boys was significantly higher than girls. This study, like other studies showed high correlation between being overweight and an increase in systolic and diastolic blood pressure.

Metabolic syndrome and esophageal and gastric cancer

BACKGROUND

The role of the metabolic syndrome in the etiology of esophageal and gastric cancer is unclear.

METHODS

This was a large nationwide cohort study based on data from 11 prospective population-based cohorts in Norway with long-term follow-up, the Cohort of Norway (CONOR) and the third Nord-Trøndelag Health Study (HUNT3). The metabolic syndrome was assessed by objective anthropometric and metabolic biochemical measures and was defined by the presence of at least three of the following five factors: increased waist circumference, elevated triglycerides, low high-density lipoprotein cholesterol, hypertension and high glucose. Newly diagnosed cases of esophageal adenocarcinoma, esophageal squamous-cell carcinoma and gastric adenocarcinoma were identified from the Norwegian Cancer Registry. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models with adjustment for potential confounders.

RESULT

Among 192,903 participants followed up for an average of 10.6 years, 62 developed esophageal adenocarcinoma, 64 had esophageal squamous-cell carcinoma and 373 had gastric adenocarcinoma. The metabolic syndrome was significantly associated with an increased risk of gastric adenocarcinoma (HR 1.44, 95% CI 1.14-1.82), but not associated with esophageal adenocarcinoma (HR 1.32, 95% CI 0.77-2.26) or esophageal squamous-cell carcinoma (HR 1.08, 95% CI 0.64-1.83). Increased waist circumference was associated with an increased HR of esophageal adenocarcinoma (HR 2.48, 95% CI 1.27-4.85). No significant association was found between any single component of the metabolic syndrome and risk of esophageal squamous-cell carcinoma. High waist circumference (HR 1.71, 95% CI 1.05-2.80), hypertension (HR 2.41, 95% CI 1.44-4.03) and non-fasting glucose (HR 1.74, 95% CI 1.18-2.56) were also related to an increased risk of gastric adenocarcinoma in women, but not in men.

CONCLUSION

Metabolic syndrome was associated with an increased risk of gastric adenocarcinoma in women. Of the individual components of the metabolic syndrome, high waist circumference was positively associated with risk of esophageal adenocarcinoma. Positive associations were also observed for women between high waist circumference, hypertension, high non-fasting glucose and risk of gastric adenocarcinoma. However, further evidence is warranted due to the limited number of cases and the inability to effectively identify gastric cardia adenocarcinoma.

Screening for hypertension in children and adolescents to prevent cardiovascular disease

BACKGROUND AND OBJECTIVE

The prevalence of hypertension is increasing in children, and may persist into adulthood. This systematic review was conducted for the US Preventive Services Task Force recommendation on the effectiveness of screening asymptomatic children and adolescents for hypertension in order to prevent cardiovascular disease.

METHODS

Eligible studies were identified from Medline and the Cochrane Library (through July 2012). We included trials and controlled observational studies in asymptomatic children and adolescents on the effectiveness and harms of screening and treatment, as well as accuracy of blood pressure measurement. One author extracted study characteristics and results, which were checked for accuracy by a second author.

RESULTS

No studies evaluated the effects of screening for hypertension on health outcomes. Two studies of screening tests for elevated blood pressure reported moderate sensitivities (0.65, 0.72) and specificities (0.75, 0.92). Sensitivities and specificities of child hypertension for the later presence of adult hypertension (7 studies) were wide ranging (0-0.63 and 0.77-1.0, respectively), and associations between child hypertension and carotid intima media thickening and proteinuria in young adults (3 studies) were inconsistent. Seven studies reported that drug interventions effectively lowered blood pressure in adolescents over short follow-up periods. No serious treatment-related adverse effects were reported.

CONCLUSIONS

There is no direct evidence that screening for hypertension in children and adolescents reduces adverse cardiovascular outcomes in adults. Additional studies are needed to improve diagnosis and risk stratification of children with elevated blood pressure and to quantify risks and benefits of interventions.

