1
|
Hassan MM, Sarry Eldin AM, Musa N, El-Wakil KH, Ali M, Ahmed HH. Insights into the implication of obesity in hypogonadism among adolescent boys. J Pediatr Endocrinol Metab 2022; 35:1497-1504. [PMID: 36282972 DOI: 10.1515/jpem-2022-0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/03/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This research aimed at uncovering the mechanisms behind obesity-related hypogonadism in adolescent boys and to investigate the association between anthropometric characteristics and testicular functions of these boys. METHODS This study included 60 adolescent boys (12-18 years) with exogenous obesity (BMI≥95th percentile) and 30 age matched lean controls (BMI=15th-85th percentile). Full clinical examination, anthropometric measurements and pubertal assessment were performed. Laboratory investigations included hemoglobin, hematocrit, lipid panel, LH, FSH, free and total testosterone, inhibin B and estradiol. RESULTS The results indicated the presence of positive family history of obesity in 85% of obese boys vs. 40% of the lean counterparts. Concerning SBP of obese boys, 7% were hypertensive (95th percentile), 25% were prehypertensive (between 90th and 95th percentiles) while, DBP findings showed that 33% are hypertensive and 33% are prehypertensive. Meanwhile, 13.3% of lean controls were prehypertensive. Anthropometric measurements and lipid profile values revealed a significant difference between obese and lean boys. Compared to obese boys the normal weight boys had higher levels of free testosterone (21.15 ± 2.90 pg/mL vs. 11.38 ± 3.96 pg/mL, p<0.001), total testosterone (10.59 ± 6.63 ng/dL vs. 3.23 ± 1.70 ng/dL, p<0.001), FSH (7.33 ± 3.75 mIU/mL vs. 5.63 ± 3.96 mIU/mL, p=0.026) and inhibin B (83.28 ± 27.66 pg/mL vs. 62.90 ± 17.85 pg/mL, p=0.001) and they registered lower level of estradiol (18.48 ± 7.33 pg/mL vs. 40.20 ± 7.91 pg/mL, p<0.001). In obese boys, BMI SDS significantly correlated with lipid profile and estradiol whereas, it showed significant negative correlation with LH, free and total testosterone and inhibin B. Penile length significantly correlated with LH while it revealed significant negative correlation with cholesterol. CONCLUSIONS This study evidenced a close association between obesity and hypogonadism in adolescent boys which could be due to the increased estradiol level and decreased T/E2 ratio.
Collapse
Affiliation(s)
- Mona M Hassan
- Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Azza M Sarry Eldin
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Noha Musa
- Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khaled H El-Wakil
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - May Ali
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Hanaa H Ahmed
- Hormones Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| |
Collapse
|
2
|
Wieniawski P, Werner B. Prediction of the hypertension risk in teenagers. Cardiol J 2022; 29:994-1003. [PMID: 32515484 PMCID: PMC9788731 DOI: 10.5603/cj.a2020.0079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Creation of a hypertension risk stratification model and development of an algorithm to detect hypertension in teenagers. METHODS The study group consisted of 690 middle and high school students, aged 15-17 years, from the metropolitan area of Warsaw, Poland. Information concerning family history and presence of risk factors for cardiovascular disease was gathered. Three-time blood pressure measurements were taken during at least two separate visits, which were at least a week apart, using the auscultatory method, according to standard procedures. Anthropometric measurements included: body weight, height, arm, hip and abdominal circumference, skin-fold thickness measured on the rear surface of an arm, below the inferior angle of the scapula and at the belly. Following indexes were determined: body mass index, waist to hip ratio (WHR), waist to height ratio, hip to height ratio. RESULTS A logistic regression model, describing the risk of hypertension in adolescents aged 15-17 was invented. p(x) = (e^g(x))/(1+e^g(x)) where ĝ(x) = -0.097 × height+0.085 × weight+7.764 × WHR+1.312 × family hypertension. Family hypertension means presence of hypertension among members of the closest family. The formula was created, allowing the pre-selection of adolescents at risk of hypertension during screening. Next an algorithm for the detection of hypertension for practical use was proposed. CONCLUSIONS Body weight, WHR and incidence of hypertension in the family are the strongest predictors of hypertension in teenagers. Proposed screening algorithm can be a useful tool for selecting teenagers at risk of hypertension and in need of specialized diagnostics and care.
Collapse
|
3
|
The association between fluoride in water and blood pressure in children and adolescents. Pediatr Res 2022; 92:1767-1772. [PMID: 35190682 DOI: 10.1038/s41390-022-01982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 01/10/2022] [Accepted: 01/16/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The objective of this study was to determine the association between water and plasma fluoride and blood pressure (BP) among children and adolescents. METHODS Our study population was individuals of 8-18 years in the 2013-2016 National Health and Nutrition Examination Survey. We performed a multivariable linear and logistic regression analysis to examine the relationship between fluoride and BP. RESULTS In a linear regression analysis for systolic BP (SBP) (mm Hg) adjusting for age, sex, race, and poverty, fluoride in water (mg/L) was significant with a coefficient of -0.44 (p = 0.046) among adolescents (12-18 years). Additional adjustments for race, poverty, serum levels of cotinine, and BMI remained significant. While an inverse relationship was found in children (8-11 years), none were significant. Fluoride in plasma was not significant across all ages. The odds ratio of high BP for an increase in water fluoride also was not significant. CONCLUSIONS Higher concentrations of fluoride in water were associated with low SBP only among adolescents. Fluoride alone cannot be responsible for BP as several biological metabolic processes may influence its physiological effects. Fluoride consumption should be considered in conjunction with these processes. IMPACT The high fluoride in drinking water was statistically significantly associated with low systolic BP in children and adolescents. The odds ratio of high BP for an increase in fluoride in drinking water was not significant. Our study contributes to the existing literature by providing individualized data and results on an individual level.
