Blood pressure during adolescence: a study among Belgian adolescents selected from a high cardiovascular risk population

Factors influencing adolescent blood pressure: the Debrecen Hypertension Study

AIM

To obtain epidemiological data on the blood pressure (BP) status of high school students and factors influencing BP.

METHODS

Subjects filled out a questionnaire and three repeated BP measurements were taken. All high school attending students in Debrecen (final sample n = 10,194, mean age 16.6 ± 1.0 years) participated in the study.

RESULTS

Boys had significantly higher systolic BP (+11.3 mm Hg) and diastolic BP (+2.2 mm Hg) than girls (p < 0.001). There was a positive correlation between weight and BP (r(syst) = 0.42, r(diast) = 0.29), height and BP (r(syst) = 0.33, r(diast) = 0.15), body mass index (BMI) and BP (r(syst) = 0.31, r(diast) = 0.27). Multiple regression was used for statistical analysis. Gender (β = 0.36), BMI (β = 0.25), hypertension of parents (father β = 0.04 and mother β = 0.02), smoking, alcohol consumption and age determined systolic outcomes in descending order. For the diastolic model, BMI remained a strong determining factor (β = 0.25) and gender was also significant (β = -0.09). Entering independents together accounted for 28.2% of the total variance in systolic and for 18.1% in diastolic BP.

CONCLUSION

Body weight is central to determining BP. Because that is an alterable cardiovascular risk factor, we presume that lifestyle modification will not only result in reduced weight, but also in decreased BP.

Blood pressure references for Polish children and adolescents

The objective of this study was to develop age- and gender-specific reference ranges for blood pressure in a large national database on blood pressure levels throughout childhood and adolescence in young Poles. A prospective cross-sectional study was performed in 2002-2005 in the representative sampling sites, selected randomly from the entire Poland. Altogether, 6,447 school pupils, aged 7-18 years, were involved in the study of which 3,176 were boys and 3,271 were girls. Statistical analysis was performed using STATISTICA for Windows 7.1. The normal range of blood pressure, determined by age and the category of body height percentiles, revealed percentiles values which might serve as reference values to identify cases of high normal blood pressure (the mean blood pressure between 90th and 95th percentiles for age and gender) and hypertension (the mean blood pressure equals or exceeds the 95th percentiles on at least three occasions).

Correlations between the blood pressure and other health variables in Spanish adolescents

The aim of this paper was to study the correlations between blood pressure and other health variables in Spanish adolescents. 204 boys and 270 girls (aged 13-17 years, with written parental consent,) from 18 private and 17 public educative centers from 16 of 21 districts of the city of Madrid, constituted the representative sample. 12.7% of the boys and 35.6% of the girls were inactive or sedentary. Socioeconomic status significantly determined the physical activity of girls, especially in the age group 16-17 years. The tobacco consumption by girls was significantly greater than by boys. A significant inverse relation of tobacco consumption with physical activity was found for boys. Among the girls, 47.4% were lightly overweight to obese as opposed to 14.7% of boys. A significant association between adiposity and physical activity in the girls was observed. The averages for the systolic/diastolic blood pressure were 125.6/71.3 mm Hg in boys and 118/69.4 mm Hg in girls. A significant relation between gender and systolic blood pressure was found. A relation between physical activity and diastolic blood pressure for boys was observed (69.9 mm Hg for active or very active and 74.1 mm Hg for moderately active to sedentary). The lack of existing relations between blood pressure and others variables support the hypothesis that these variables require a longer-term to become obvious cardiovascular risk factors. We believe, therefore, that girls and those from lower socioeconomic status should receive high-priority attention concerning health-related habits.

Metabólitos séricos da vitamina D não se correlacionam com pressão arterial em adolescentes

OBJETIVO: O objetivo deste estudo foi avaliar a associação entre o estado nutricional da vitamina D, a adiposidade e a pressão arterial (PA) em adolescentes. MÉTODOS: Foi realizada avaliação antropométrica, da composição corporal, da ingestão alimentar, de medidas bioquímicas e aferição da PA de 205 adolescentes, com média de idade de 18,2 anos. RESULTADOS: Destes, 12,19% apresentaram PA elevada. O nível sérico médio da 25OHD foi 29,2(0,8) ng/mL, e 62% dos adolescentes apresentaram insuficiência de vitamina D. Não foi encontrada correlação significativa entre a PAS e a PAD com a 25OHD e a 1,25(OH)2D. Houve correlação negativa entre a PAD com os níveis séricos de adiponectina, e tanto a PAS quanto a PAD apresentaram correlação positiva com a circunferência da cintura em ambos os sexos. CONCLUSÃO: Não houve relação entre os níveis séricos de vitamina D e a PA. Porém, a gordura visceral apresenta risco potencial para elevação da PA em adolescentes.