Blood pressure-to-height ratio as a screening measure for identifying children with hypertension

The present study evaluated the feasibility and accuracy of the blood pressure-to-height ratio (BPHR) and proposed the optimal thresholds of BPHR for identifying hypertension in Han children aged 7-12 years. In 2011, anthropometric measurements were assessed in a cross-sectional population-based study of 1,352 Han children aged 7-12 years. Hypertension was defined according to the 2004 National High Blood Pressure Education Program Working Group definition (as gold standard). The following equations for BPHR were used: systolic blood pressure-to-height ratio (SBPHR) = SBP (mmHg)/height (cm) and diastolic blood pressure-to-height ratio (DBPHR) = DBP (mmHg)/height (cm). Receiver operating characteristic curve analyses were performed to assess the accuracy of SBPHR and DBPHR as diagnostic tests for elevated SBP and DBP, respectively. After the cutoff points were determined, hypertension was defined by SBPHR/DBPHR (new standard), and the sensitivity and specificity were calculated. The accuracy of SBPHR and DBPHR (assessed by area under the curve) for identifying elevated SBP and DBP was over 0.85 (0.946-1.000). SBPHR cutoff values for elevated SBP were calculated to be 0.76-0.88 mmHg/cm in boys and 0.78-0.90 mmHg/cm in girls. DBPHR cutoff values for elevated DBP were calculated to be 0.51-0.60 mmHg/cm in boys and 0.51-0.58 mmHg/cm in girls. When hypertension was defined by BPHR, the sensitivities were 100 % in boys and 95.0 % in girls. The specificity was 94.3 % in boys and 96.8 % in girls. BPHR is a simple, inexpensive, and accurate index for screening hypertension in Han children.

Índice de massa corpórea, sobrepeso e pressão arterial em escolares na província de Limpopo, África do Sul

OBJETIVO: Avaliar a relação entre índice de massa corporal, sobrepeso e pressão arterial em crianças e adolescentes da área rural da África do Sul. MÉTODOS: A amostra abrangeu 1.172 escolares (541 meninos e 631 meninas) com idades entre 10 e 16 anos. Estatura, massa corporal e dobras cutâneas foram medidas por meio de procedimentos padrão. O sobrepeso foi definido pelo índice de massa corporal para idade e sexo. A pressão arterial foi monitorada três vezes em cada criança com o uso de aparelhos eletrônicos validados (Omron HEM-705 CP, Omron, Tóquio, Japão). A hipertensão foi determinada como a média de três leituras da pressão arterial, em que a sistólica ou a diastólica foi igual ou acima do percentil 90 para idade e sexo. Estatísticas descritivas foram calculadas para todas as variáveis. RESULTADOS: A prevalência de sobrepeso foi de 5,5% para meninos e 4,4% para meninas. A taxa de crianças com pressão arterial acima do percentil 90 variou de 2,3 a 5,9%. A probabilidade do desenvolvimento de hipertensão em crianças é perceptível aos dez anos, tanto para os meninos (0,2%) quanto para as meninas (0,1%), e oscilou de 0,2 a 1,7% para o sexo masculino e de 0,1 a 1,2% para o feminino. Considerando-se a amostra total, a prevalência de hipertensão foi de 4,1% para os meninos e 2,8% para as meninas. A pressão arterial apresentou correlação positiva com estatura, massa corporal, índice de massa corporal, gordura corpórea e soma das dobras cutâneas (p<0,001). CONCLUSÕES: A pressão arterial aumentou com a idade tanto para os meninos quanto para as meninas. A medição da pressão arterial de rotina, como parte do exame físico em escolares, é crucial para fins de prevenção e medidas de intervenção precoces.

Validation of the APLS age-based vital signs reference ranges in a Chinese population

Reference ranges for vital signs may differ significantly among children of different ethnic origins.

AIM

(1) To validate the Advanced Paediatric Life Support (APLS) age-based vital signs reference ranges in Chinese children in Hong Kong. (2) To derive age-based centile curves for systolic blood pressure, heart rate and respiratory rate for Chinese children. (3) To summarize the reference ranges in a table format appropriate for applying APLS to ethnic Chinese patients.