Collapse
|
4
|
Yang Y, Dai J, Min J, Wu H, Huang S, Li Q, Chai J. Prevalence trends of hypertension and influence factors among children and adolescents aged 7-17 years in China, 2011-2015: A serial cross-sectional study. Front Public Health 2022; 10:887285. [PMID: 36311569 PMCID: PMC9608369 DOI: 10.3389/fpubh.2022.887285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/30/2022] [Indexed: 01/21/2023] Open
Abstract
Hypertension has rapidly increased in the last decades throughout the world. It is an emerging disease. However, limited information is available on secular trends and factors of childhood and adolescents' hypertension in China. In this study, 5-year successive data were derived from a cross-sectional study of the China Health and Nutrition Survey (CHNS) in 2011 and 2015. We used systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) at least 95th percentile on the basis of age, sex, and height percentiles to define hypertension (HBP). A total of 2,827 children and adolescents aged 7-17 years were included. The age-standardized prevalence of hypertension was increased significantly across 5 years: the standardized prevalence of hypertension was increased from 8.08% (2011) to 11.46% (2015) in China (P < 0.01). The mean SBP of boys increased from 101.21 to 102.79 mmHg, while the mean SBP of girls increased from 98.96 to 100.04 mmHg. The mean DBP of boys increased from 61.20 to 67.40 mmHg, while the mean DBP of girls increased from 64.34 to 65.76 mmHg. The prevalence of hypertension grew continuously in both sexes, but the pace of change for boys was more rapid than that for girls. This study confirmed that the association between rural (odds ratio [OR] = 1.394, 95%CI 1.032-1.883), overweight/obesity (OR = 2.621, 95%CI 1.506-4.562), and BP levels was highly correlated (P < 0.05). The possible protecting factors associated with hypertension were being a girl (OR = 0.788, 95%CI 0.595-1.043). There was no association between weekly physical activity, daily sleep duration, and hypertension (P > 0.05). Further in-depth analysis of influencing factors and comprehensive interventions should be urgently implemented to combat the hypertension epidemic among children and adolescents in China.
Collapse
Affiliation(s)
- Yunjuan Yang
- Department of School Health, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China,Public Health School, Kunming Medical University, Kunming, China,Public Health School, Dali University, Dali, China,*Correspondence: Yunjuan Yang
| | - Jing Dai
- Management and Economy School, Kunming University of Science and Technology, Kunming, China
| | | | - Huamei Wu
- The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Songquan Huang
- The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qingsheng Li
- Department of School Health, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Jiajia Chai
- Management and Economy School, Kunming University of Science and Technology, Kunming, China
| |
Collapse
|
5
|
Gour-Provençal G, Costa C. Metabolic Syndrome in Children With Myelomeningocele and the Role of Physical Activity: A Narrative Review of the Literature. Top Spinal Cord Inj Rehabil 2022; 28:15-40. [PMID: 36017122 DOI: 10.46292/sci21-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives The purpose of this review is to describe the current scientific literature on the prevalence of metabolic syndrome in children with myelomeningocele and to gain insight into the baseline levels of aerobic fitness, endurance, and strength in this population in order to identify gaps in knowledge, suggest potential primary prevention strategies, and provide recommendations for future studies. Methods A literature review of articles published in English and French between 1990 and April 2020 was conducted. Results Obese adolescents with myelomeningocele have an increased prevalence of components of the metabolic syndrome. Children and adolescents with myelomeningocele have decreased aerobic fitness and muscular strength, decreased lean mass, and increased fat mass, all of which, when combined with higher levels of physical inactivity, put them at higher risk of developing metabolic syndrome and cardiovascular diseases. Conclusion Until more research is conducted, addressing weight-related challenges and promoting healthy habits (such as optimal activity levels) could be easily integrated into yearly myelomeningocele clinics. An actionable suggestion might be to systematically weigh and measure children in these clinics and utilize the results and trends as a talking point with the parents and children. The follow-up appointments could also be used to develop physical activity goals and monitor progress. We recommend that the health care practitioner tasked with this intervention (physician, nurse, etc.) should be aware of locally available accessible sports platforms and have knowledge of motivational interviewing to facilitate removal of perceived barriers to physical activity.
Collapse
Affiliation(s)
| | - Camille Costa
- Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
| |
Collapse
|
6
|
He Y, Li SM, Zhang Q, Cao K, Kang MT, Liu LR, Li H, Wang N. The performance of an integrated model including retinal information in predicting childhood hypertension. Pediatr Res 2022; 91:1600-1605. [PMID: 33947999 DOI: 10.1038/s41390-021-01535-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The objective of this study was to examine the association of an integrated model (composed of retinal arteriolar caliber, height, and sex) with blood pressure (BP) among a group of Chinese children, and assess the predictive value of the integrated model for childhood hypertension. METHODS This study included 1460 candidates aged 12.634 ± 0.420 years. Height, weight, waist circumference, and BP were obtained and ophthalmological measurements were taken. The computer-imaging program (IVAN, University of Wisconsin, Madison, WI) was used to measure calibers of retinal vessels. Receiver-operating characteristic curve (ROC) analyses were performed to assess the accuracy of the integrated model as a diagnostic test of elevated BP in children. RESULTS The accuracy of the integrated model (assessed by area under the curve) for identifying elevated BP was 0.777 (95% confidence interval: 0.742-0.812). The optimal threshold of the integrated model for defining hypertension was 0.153, and the calculation formula for the specific predictive risk was: Logit (p/1 - p) = -5.666 - 0.261 × retinal arteriolar caliber + 0.945 × sex + 0.438 × height. In identifying elevated BP, the sensitivity and specificity were 0.711 and 0.736, respectively. CONCLUSIONS The model containing eye message is a comprehensive and relatively effective index to identify elevated BP in 12-year-old children, which can offer assistance to further understand childhood microcirculation disease. IMPACT We firstly incorporated retinal vascular diameter, sex, and height into one integrated model to identify hypertension in 12-year-old children. The current discrimination of hypertension in children is difficult. There have been some studies to simplify the diagnosis of children's hypertension, but they were limited to anthropometric measurements. We proposed a composed model containing microcirculation information to predict childhood hypertension. Based on the knowledge that microcirculation is not only a means to study the manifestations but also early pathogenic correlates of hypertension, the combined model containing microcirculation message as a method may provide new insights into the diagnosis of childhood hypertension.