Overweight and blood pressure: results from the examination of a selected group of adolescents in northern Italy

OBJECTIVE

The aim of the present study was to investigate blood pressure (BP) levels and their relationship with different indices of body fat in a group of adolescents, in order to evaluate the prevalence of hypertension and plan preventive and corrective strategies.

DESIGN

Cross-sectional study in primary care.

SETTING

All high schools in the Aosta Valley region, northern Italy.

SUBJECTS

Five hundred and thirty-two adolescents of both sexes, aged 15.4 (standard deviation 0.7) years. The following parameters were measured: body weight, body height, body mass index (BMI), four skinfold thicknesses, body fat mass, waist and hip circumferences and BP.

RESULTS

BMI data indicated a high prevalence of overweight subjects in both sexes, but higher in males, while the prevalence rate of obese adolescents was lower. Of the total, 11.8 % of subjects suffered from systolic hypertension, while 6.9 % suffered from diastolic hypertension. In linear correlation analysis, BMI and all adiposity indices, except waist:hip ratio, were found to be significantly associated (P ranging between 0.05 and 0.001) with both systolic BP and diastolic BP in both sexes, with r ranging between 0.152 and 0.359. Multiple regression analysis with the stepwise method showed BMI and body fat mass to have the strongest association (P < 0.001) with BP, with r ranging between 0.275 and 0.359.

CONCLUSION

Unless reversed, these conditions are worrying and predict the possible development of cardiovascular disease in adulthood. There is a pressing need to develop a comprehensive medical and nutrition plan, together with preventive and corrective strategies, in school programmes.

Fatores de risco associados à pressão arterial elevada em adolescentes

Níveis elevados de pressão arterial (PA) na infância e adolescência têm sido freqüentemente associados a outros fatores de risco cardiovasculares, além de hipertensão arterial na fase adulta da vida. O presente estudo objetivou identificar fatores de risco associados à PA elevada em adolescentes. Participaram do estudo 674 adolescentes de escolas públicas e privadas, de ambos os sexos (303 rapazes e 371 moças), com idade de 14 a 17 anos (16,5 DP 0,9), da cidade de João Pessoa, Paraíba. Mediante aplicação de um questionário, foram levantadas informações sobre: a) indicadores sociodemográficos; b) nível de prática da atividade física; c) hábitos alimentares; c) índice de massa corporal; e) fumo e bebidas alcoólicas; e foram realizadas medidas de PA. A prevalência de PA elevada foi de 7,4%, sendo maior nos rapazes (10,2%) quando comparada com a das moças (5,1%, p < 0,01). Os resultados da análise multivariada demonstraram que adolescentes com excesso de peso apresentaram probabilidade cerca de cinco a seis vezes maior de ter PA elevada, comparados com os de baixo peso/peso normal (rapazes: OR = 5,5; IC 95% = 1,11-27,53 e moças: OR = 4,8; IC 95% = 1,51-15,45). As demais variáveis não se mostraram associadas à PA elevada. Nesse estudo, entre os diversos fatores de risco analisados, o excesso de peso corporal se apresentou como o único fator de risco potencial para elevação da PA em adolescentes.

Blood pressure and related cardiovascular disease risk factors in 6-18 year-old students in Italy

OBJECTIVES

The aims of this study were to provide data on blood pressure (BP) levels, to measure prevalence of high-normal or high BP and to identify a set of conditions that may predict high BP (HBP) in a population of children and adolescents in Italy.

METHODS

A random sample of students 6-18 years old attending randomly selected schools in Catanzaro, Italy, was recruited. All students completed a questionnaire on their health and on health behaviours, such as physical activity, diet, drinking and smoking. Blood pressure, heart rate, height, weight and body mass index (BMI) were recorded.

RESULTS

Of the 603 subjects examined, 12.8% had high-normal BP, 3.5% hypertension (HTN) and 11.1% were obese. High-normal or high diastolic BP (DBP) was significantly more likely in older subjects with a higher BMI, in those with a smoker mother and in preterm children, whereas high-normal or high systolic BP (SBP) was significantly more likely to be found in older subjects with a higher BMI and in those who had at least one parent with HTN. High-normal or high DBP or SBP were significantly predicted by BMI and age.