METHOD

A cross-sectional study was performed on a population of healthy Chinese children recruited from 8 kindergartens and 6 primary schools in Hong Kong. Trained operators visit the sites to obtain measurements. Age-groups: small toddlers (12-23 months); pre-school (24-59 months); and school (60-143 months). Z-test was used to assess statistical significance for proportions of each parameter falling outside the APLS reference range. One-sample t-test was used for comparison with APLS means according to age-groups. LMS Chartmaker Pro v2.3 software was used to describe the data in centile curves.

RESULTS

A total of 1353 patients (55.1% boys) were included. For heart rate, systolic blood pressure and respiratory rate respectively, 34.1%, 55.9% and 55.7% of corresponding measurements were outside the APLS age-based reference ranges. In the 'pre-school' and 'school' age-groups, the mean value for blood pressure is significantly higher, and the mean values for heart rate and respiratory rate significantly lower, in comparison to APLS mean values.

CONCLUSION

Independently derived vital signs reference ranges are more appropriate for use when applying APLS to Chinese patients in Hong Kong.

Impact of elevated cystatin C level on cardiovascular disease risk in predominantly high cardiovascular risk populations: a meta-analysis

BACKGROUND

Chronic kidney disease is a growing public health problem that carries substantial risk for cardiovascular disease (CVD). Single studies have differentially examined the role of cystatin C, a novel renal index, with varying cut-point use. We undertook a meta-analysis of prospective studies to properly assess the link between cystatin C (dichotomized and continuous) versus CVD.

METHODS AND RESULTS

Systematic literature search for studies reporting a multivariate-adjusted estimate, represented as relative risk (RR) with 95% confidence interval (CI), of the association between cystatin C and subsequent risk of (1) any CVD event and (2) specific CVD events. Data were collated from 14 studies, with 13 high cardiovascular risk population cohorts and 1 general population cohort, involving 22 509 subjects with 2321 CVD events, 741 coronary heart disease events, and 828 stroke events. Highest cystatin C category versus lowest was associated with greater risk of CVD (RR, 2.62; 95% CI, 2.05 to 3.37, P<0.001), coronary heart disease (RR, 1.72; 95% CI, 1.27 to 2.34; P<0.001), and stroke (RR, 1.83; 95% CI, 1.12 to 3.00; P=0.02) after adjustment for established cardiovascular risk factors. Each standard deviation rise in cystatin C concentration boosted CVD risk (RR, 1.34; 95% CI, 1.18 to 1.51; P<0.001). Highest cystatin C category was also independently linked to greater risk of all-cause mortality and heart failure.

CONCLUSIONS

The meta-analysis, mostly derived from high cardiovascular populations, showed that cystatin C is strongly and independently associated with subsequent CVD risk. Further investigation is warranted to clarify whether measurement of cystatin C can usefully enhance CVD stratification beyond established predictors already in clinical use.

Relationship between height and blood pressure in Japanese schoolchildren

BACKGROUND

Blood pressure examinations for health education use have been conducted at several schools in Japan. It has been reported that blood pressure is closely associated with bodyweight and height in US children. The aim of the present paper was to evaluate the association between height and blood pressure in Japanese schoolchildren.

METHODS

In Iwata city in Japan, blood pressure screening was conducted by the school administration. A total of 98.9% (10,152/10,270 children) of all fifth (10-year-olds) and ninth graders (14-year-olds) residing in the Old Iwata area from 2002 to 2007 were analyzed.

RESULTS

In 10-year-old and 14-year-old boys, regression analysis indicated that a positive correlation between weight and blood pressure was the strongest among the three body size indices (height, weight, and body mass index), but the association between height and blood pressure was also significant. For girls from both the 10 and 14 year age groups, the correlation of weight and blood pressure was stronger than those for the other body size indices, but there were also significant associations between height and blood pressure, except for height and diastolic blood pressure in the 14-year-olds.

CONCLUSIONS

There is a significant positive relationship between height and blood pressure. Further study is necessary to provide a blood pressure reference based on height in the Japanese program to prevent children from developing lifestyle-related risk factors.

Low glomerular filtration rate and risk of stroke: meta-analysis

OBJECTIVE

To qualitatively and quantitatively investigate the link between a low estimated glomerular filtration rate (eGFR) at baseline and risk of future stroke.