Collapse
Affiliation(s)
- Yuan He
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, China
| | - Shi-Ming Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, China
| | - Qing Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Meng-Tian Kang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, China
| | - Luo-Ru Liu
- Anyang Eye Hospital, Anyang, Henan, China
| | - He Li
- Anyang Eye Hospital, Anyang, Henan, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, China.
| | | |
Collapse
|
7
|
Kolanowski W, Ługowska K, Trafialek J. Increased Physical Activity at School Benefits Arterial Blood Pressure in Children-A Prospective Follow-Up Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084662. [PMID: 35457528 PMCID: PMC9032198 DOI: 10.3390/ijerph19084662] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
(1) Background: A sedentary lifestyle and low physical activity (PA) increase the risk of hypertension in children. The aim of this study was to assess the impact of increased PA at school by elevation of the number of compulsory physical education (PE) lessons on arterial blood pressure in children during a two-year follow-up. (2) Methods: Children (n = 245) born in 2007 attending a standard or elevated number of PE lessons in the school timetable (4 and 10 h a week, respectively) took part in the study. Blood pressure was measured starting from age approx. 10 to 12. (3) Results: Starting from a similar level, after 2 years, the percentage of children with normal blood pressure decreased in the standard-PE children from 83.25% to 78.03% but increased in the elevated-PE ones from 83.15% to 86.13%. The prevalence of both prehypertension and hypertension increased by one-third in the standard-PE children from 16.74% to 21.97% but decreased by one-sixth in the elevated-PE ones from 16.85% to 13.87%. The prevalence of hypertension itself increased by one-third in the standard-PE children from 9.82% to 13.12% but decreased in the elevated-PE ones by one-fifth from 9.60% to 7.75% (4) Conclusions: An increase in PA at school by the elevation of the number of PE lessons benefits children's arterial blood pressure. Early prevention of hypertension in children can be supported by an adequate number of PE lessons in the school timetable.
Collapse
Affiliation(s)
- Wojciech Kolanowski
- Faculty of Health Sciences, Medical University of Lublin, 20-400 Lublin, Poland
- Correspondence: ; Tel.: +48-603842005
| | - Katarzyna Ługowska
- Faculty of Medical and Health Sciences, Siedlce University, 08-110 Siedlce, Poland;
| | - Joanna Trafialek
- Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, 02-787 Warsaw, Poland;
| |
Collapse
|
8
|
Corken A, Thakali KM. Maternal Obesity Programming of Perivascular Adipose Tissue and Associated Immune Cells: An Understudied Area With Few Answers and Many Questions. Front Physiol 2022; 12:798987. [PMID: 35126181 PMCID: PMC8815821 DOI: 10.3389/fphys.2021.798987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/09/2021] [Indexed: 12/11/2022] Open
Abstract
At present, the worldwide prevalence of obesity has become alarmingly high with estimates foreshadowing a continued escalation in the future. Furthermore, there is growing evidence attributing an individual’s predisposition for developing obesity to maternal health during gestation. Currently, 60% of pregnancies in the US are to either overweight or obese mothers which in turn contributes to the persistent rise in obesity rates. While obesity itself is problematic, it conveys an increased risk for several diseases such as diabetes, inflammatory disorders, cancer and cardiovascular disease (CVD). Additionally, as we are learning more about the mechanisms underlying CVD, much attention has been brought to the role of perivascular adipose tissue (PVAT) in maintaining cardiovascular health. PVAT regulates vascular tone and for a significant number of individuals, obesity elicits PVAT disruption and dysregulation of vascular function. Obesity elicits changes in adipocyte and leukocyte populations within PVAT leading to an inflammatory state which promotes vasoconstriction thereby aiding the onset/progression of CVD. Our current understanding of obesity, PVAT and CVD has only been examined at the individual level without consideration for a maternal programming effect. It is unknown if maternal obesity affects the propensity for PVAT remodeling in the offspring, thereby enhancing the obesity/CVD link, and what role PVAT leukocytes play in this process. This perspective will focus on the maternal contribution of the interplay between obesity, PVAT disruption and CVD and will highlight the leukocyte/PVAT interaction as a novel target to stem the tide of the current obesity epidemic and its secondary health consequences.
Collapse
Affiliation(s)
- Adam Corken
- Arkansas Children’s Nutrition Center, Little Rock, AR, United States
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Keshari M. Thakali
- Arkansas Children’s Nutrition Center, Little Rock, AR, United States
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- *Correspondence: Keshari M. Thakali,
| |
Collapse
|
9
|
Wieniawski P, Werner B. Epidemiology of Obesity and Hypertension in School Adolescents Aged 15-17 from the Region of Central Poland-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052394. [PMID: 33804520 PMCID: PMC7967734 DOI: 10.3390/ijerph18052394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 02/07/2023]
Abstract
The aim of this cross-sectional study was to assess the prevalence of abnormal weight and anthropometric parameters along with abnormal blood pressure values in adolescents in Poland. Anthropometric measurements were taken in the studied age group and the correlation between these values and blood pressure values and the diagnosis of hypertension was analyzed. The main aim of the study was to characterize the particular age group in the selected population: 690 students aged 15–17 years were examined. Blood pressure and anthropometric values including height, weight, circumferences of the hips, abdomen and arms, as well as skinfolds on the back of the arm, below the scapula and the stomach, were taken. The following indexes were calculated: WHR (waist to hip ratio), WHtR (waist to height ratio), BAI (body adiposity index-hip to height ratio) and BMI (body mass index). Mean SBP (systolic blood pressure) was 112.3 (standard deviation (SD) 12.2) mmHg, and DBP (diastolic blood pressure) was 66.9 (SD 6.9) mmHg. The prevalence of hypertension in the studied group was 5.8% (3.2% boys, 2.6% girls) and prehypertension was present in 4.4% (1.6% boys, 2.8% girls). The prevalence of excess body weight was 23.6%-obesity 11.3% (40 girls, 27 boys) and overweight 12.3% (50 girls, 34 boys). Correlations between BMI and waist, hip and arm circumference, subscapular and abdominal skinfold thickness, WHtR and BAI were r = 0.86, r = 0.84, r = 0.88, r = 0.81, r = 0.75, r = 0.88 and r = 0.81, respectively (p < 0.05). Significant differences (p < 0.05) of SBP and DBP values, depending on weight category, as defined by BMI, were observed. Abnormal blood pressure values occur in one tenth and abnormal body weight in almost a quarter of the studied population. Obese and overweight children have higher SBP and DBP values compared to children with normal body weight.