CONCLUSIONS

Interventions should focus at reducing obesity and encouraging proper dietary habits, sufficient exercise and cessation of smoking habit in parents too, especially in children with a family history of HTN.

Blood pressure distribution in a Hungarian adolescent population: comparison with normal values in the USA

OBJECTIVES

To describe the blood pressure characteristics and distribution of all adolescent high school students (aged 15-18 years) in Debrecen (total population 230 000), Hungary. To define threshold values for normal blood pressure by age-, sex- and height-specific groups. To compare our data with results from a USA meta-analysis, which forms the basis of current guidelines.

PARTICIPANTS AND METHODS

All young people attending high school in Debrecen (final sample = 10 359) participated in the study. After they had rested for 10 min, three blood pressure measurements were taken from the right upper arm, separated by 5 min intervals. All measurements were obtained by a validated, automated, digital Omron M4 device.

RESULTS

The 50th, 90th and 95th percentile values of blood pressure were defined by dividing the adolescent population into age-, sex- and height-specific subgroups. In comparison with USA guidelines, in our sample the systolic blood pressure of boys in the different subgroups was 6-11 mmHg greater, whereas this difference was less marked for girls (1-5 mmHg). There were no marked differences in diastolic blood pressure, but our values were slightly lower.

CONCLUSIONS

Our findings demonstrate the influence of geographical and ethnic variations on blood pressure. Acceptance and use of non-population-specific blood pressure distributions may lead to under- or overdiagnosis of adolescent hypertension. The use of geographically more relevant data should be encouraged.

Blood pressure measurement in epidemiological investigations in teenagers

BACKGROUND

The use of sphygmomanometers may lead to problems in investigations on health of young people. The purpose of this paper is to present the validation of the blood pressure (BP) collected during the survey 'Youth Heart Health' in Hainaut by using second sample of young people in Hainaut for which BP was measured by a manual taking of tension and by an electronic device.

METHODS

Validation was done with a control sample of 343 young with five successive BP measures: twice with the mercury sphygmomanometer and three with DXL. We compared the manual and the electronic measures in order to study the correlation between the two methods. The control sample was used in order to compare the BP measurements with the results of the survey on the health of young people in Hainaut.

RESULTS

The differences between manual systolic BP and Dinamap measures are significant (differences in averages 3.6 mmHg; d.s. 7.8; 95% CI: 2.8-4.4 mmHg; p < 0.001) and the regression coefficient is -0.015. Diastolic BP is significantly higher with the manual method than with Dinamap (differences in means: 8.2 mmHg; d.s. 7.0; 95% CI: 7.4-8.9 mmHg; p < 0.001) and the coefficient of regression is 0.096. We observe a difference in BP between the general survey and the control group (10.3 mmHg for systolic manual control and of 10.9 mmHg for systolic electronic control; 3.3 mmHg for diastolic manual control and of 11.5 mmHg for diastolic electronic control).

CONCLUSIONS

The values of BP of the 'Youth Heart Health' are significantly higher. These observations indicate the difficulties in the choice of the tool for measurements of BP in epidemiological investigations in the teenagers. In order to decrease skews of observations in the measurement of BP, it is recommended to use a valid electronic instrument. Dinamap XL is an instrument of choice in such studies of young people. Environmental and organisational factors may also explain the observed difference, which means that survey's protocols should address this issue carefully.

Issues in adolescent health: a challenge for nursing

The young people of today are the greatest investment we as adults have in our future. The care and nurturing we afford the adolescent is just as important as that which we afford to children or the elderly. Although most adolescents have a preoccupation with their bodies, they do not always engage in activities that will protect and develop them. Adolescents are often exposed to peer pressure, the effects of which may impact negatively on their behaviour and their health. Many adolescent health and behavioural issues evolve from developmental changes and can manifest in a confrontational attitude toward society, parents and others. They are hormonally 'fully charged', and their adolescent sexuality can have enormous effects on their future physical, psychosocial, moral and sexual development. Nurses have a pivotal role to play in ensuring children and adolescents learn the facts relating to the consequences of engaging in unhealthy behaviour and lifestyle. Nurses must also encourage parents to model and reinforce good health practices, such as serving balanced and nutritious meals at regular times and planning positive family activities. In this paper we review some of the salient issues in adolescent health today.