DESIGN

Systematic review and meta-analysis of prospective studies.

DATA SOURCES

PubMed (1966-October 2009) and Embase (1947-October 2009). Selection criteria Inclusion criteria were studies that prospectively collected data within cohort studies or clinical trials, estimated glomerular filtration rate at baseline using the modification of diet in renal disease or Cockcroft-Gault equations, assessed incident stroke, had a follow-up of at least one year, and reported quantitative estimates of multivariate adjusted relative risk and 95% confidence interval for stroke associated with an eGFR of 60-90 ml/min/1.73 m(2) or <60 ml/min/1.73 m(2). Data abstraction Two investigators independently abstracted data from eligible studies. Estimates were combined using a random effects model. Heterogeneity was assessed by P value of χ(2) statistics and I(2). Publication bias was assessed by visual examination of funnel plots.

RESULTS

21 articles derived from 33 prospective studies: 14 articles assessed eGFR <60 ml/min/1.73 m(2) and seven assessed eGRF at both <60 ml/min/1.73 m(2) and 60-90 ml/min/1.73 m(2) for a total of 284 672 participants (follow-up 3.2-15 years) with 7863 stroke events. Incident stroke risk increased among participants with an eGFR <60 ml/min/1.73 m(2) (relative risk 1.43, 95% confidence interval 1.31 to 1.57; P<0.001) but not among those with an eGFR of 60-90 ml/min/1.73 m(2) (1.07, 0.98 to 1.17; P=0.15). Significant heterogeneity existed between estimates among patients with an eGFR <60 ml/min/1.73 m(2) (P<0.001). In subgroup analyses among participants with an eGFR <60 ml/min/1.73 m(2), heterogeneity was significant in Asians compared with non-Asians (1.96, 1.73 to 2.23 v 1.25, 1.16 to 1.35; P<0.001), and those with an eGFR of 40-60 ml/min/1.73 m(2) v <40 ml/min/1.73 m(2) (1.28, 1.04 to 1.56 v 1.77, 1.32 to 2.38; P<0.01).

CONCLUSIONS

A baseline eGFR <60 ml/min/1.73 m(2) was independently related to incident stroke across a variety of participants and study designs. Prompt and appropriate implementation of established strategies for reduction of vascular risk in people with know renal insufficiency may prevent future strokes.

The association of fat patterning with blood pressure in rural South African children: the Ellisras Longitudinal Growth and Health Study

BACKGROUND

Hypertension is one of the major causes of death in developed and underdeveloped nations. Essential hypertension and obesity may have their inception in childhood, with little data in African children to support these findings. Objectives were to determine the prevalence of overweight and hypertension in rural children in South Africa. Additionally, the association between fat-patterning ratios and blood pressure (BP) was investigated.

METHODS

Data were collected from 1884 subjects (967 boys and 917 girls), aged 6-13 years, participating in the Ellisras Longitudinal Study. Height; weight; and triceps, biceps, subscapular, and suprailiac skinfolds were measured according to the protocol of the International Society for the Advancement of Kinanthropometry. Skinfold ratio was used as an indicator of the central pattern of body fat. Internationally recommended cut-off points for body mass index (BMI) were used. Hypertension, defined as the average of three separate BP readings where the systolic BP or diastolic BP is >or=95th percentile for age and sex, was determined.

RESULTS

The prevalence of hypertension ranged from 1 to 5.8% for boys and 3.1 to 11.4% for girls, and that of overweight from 1.1 to 2.9% for boys and 0.6 to 4.6% for girls. The association between high systolic BP and high BMI was -3.0, while that for high diastolic BP and high BMI was -0.68.

CONCLUSIONS

The prevalence of hypertension is evident from the age 6 years for girls, while that of overweight was low. Overweight became evident from the age 10 to 13 years for both sexes. A significant association between high diastolic BP and high BMI was noted, while children with low BMIs were less likely to be hypertensive. Investigating habitual physical activity, fitness and dietary patterns will shed more light on the association of fat patterning and BP in this population.