Collapse
|
10
|
Min J, Griffis HM, Mendoza M, Tam V, Kaplinski M, Kogon AJ, Hanson H, Meyers KE, Natarajan SS. The Impact of Early Recognition and Treatment of Systemic Hypertension on Reducing Blood Pressure: The Hypertension and Vascular Evaluation Program. Clin Pediatr (Phila) 2020; 59:970-977. [PMID: 32476462 DOI: 10.1177/0009922820927037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to evaluate the effect of an outpatient systemic hypertension program and associated factors with attending recommended follow-up visit. All visits were tracked in the program, 2011 to 2018. We examined patient characteristics by follow-up status and changes in systolic blood pressure (SBP) and the risk of hypertension in follow-up patients using a mixed-effects regression model. Among 310 patients with first visits, 113 patients returned for a follow-up visit. Patients who did not attend a follow-up were older and less likely to have a severe chronic condition or a family history of hypertension than followed-up patients. The risk of hypertension was significantly reduced by the number of follow-up visits (odds ratio = 0.53, 95% confidence interval = 0.31-0.92). Adolescent SBP and body mass index percentiles decreased with more follow-up visits. As the risk of hypertension is significantly reduced with follow-up visits, additional effort should be made to improve the likelihood of follow-up attendance.
Collapse
Affiliation(s)
- Jungwon Min
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather M Griffis
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Melodee Mendoza
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Vicky Tam
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Amy J Kogon
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, US
| | | | - Kevin E Meyers
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, US
| | - Shobha S Natarajan
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
11
|
Arango-Paternina CM, Lobelo F, Páez-Rubiano DC, Petro-Petro JA, Llano-Garcia M, Duperly-Sanchez J, Parra D. Association between high blood pressure and fitness and fatness in adolescents. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n3.77559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Excess adiposity is considered the most important risk factor for high blood pressure (HBP) in children and adolescents.Objectives: To explore the association between HBP and overweight (OW) and abdominal obesity (AO), mediated by cardiorespiratory fitness (CRF). To analyze the combined effect of excess adiposity and CRF on HBP among a sample of school-aged children from Montería, Colombia.Materials and methods: Cross-sectional study conducted in a sample of 546 adolescents aged between 11 and 18 years, from 14 randomly selected schools in Montería. Blood pressure, anthropometric, and fitness measures were evaluated by trained personnel using standardized protocols and instrumentation. The association of HBP with fitness and fatness was analyzed using logistic regression models.Results: HBP was associated with OW, AO and low CRF. The inclusion of CRF in this model did not attenuate the association between HBP and OW and between HPB and AO. Adolescents with higher adiposity and low CRF were more likely to have HBP compared with those with lower adiposity and high CRF. Moreover, it was found that excess adiposity and low CRF had an additive effect on the risk of HBP among the sample.Conclusion: HBP is a prevalent condition in children and adolescents from Montería, Colombia. HBP is significantly associated with OW, AO, and low CRF; therefore, it is necessary to implement initiatives to promote healthy habits aimed at this population in order to reduce the incidence rate of HBP in Colombian adolescents.
Collapse
|
12
|
Solomon-Moore E, Salway R, Emm-Collison L, Thompson JL, Sebire SJ, Lawlor DA, Jago R. Associations of body mass index, physical activity and sedentary time with blood pressure in primary school children from south-west England: A prospective study. PLoS One 2020; 15:e0232333. [PMID: 32348363 PMCID: PMC7190166 DOI: 10.1371/journal.pone.0232333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/13/2020] [Indexed: 12/13/2022] Open
Abstract
Elevated blood pressure in children is a significant risk factor for the development of cardiovascular disease in adulthood. We examined how children’s body mass index (BMI), physical activity and sedentary time at ages 9 and 11 are associated with blood pressure at age 11. Data were from 1283 children from Bristol, UK, who participated in the study aged 11 years, 797 of whom also participated in the study aged 9 years. Child height, weight and blood pressure were measured, and children wore accelerometers for five days, from which moderate-to-vigorous-intensity physical activity and sedentary minutes per day were derived. Multiple imputation of missing data and adjusted linear and logistic regression models were used to examine associations. Child BMI at 11 years was cross-sectionally associated with higher systolic and diastolic blood pressure (mean difference [95% confidence interval]: 0.91 [0.32 to 1.50] mm Hg and 1.08 [0.54 to 1.62] mm Hg, respectively, per standard deviation (SD) of BMI). BMI at age 9 was also positively associated with diastolic blood pressure at age 11 (1.16 mmHg per two years [0.49 to 1.84], per SD of BMI). For girls, sedentary time at age 9 years was associated with increased odds of having high systolic blood pressure at age 11 (odds ratio: 1.08 [1.01 to 1.16], per 10 minutes per day). There was no evidence of associations between sedentary time and blood pressure among boys. Similarly, there was little evidence that physical activity was associated with blood pressure in either cross-sectional or prospective analyses. Effective strategies are needed to prevent excess bodyweight among children in order to reduce cardiovascular disease risk.
Collapse
Affiliation(s)
- Emma Solomon-Moore
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Ruth Salway
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Lydia Emm-Collison
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Janice L. Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Simon J. Sebire
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Deborah A. Lawlor
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
13
|
Packyanathan JS, Preetha S. Comparison of the effect of Yoga, Zumba and Aerobics in controlling blood pressure in the Indian population. J Family Med Prim Care 2020; 9:547-551. [PMID: 32318379 PMCID: PMC7114029 DOI: 10.4103/jfmpc.jfmpc_607_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/01/2020] [Accepted: 01/10/2020] [Indexed: 01/05/2023] Open
Abstract
Aim: This study aims at comparing the effect of Yoga, Zumba dance, and Aerobic exercises in controlling blood pressure among the Indian population without using hypertensive drugs. Objective: This study is designed to analyze the effect of Yoga, Zumba, and Aerobics in controlling blood pressure among the Indian population and to determine which of the three is better to treat hypertension without using hypertensive drugs. Background: Hypertension is a disease which is nowadays most commonly seen among children and adolescents and has been found that regular exercise tends to reduce the levels of high blood pressure in a very effective way among which the effects of aerobics exercise on reducing high blood pressure in hypertensive patients had been more convincing that regular aerobics exercise reduces the blood pressure by > 1.5 mmHg.
Collapse
Affiliation(s)
| | - S Preetha
- Department of Physiology, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| |
Collapse
|
14
|
Drivsholm A, Lund MAV, Hedley PL, Jespersen T, Christiansen M, Hansen T, Holm JC. Associations between thyroid-stimulating hormone, blood pressure and adiponectin are attenuated in children and adolescents with overweight or obesity. J Pediatr Endocrinol Metab 2019; 32:1351-1358. [PMID: 31714888 DOI: 10.1515/jpem-2019-0359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/11/2019] [Indexed: 11/15/2022]
Abstract
Background The association between thyroid-stimulating hormone (TSH) concentrations and blood pressure is well described in adults, but only studied to a limited extent in children and adolescents and almost entirely in population-based cohorts. The present study investigates the association between TSH and blood pressure, and the influence of leptin and adiponectin, in a cohort of children and adolescents enrolled in obesity treatment compared with a population-based cohort. Methods We studied 4154 children and adolescents aged 6-18 years from an obesity clinic cohort and a population-based cohort from The Danish Childhood Obesity Data- and Biobank. Anthropometrics, blood pressure and biochemical markers, including TSH, leptin and adiponectin concentrations, were collected. Adjusted correlation and interaction analyses were performed. Results Patients from the obesity clinic cohort exhibited higher concentrations of TSH and higher blood pressure than participants from the population-based cohort. TSH standard deviation scores (SDS) were significantly associated with all blood pressure-related variables in the population-based cohort, but only with systolic blood pressure SDS and hypertension in the obesity clinic cohort. The interaction between TSH SDS and adiponectin was found to be independently associated with systolic blood pressure and hypertension in the population-based cohort only. Conclusions The significant associations between TSH, adiponectin and blood pressure, observed in children and adolescents from a population-based cohort, are attenuated or absent in children and adolescents with overweight or obesity, suggesting that childhood obesity distorts the healthy interplay between the thyroid axis, thyroid-adipokine interaction and blood pressure.
Collapse
Affiliation(s)
- Alberte Drivsholm
- The Children's Obesity Clinic, European Centre of Management (EASO), Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Asp Vonsild Lund
- The Children's Obesity Clinic, European Centre of Management (EASO), Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Paula L Hedley
- Department for Congenital Disorders, Danish National Biobank and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Christiansen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department for Congenital Disorders, Danish National Biobank and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jens-Christian Holm
- The Children's Obesity Clinic, European Centre of Management (EASO), Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark.,The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
15
|
Ma S, Xu C, Ma J, Wang Z, Zhang Y, Shu Y, Mo X. Association between perfluoroalkyl substance concentrations and blood pressure in adolescents. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2019; 254:112971. [PMID: 31394346 DOI: 10.1016/j.envpol.2019.112971] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Abstract
The effects of exposure to some environmental chemicals on blood pressure have been determined, but the association between non-occupational exposure to perfluoroalkyl substances (PFASs) and blood pressure in adolescents remains unknown. The association between blood pressure and PFAS concentrations was studied by analysing data from 2251 participants filtered from the population enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2012. After adjusting for age, sex, race, BMI, cotinine level, dietary intake of calcium, caloric intake, sodium consumption, potassium consumption and sampling year, we estimated the coefficients (betas) and 95% confidence intervals (CIs) for the relationship between PFAS concentrations and blood pressure with multiple linear regression models. Potential non-linear relationships were assessed with restricted cubic spline models. Blood levels of perfluorooctane sulfonic acid (PFOS) had a strong positive association with diastolic blood pressure (DBP) in adolescents in the linear model, while the result was not significant in the non-linear model. No significant association was observed between the concentration of any other PFASs and blood pressure. According to the fully adjusted linear regression model (P = 0.041), the mean DBP values in boys in the higher PFOS quintile were 2.70% greater than the mean DBP values of boys in the lowest PFOS quintile. Furthermore, serum PFOS concentrations predominantly affected blood pressure in male adolescents compared with female adolescents. These results provide epidemiological evidence of PFOS-related increases in DBP. Further research is needed to address related issues.
Collapse
Affiliation(s)
- Siyu Ma
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Cheng Xu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Ji Ma
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Zhiqi Wang
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Yuxi Zhang
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Yaqin Shu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
| |
Collapse
|
16
|
Amiri P, Vahedi-Notash G, Naseri P, Khalili D, Hashemi Nazari SS, Mehrabi Y, Mahdavi Hazaveh AR, Azizi F, Hadaegh F. National trends of pre-hypertension and hypertension among Iranian adolescents across urban and rural areas (2007-2011). Biol Sex Differ 2019; 10:15. [PMID: 30922399 PMCID: PMC6439987 DOI: 10.1186/s13293-019-0230-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/18/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The current nationwide study, for the first time, aimed to assess and compare the trend of pre-hypertension and hypertension among urban and rural adolescents in Iran. METHODS This study has been conducted in the framework of the National Surveys of Risk Factors for Non-Communicable Diseases. To estimate pre-hypertension and hypertension prevalence among 9715 adolescents, aged 15-19 years, data collected in four repeated cross-sectional surveys (2007-2011) has been used. The prevalence trends of pre-hypertension and hypertension were examined across urban and rural areas of Iran. To calculate the adjusted prevalence ratios (PRs) of pre-hypertension and hypertension over cycles across area of residence and genders, a complex sample survey and multinomial logistic analysis were performed. RESULTS Using the definition of pre-hypertension and hypertension presented by the seventh Joint National Committee (JNC-VII) for adolescents, after adjusting for confounders, the prevalence of pre-hypertension changed in both urban (boys:28.96% to 29.24% and girls:18.33% to 20.06%) and rural (boys 31.58% to 32.05% and girls 22.25% to 24.13%) areas over the study duration. Non-significant rising prevalence of hypertension was also observed in boys and girls of both regions (urban 12.76% to 15.04% and 8.02% to 9.06%; rural 9.95% to 11.79% and 10.35% to 11.60%, for boys and girls respectively). The adjusted prevalence ratios (PRs) of pre-hypertension (2.16; 95% CI 1.68-2.79 and 1.92, 95% CI 1.57-2.34, in urban and rural, respectively) and hypertension (2.40; 95% CI 1.65-3.51 and 1.82, 95% CI 1.36-2.45, in urban and rural, respectively) were higher in boys than girls. Comparing the adjusted PRs of pre-hypertension and hypertension in urban versus rural areas, in both genders, showed higher PRs of pre-hypertension in rural girls (1.33, 95% CI 1.01-1.75). CONCLUSION The current results showed high constant trends of pre-hypertension and hypertension in Iranian boys and girls, residing in both urban and rural areas.
Collapse
Affiliation(s)
- Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golnaz Vahedi-Notash
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Naseri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Saeed Hashemi Nazari
- Safety Promotion and Injury Prevention Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Reza Mahdavi Hazaveh
- Center for Non-communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
17
|
Samuels JA, Zavala AS, Kinney JM, Bell CS. Hypertension in Children and Adolescents. Adv Chronic Kidney Dis 2019; 26:146-150. [PMID: 31023449 DOI: 10.1053/j.ackd.2019.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 01/06/2023]
Abstract
Hypertension is a growing problem in children and adolescents, with primary hypertension becoming the most common etiology. In addition to demonstrating that high blood pressure in children and young adults is likely to remain elevated into adulthood, this review (1) addresses important aspects of measuring blood pressure in children and adolescents, (2) defines elevated blood pressure and hypertension in this age group, (3) describes the initial evaluation and workup of abnormally high blood pressure, and (4) introduces treatment strategies for youth with sustained hypertension.