Differences in resting cardiovascular parameters in 10- to 15-year-old children of different ethnicity: the contribution of physiological and psychological factors

BACKGROUND

The health status of children in the North West Province of South Africa was examined using the Transition and Health during Urbanization in South Africa in Children study. This is an epidemiological, cross-sectional study for which 1,244 children between 10 and 15 years of age were recruited from 44 schools.

PURPOSE

Our objective was to investigate whether differences exist between resting cardiovascular parameters of Black, White, colored, and Indian children and evaluate the contribution of physiological and psychological factors.

METHODS

Blood pressure was monitored with the Finapres apparatus. By means of the Fast Modelflo software program, the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure, heart rate, cardiac output (CO), total peripheral resistance (TPR), and "Windkessel" compliance (Cw) of the arterial system were obtained. The psychological data were obtained by validated questionnaires.

RESULTS

After correction for body mass index, the SBP of the White children was significantly higher (p < .05) than the SBP of the other ethnic groups. The DBP showed no significant differences. The TPR measurements of the Black and colored children were significantly higher (p < .05) than the TPR of the White children, and the Cw measurements of the Black and colored children were significantly lower than the Cw of the White children. Significant correlations (p < .05) were found between the SV, CO, TPR, Cw, and the total score on violence in the Black and colored children.

CONCLUSIONS

There are differences in the resting cardiovascular parameters in the different ethnic groups studied. The higher levels of violence to which the Black and colored children are exposed could alter vascular sensitivity to sympathetic stimulation. This may contribute via the higher -adrenergic sensitivity to the pathogenesis of hypertension in their later lives.

Elevated mortality rates from circulatory disease in African American men and women of Los Angeles County, California--a possible genetic susceptibility?

OBJECTIVE

Reports of higher mortality in African Americans have often focused on socioeconomic differences. Such differences do not explain the excess mortality in African Americans compared with Hispanics in Los Angeles County. We suggest the existence of genetic factors to explain at least some of the differences in mortality risk.

METHODS

We compared the mortality rates from circulatory diseases in African American and Hispanic adults of Los Angeles County for 1988 to 1992 with the frequency of the angiotensin-converting enzyme (ACE) genotype.

RESULTS

African American adults 45 to 74 years old had a 2-fold higher overall mortality rate than Hispanics. The largest differences were seen for hypertensive disease and cardiomyopathy in men; the most striking differences were seen in the youngest age group. Rates were lower in women than in men, but African American women also showed substantial excess compared with Hispanics. ACE genotype also showed a significant difference between the Hispanic and African American population; the latter had a significantly higher prevalence of the DD genotype, which is associated with a higher level of circulating enzyme, and lower prevalence of the II genotype, which is associated with a lower enzyme level.

CONCLUSION

African American adults aged 45 to 74 years in Los Angeles County have a substantial excess mortality from hypertensive diseases compared with a similar Hispanic population. The frequency of the ACE DD genotype was higher in African Americans than in Hispanics. These studies may indirectly support the possibility of a genetic contribution to the excess hypertensive disease mortality in African Americans.

Treatment of pediatric hypertension

We conducted a MEDLINE search from January 1966-March 1999 to obtain information on clinical trials of treatment of pediatric hypertension. An article was selected for review if it described a randomized or nonrandomized study; randomized studies were given priority. Case reports were considered when studies were unavailable. Review articles were useful in identifying references. According to data we collected, hypertension is present in 1-3% of the pediatric population. Nonpharmacologic treatment may be effective initially in those with mild to moderate disease or as an adjunct to drug therapy. Drugs for treatment of chronic hypertension include calcium channel blockers, angiotensin-converting enzyme inhibitors, diuretics, and beta-blockers. Patient and drug characteristics determine therapy. Intravenous labetalol, nicardipine, and nitroprusside are effective for treating hypertensive emergencies.

Alliteration in medicine: a puzzling profusion of p's

PROBLEM

Puzzling, progressive profusion of alliterative "p's" in published papers.

PURPOSE

To depict this particular "p" predominance with pinpoint precision. PLAN: Periodic, painstaking perusal of periodicals by a professor of paediatrics.

PROPOSAL

The "p" plethora is positively perplexing and potentially perturbing.

The San Antonio Biethnic Children's Blood Pressure Study: auscultatory findings

INTRODUCTION

The purpose of this study were to: (a) examine for possible ethnicity-related and gender-related differences in blood pressure (BP) in Mexican American and non-Hispanic White schoolchildren; (b) compare auscultatory and oscillometric BP levels; and (c) establish auscultatory BP standards using the width of the BP cuff based on the circumference of the arm in schoolchildren in K-12.

METHODS

Participants were 6259 schoolchildren in kindergarten through 12th grade in the San Antonio, Texas, area. Auscultatory and oscillometric BP readings were obtained in random sequence, using BP cuff width 40% to 50% of the circumference of the upper arm. Averages of 3 readings were used for statistical analyses.

RESULTS

Auscultatory systolic pressures (SPs) in preadolescent Mexican American boys and girls were higher (1 to 3 mm Hg) auscultatory (SP) than in their White counterparts, but the difference was clinically not important. Diastolic pressures (DP) showed no important differences. Auscultatory SPs in 13- to 18-year-old boys of both ethnic groups were significantly (P < .05) higher (3 to 12 mm Hg) than they were for girls, with no ethnic differences. Oscillometric SP was higher than auscultatory SP in children of all ages studied. Oscillometric (DP) was slightly lower (0 to 5 mm Hg) than was auscultatory K4 and higher (4 to 5 mm Hg) than was auscultatory K5 DP.

DISCUSSION

No important ethnicity-related difference was found for auscultatory BP, but significant gender-related differences (boys greater than girls) were found in SP in subjects ages 13 to 18 years. Differences in BP readings by oscillometric and auscultatory methods do not allow interchange of readings. This study provides, for the first time, auscultatory BP standards using BP cuff width 40% to 50% of the arm circumference.

Childhood hypertension. An update on etiology, diagnosis, and treatment

In the general population, an estimated 70% or more of premature morbidity can be attributed to tobacco use, undertreatment of hypertension, and obesity. From a public health perspective, health-related behaviors that reduce the risk for cardiovascular disease should be encouraged for all children and their families. Pediatricians are obligated to accurately and frequently monitor patients' blood pressures. When discovered, elevated blood pressure should be appropriately investigated, with the evaluation being tailored to the age of the child and to the severity of the blood pressure elevation. Investigation should focus on not only a search for a cause but also target organ effects. Timely recognition of abnormal blood pressure and appropriate interventions are necessary to affect the future development of cardiovascular and renal morbidity and mortality.

Blood pressure at age 3-24 years in a rural community in Anhui, China

PURPOSE

This community-based study in Anhui, China examined the sex-specific pattern of blood pressure (BP) and its major determinants between age 3 and 24 years.

METHODS

BP, height, weight, and related covariates were obtained from all eligible subjects by consistent methods. A generalized additive model was used to explore independent relations between BP and covariates. The sample for analyses included a total of 14,277 subjects (7244 males and 7033 females).

RESULTS

Systolic blood pressure (SBP) increased linearly with age to an apparent plateau around the age of 15 years in girls and 20 years in boys. Diastolic blood pressure (DBP) essentially paralleled SBP. Until the age of 10, both SBP and DBP were similar in boys and girls; thereafter, values for boys surpassed those for girls with an average difference of 9 mmHg and 4 mmHg for SBP and DBP, respectively, at 20 years of age. This sex difference appeared to persist into early adulthood. The independent relation between BP and each of the three major determinants (age, height, and weight) was nonlinear over the age range studied. Sex-specific regression models with linear terms for age, height and weight were developed for each of four age groups (3-9, 10-14, 15-19, 20-24 years). The 5th, 10th, 90th, and 95th percentiles based on the percentage of predicted values can serve as the cutoffs for low, normal-low, normal-high, and high BP. The predicted values were derived from the above regression models that take into account an individual's sex, age, height, and weight.

CONCLUSIONS

This analysis provided important basis for classification of hypertension status and subsequent investigation of environmental risk factors in this population.