Collapse
|
18
|
Burton ET, Wilder T, Beech BM, Bruce MA. Associations Among Caregiver Feeding Practices and Blood Pressure in African American Adolescents: The Jackson Heart KIDS Study. FAMILY & COMMUNITY HEALTH 2019; 42:133-139. [PMID: 30768478 PMCID: PMC6383774 DOI: 10.1097/fch.0000000000000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Caregiver feeding practices have been linked to youth health outcomes. The present study examined associations among caregiver feeding practices and blood pressure in 212 African American adolescents via the Child Feeding Practices Questionnaire. Results revealed a positive association between caregivers' concern about their child's weight and diastolic blood pressure, which was more acute for older adolescent boys. Caregivers' perceived responsibility for the quality and quantity of food their child receives was also associated with lower diastolic blood pressure in older adolescent boys. Feeding practices are ideal targets of lifestyle intervention, and health care providers should continue to involve caregivers as adolescents approach adulthood.
Collapse
Affiliation(s)
- E. Thomaseo Burton
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
- Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis, TN
| | - Tanganyika Wilder
- Department of Biological Sciences, Florida A&M University, Tallahassee, FL
| | - Bettina M. Beech
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS
- Myrlie Evers-Williams Institute for the Elimination of Health Disparities, University of Mississippi Medical Center, Jackson, MS
| | - Marino A. Bruce
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS
- Myrlie Evers-Williams Institute for the Elimination of Health Disparities, University of Mississippi Medical Center, Jackson, MS
- Center for Research on Men’s Health, Vanderbilt University, Nashville, TN
| |
Collapse
|
19
|
Lou-Meda R, Stiller B, Antonio ZL, Zielinska E, Yap HK, Kang HG, Tan M, Glazer RD, Valentin MA, Wang L. Long-term safety and tolerability of valsartan in children aged 6 to 17 years with hypertension. Pediatr Nephrol 2019; 34:495-506. [PMID: 30397789 PMCID: PMC6349801 DOI: 10.1007/s00467-018-4114-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The present study aimed to assess the long-term safety and tolerability of valsartan in hypertensive children aged 6-17 years, with or without chronic kidney disease (CKD). METHODS This was an 18-month, open-label, multicentre, prospective study conducted in 150 patients with history of hypertension with or without CKD. The primary endpoint was long-term safety and tolerability of valsartan and valsartan-based treatments, assessed in terms of adverse events (AEs), serious AEs, laboratory measurements, estimated glomerular filtration rate (eGFR), urinalysis and electrocardiogram. RESULTS Of 150 enrolled patients, 117 (78%) completed the study. At week 78, a clinically and statistically significant reduction in mean sitting systolic and diastolic blood pressures was observed in all patients (- 14.9 mmHg and - 10.6 mmHg, respectively). Within the first 3 months of treatment, mean urine albumin creatinine ratio decreased in CKD population, which was sustained. A higher percentage of CKD patients had at least one AE compared to non-CKD patients (85.3% vs. 73.3%, respectively). The majority of AEs were mild (50.7%) or moderate (18.7%) in severity. As expected, in patients with underlying CKD, increases in serum potassium, creatinine and blood urea nitrogen were more commonly reported compared to non-CKD patients. A > 25% decrease in Schwartz eGFR was observed in 28.4% of CKD patients and 13.5% of non-CKD patients. CONCLUSIONS Valsartan was generally well tolerated, with an AE profile consistent with angiotensin receptor blockers in the overall population and in patients with underlying CKD. Long-term efficacy was maintained and a beneficial effect on proteinuria was observed.
Collapse
Affiliation(s)
- Randall Lou-Meda
- Fundación para el Niño Enfermo Renal/H. Roosevelt, 6 Avenida 9-18 zona 10 Edificio Sixtino II, Ala I, Oficina 804, Guatemala City, Guatemala.
| | - Brigitte Stiller
- University Heart Center Freiburg, Bad Krozingen, Department of Congenital Heart Fundación para el Niño Enfermo Renal Disease and Pediatric Cardiology, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Zenaida L Antonio
- Department of Pediatric Nephrology, National Kidney and Transplant Institute, Quezon City, Philippines
| | - Ewa Zielinska
- Niepubliczny Zakład Opieki Zdrowotnej, Ezmed, Warsaw, Poland
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hee Gyung Kang
- Division of Pediatric Nephrology, Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Monique Tan
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Linda Wang
- Shanghai Novartis Trading Ltd, Shanghai, China
| |
Collapse
|
20
|
Harbin MM, Hultgren NE, Kelly AS, Dengel DR, Evanoff NG, Ryder JR. Measurement of Central Aortic Blood Pressure in Youth: Role of Obesity and Sex. Am J Hypertens 2018; 31:1286-1292. [PMID: 30107492 DOI: 10.1093/ajh/hpy128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 08/08/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The relationship between pediatric severe obesity (SO) and central aortic blood pressure (BP) has yet to be established. METHODS We conducted a cross-sectional study of 348 youth (48.5% male, age 12.7 ± 0.1 years) with a wide range of body mass index (BMI) values: normal weight (NW; ≥5th and <85th BMI percentiles), overweight/obesity (OW/OB; 85th to <120% of the 95th BMI percentile), and SO (≥120% of the 95th BMI percentile). Measures of central aortic BP were obtained via applanation tonometry with SphygmoCor MM3 software. RESULTS After adjustment for covariates, no significant sex differences were observed for radial-aortic systolic blood pressure (SBP) (P = 0.39), carotid-aortic SBP (P = 0.99), radial-aortic diastolic blood pressure (DBP) (P = 0.44), and carotid-aortic DBP (P = 0.53). Compared to youth with NW, youth with SO exhibited higher radial-aortic SBP (SO vs. NW: 102 ± 1 mm Hg vs. 90 ± 1 mm Hg, P<0.001), carotid-aortic SBP (SO vs. NW: 121 ± 1 mm Hg vs. 109 ± 1 mm Hg, P<0.001), and carotid-aortic DBP (SO vs. NW: 60 ± 1 mm Hg vs. 56 ± 1 mm Hg, P = 0.04). Compared to youth with OW/OB, youth with SO had higher radial-aortic SBP (OW/OB: 97 ± 1 mm Hg, P = 0.002) and carotid-aortic SBP (OW/OB: 114 ± 1 mm Hg, P = 0.007). After adjusting for either total-body percent fat mass or visceral adipose tissue, BMI was still a significant predictor of both radial-aortic and carotid-aortic SBP and DBP (P<0.001, all). CONCLUSIONS In a cohort of youth with a wide range of adiposity levels, central aortic BP was elevated among individuals with SO and associated with BMI but not body fatness.
Collapse
Affiliation(s)
- Michelle M Harbin
- Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Neil E Hultgren
- Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aaron S Kelly
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Donald R Dengel
- Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nicholas G Evanoff
- Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Justin R Ryder
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
21
|
Çakıcı EK, Eroğlu FK, Yazılıtaş F, Bülbül M, Gür G, Aydoğ Ö, Güngör T, Erel Ö, Alışık M, Elhan AH. Evaluation of the level of dynamic thiol/disulphide homeostasis in adolescent patients with newly diagnosed primary hypertension. Pediatr Nephrol 2018; 33:847-853. [PMID: 29297098 DOI: 10.1007/s00467-017-3865-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thiol/disulphide homeostasis plays a critical role in numerous intracellular enzymatic pathways including antioxidant defense and detoxification. This study was designed to investigate the impact of thiol/disulfide homeostasis in adolescent patients with recently diagnosed primary hypertension (HT) using a novel and automated method. METHODS Native thiol/disulphide levels were measured by a novel spectrophotometric method (Cobasc 501, Roche Diagnostics, Mannheim, Germany) in 30 patients with primary HT together with 30 healthy controls. RESULTS The levels of native thiol, total thiol, and native thiol/total thiol ratios were significantly lower, while the disulphide level, disulphide/native thiol, and disulphide/total thiol ratios were significantly higher in patients with primary HT compared with the control group. There were significant positive correlations between 24-h mean systolic and diastolic blood pressure and disulphide levels, disulphide/native thiol, and disulphide/total thiol ratios. A multiple linear regression model showed that a disulphide/native thiol ratio above 5 and family history of HT are independent predictors of HT. CONCLUSIONS Our study showed that dynamic thiol/disulphide homeostasis shifted towards disulphide formation in adolescent patients with primary HT. Understanding the role of thiol/disulfide homeostasis in primary HT might provide new therapeutic intervention strategies for patients.
Collapse
Affiliation(s)
- Evrim Kargın Çakıcı
- Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - Fehime Kara Eroğlu
- Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Fatma Yazılıtaş
- Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Mehmet Bülbül
- Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Gökçe Gür
- Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Özlem Aydoğ
- Department of Pediatric Nephrology, 19 Mayis University Medical School, Samsun, Turkey
| | - Tülin Güngör
- Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Özcan Erel
- Department of Biochemistry, Yıldırım Beyazıt University Medical School, Ankara, Turkey
| | - Murat Alışık
- Department of Biochemistry, Yıldırım Beyazıt University Medical School, Ankara, Turkey
| | - Atilla Halil Elhan
- Department of Biostatistics, Ankara University Medical School, Ankara, Turkey
| |
Collapse
|
22
|
Fobian AD, Elliott L, Louie T. A Systematic Review of Sleep, Hypertension, and Cardiovascular Risk in Children and Adolescents. Curr Hypertens Rep 2018; 20:42. [PMID: 29717377 DOI: 10.1007/s11906-018-0841-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Many of the risk factors for heart disease have recently been shown to develop during childhood such as left ventricular hypertrophy and fibrous plaque lesions. As risk for cardiovascular disease in children and adolescents has risen, sleep duration has decreased, and inadequate sleep in children and adolescents has been found to be associated with cardiovascular disease risk. The aims of this manuscript are to provide an updated systematic review of the literature assessing sleep, hypertension, and cardiovascular risk and evaluate the strength of the evidence based on the available research. RECENT FINDINGS A systematic review was conducted using six databases from January 1, 2015 through March 9, 2018. We sought studies which looked at the relationship between sleep duration, sleep timing, or sleep quality and outcome variables of hypertension, inflammation, obesity, glucose or insulin, and lipids in children and adolescents. We found 24 studies which met our criteria. Nine studies included hypertension as an outcome variable; fifteen included obesity; thirteen included glucose or insulin; eight included lipids; and three included measures of inflammation. The existing literature on sleep and cardiovascular disease in children and adolescents is limited and relatively weak. Only one RCT was identified, and the overwhelming majority of studies had a high risk of bias. The strongest evidence of an association with sleep is with obesity, hypertension, and insulin sensitivity. Further research using more standardized methods and objective measures is needed to determine if a causal relationship truly exists between sleep and cardiovascular risk.
Collapse
Affiliation(s)
- Aaron D Fobian
- Department of Psychiatry, University of Alabama at Birmingham, 1720 2nd Ave. S., SC 1025, Birmingham, AL, 35294, USA.
| | - Lindsey Elliott
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tinnie Louie
- Department of Clinical and Diagnostic Science, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
23
|
Leon G, de Klerk E, Ho J, Jackman M, Reimer RA, Connors KE, Luca P. Prevalence of comorbid conditions pre-existing and diagnosed at a tertiary care pediatric weight management clinic. J Pediatr Endocrinol Metab 2018; 31:385-390. [PMID: 29432207 DOI: 10.1515/jpem-2016-0245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 01/18/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Childhood obesity places individuals at risk for a multitude of physical and mental health problems. The aim of this study was to assess the prevalence of obesity related comorbidities diagnosed prior to and after attending a tertiary care pediatric weight management clinic. METHODS A cross sectional retrospective chart review of patients 2-17 years old seen in the weight management clinic at Alberta Children's Hospital from May 2012 to May 2014. RESULTS A total of 199 patients were included in the review. Comorbidity prevalences were: hypertension 6 (3%), prediabetes 11 (5.5%), type 2 diabetes 3 (1.5%), dyslipidemia 105 (52.8%), non-alcoholic fatty liver disease 31 (15.6%), asthma 45 (22.6%), obstructive sleep apnea 21 (10.6%), and polycystic ovarian syndrome (PCOS) 9 (12% of females ≥10 years at the first visit). Concerns related to depression and anxiety were present in 20 (10.1%) and 25 (12.6%) patients respectively. The majority of comorbidities were identified prior to joining the clinic. Conditions requiring more specialized tests, such as diabetes and PCOS, were more commonly identified after joining the clinic. CONCLUSIONS These results give further insight into the prevalence of obesity-related comorbidities in overweight and obese children and adolescents, and demonstrate the importance of screening for these known comorbidities. It is important to have the resources and an experienced multi-disciplinary team to follow children and their families through treatment.