Cardiovascular risk factors in Mexican-American and non-Hispanic white children: The Corpus Christi Child Heart Study

BACKGROUND

Information concerning differences in cardiovascular disease risk factors between Mexican-American and non-Hispanic white children is limited. We conducted a study to determine if there were ethnic differences in cardiovascular disease risk factors in children and whether such differences were explained by differences in body mass index.

METHODS AND RESULTS

Fasting glucose, insulin, and blood lipid concentrations, blood pressure, weight, and height were measured in a cross-sectional survey among 403 third-grade children in Corpus Christi, Tex. We found significantly higher fasting insulin and glucose concentrations among Mexican-American than among non-Hispanic white children. Mexican-American boys had slightly lower levels of HDL cholesterol and higher systolic blood pressure than non-Hispanic white boys. Ethnic differences in insulin and glucose were not explained by body mass index.

CONCLUSIONS

These results provide preliminary evidence that ethnic differences in insulin, glucose, body mass index, and other risk factors occur as early as age 8 to 10 years. Additional research is warranted on differences in risk factors in Mexican-American and non-Hispanic white children and the potential importance of insulin in influencing the natural history of these characteristics.

The impact of ethnicity on response to antihypertensive therapy

The aim of this review is to assess the prevalence of complications and responses to various antihypertensive drug therapies in ethnic minority groups in the United States. In some instances, these comments are extended to responses of citizens in their countries of origin. The incidence of hypertension, mortality from hypertensive heart disease, stroke, and hypertensive renal disease are higher in African Americans. Although some Hispanic Americans have a lesser risk for hypertension, they have a greater risk for other risk factors such as diabetes and dyslipidemia. There is a similar association between income and mortality for both African Americans and Hispanic Americans. When compared to European Americans and other ethnic minorities, African Americans respond less favorably to beta blockers and angiotensin-converting enzyme (ACE) inhibitors. Nevertheless, the observed response in African Americans to ACE inhibitors and beta blockers is clinically significant. The available literature indicates that Asian American responses to calcium antagonists seem to be more favorable than responses to ACE inhibitors and equivalent to their responses to diuretic and beta blocker therapy. Although there are few published studies of drug efficacy in Hispanic Americans, there appears to be no hierarchy in response to the various antihypertensive drug classes. Ethnicity is not an accurate criterion for predicting poor response to any class of antihypertensive therapy. Thus, there is little justification to use racial profiling as a criterion for the avoidance of selected drug classes because of presumed lack of efficacy. Observed differences in the incidence of hypertension and its poor outcomes have led some investigators to postulate that the etiology of hypertension in ethnic minority groups is intrinsically different from whites. Awareness of racial differences in hypertension outcomes evolved in the United States within a historical context that does not fully appreciate that race is often a surrogate for many social and economic factors that influence health status and healthcare delivery. Poor outcomes in ethnic minority groups occur in many diseases, not only hypertension. The goal of ethnicity-related research should be to describe the diversity of disease expression in humans and to target at-risk groups for prevention and early intervention. The use of racial descriptors to explain genetic differences in ethnic groups should take a lesser priority.

Hypertension in pediatric patients: current issues

OBJECTIVE

To present current information on the diagnosis, treatment, and epidemiologic features of hypertension in children.

DESIGN

The guidelines published by the Task Force on Blood Pressure Control in Children in 1987 are critically evaluated, and more recent data are discussed.

RESULTS

Prevention of the consequences of hypertension necessitates recognition of the condition. Although hypertension in the pediatric age-group is an uncommon finding, it does exist. The diagnosis is based on careful technique, repetitive blood pressure measurements, and comparison with established norms. Normal blood pressure values for children have been derived from a series of large cross-sectional studies. Although they have certain shortcomings, they are useful. Height and weight are important determinants in the use of the normative data. The selection of a blood pressure cuff that completely encircles the arm is crucial. Tracking--the persistence of systolic and diastolic pressures at stable percentiles--is not a constant finding, but children at risk for development of hypertension as adults may be identifiable. As in the adult population, children with hypertension have no signs or symptoms that clearly distinguish primary from secondary hypertension.

CONCLUSION

Treatment of children with hypertension should be individualized. Etiologic evaluation is probably best performed at referral centers.