Collapse
Affiliation(s)
| | | | - Josephine Ho
- University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatric Endocrinology, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Michelle Jackman
- University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Raylene A Reimer
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Paola Luca
- University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatric Endocrinology, Alberta Children's Hospital, Calgary, Alberta, Canada
| |
Collapse
|
24
|
|
25
|
Mellendick K, Shanahan L, Wideman L, Calkins S, Keane S, Lovelady C. Diets Rich in Fruits and Vegetables Are Associated with Lower Cardiovascular Disease Risk in Adolescents. Nutrients 2018; 10:E136. [PMID: 29382069 PMCID: PMC5852712 DOI: 10.3390/nu10020136] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/18/2018] [Accepted: 01/23/2018] [Indexed: 12/17/2022] Open
Abstract
Obesity and cardiovascular disease (CVD) risk are public health concerns in adolescents, yet few studies have examined the association of their diet to CVD risk factors. This study investigated associations between diet, body mass index (BMI), waist circumference (WC), blood pressure (BP), and blood lipids in 163 16-17 year olds. Diet recall data were converted into Healthy Eating Index-2010 (HEI) to assess diet quality. Differences in diet between groups with normal or obese BMI, normal or hypertensive BP, and normal or altered lipids were determined. Associations between diet and BMI, WC, BP, and lipids, controlling for race, gender, and socioeconomic status, were examined. Mean HEI was 49.2 (±12.0), with no differences observed between groups. HEI was not associated with any CVD risk. Sweetened beverage consumption was higher in obese adolescents, and positively related to total cholesterol (TC). Fruit intake was negatively related to BMI and diastolic BP. Total vegetable intake was negatively related to systolic BP. Greens and beans were negatively related to TC and LDL. Whole grains were negatively related to HDL. This research suggests a cardioprotective effect of diets rich in fruits and vegetables, as well as low in sweetened beverages in adolescents.
Collapse
Affiliation(s)
- Kevan Mellendick
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC, 27412, USA.
| | - Lilly Shanahan
- Jacobs Center for Productive Youth Development, University of Zurich, CH-8050 Zurich, Switzerland.
| | - Laurie Wideman
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, 27412, USA.
| | - Susan Calkins
- Department of Human Development & Family Studies, Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, 27412, USA.
| | - Susan Keane
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, 27412, USA.
| | - Cheryl Lovelady
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC, 27412, USA.
| |
Collapse
|
26
|
Weight status, cardiorespiratory fitness and high blood pressure relationship among 5-12-year-old Chinese primary school children. J Hum Hypertens 2017; 31:808-814. [PMID: 28906485 DOI: 10.1038/jhh.2017.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/17/2017] [Accepted: 07/28/2017] [Indexed: 02/07/2023]
Abstract
Cardiorespiratory fitness (CRF) and adiposity contribute to high blood pressure (HBP) in adults and children. However, their relative importance as risk factors is unknown. We examined the relationships between weight status, CRF and HBP among Chinese primary school children. A cross-sectional study was conducted with 4926 school children aged 5-12 years. CRF was estimated from a modified Cooper test, body mass index z-scores and weight categories were calculated from objective height and weight measurements and BP was measured using an electronic sphygmomanometer. HBP was defined as >95th percentile based on reference cutoffs for Chinese boys and girls. Generalised Linear Mixed models, adjusting for age, pubertal status and height, were developed for boys and girls to explore the independent and combined associations between fitness, weight status and HBP. Seven hundred and fifty-two (15.3%) children had HBP, with a higher prevalence in obese (40.5% and 45.9% in boys and girls, respectively) and overweight (27.6% and 30.2% in boys and girls, respectively) compared with non-overweight (9.0% and 13.8% in boys and girls, respectively) children. HBP prevalence was lower in boys with higher CRF (odds ratio (OR) for the highest vs lowest CRF quartile in boys 0.64; 95% confidence interval (CI) 0.46-0.89). This association was not seen in girls. With weight status and CRF in the same model, weight status, but not CRF, remained significantly associated with HBP (obesity in boys: OR 4.19; 95% CI 2.63-6.67; in girls: OR 2.49; 95% CI 1.19-5.19). The interaction effect for CRF and weight status was non-significant. Overweight/obesity was significantly associated with HBP among children. There was no evidence of modification of this relationship by CRF.
Collapse
|
27
|
Bruce MA, Beech BM, Norris KC, Griffith DM, Sims M, Thorpe RJ. Sex, Obesity, and Blood Pressure Among African American Adolescents: The Jackson Heart KIDS Pilot Study. Am J Hypertens 2017. [PMID: 28633388 DOI: 10.1093/ajh/hpx071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This study examined the degree to which sex, weight status, and the presence of hypertension and obesity in parents/grandparents were associated with systolic (SBP) and diastolic (DBP) blood pressure (BP) among African American youth in a pilot offspring study examining obesity-related cardiovascular disease (CVD) risks among adolescents. RESULTS Fully adjusted linear regression models of the total sample produced results indicating that obesity was associated with BP (SBP: β = 7.08, P < 0.01; DBP: β = 8.14, P < 0.001). Sex-stratified analyses indicated that overweight and obesity were associated with SBP (overweight: β = 6.77, P < 0.01; obese: β = 11.65, P < 0.001) and obesity was correlated with DBP (β = 9.86, P < 0.001) among males. For females, overweight was correlated with SBP (β = 4.11, P < 0.05) while obesity was associated with DBP (β = 6.98, P < 0.01). Attempting to lose weight was inversely related to SBP (β = -4.01, P < 0.05) in the full sample and among males (β = -11.94, P < 0.001). Familial presence of hypertension and/or obesity was significantly associated with SBP among adolescent females but not males. CONCLUSIONS The relationship between weight status, familial hypertension and obesity status, and BP among adolescents vary by sex. This study underscores the need for additional research investigating the relationship between individual sex, weight status, BP and familial BP, and obesity status on risk among African American adolescents.
Collapse
Affiliation(s)
- Marino A Bruce
- Center for Research on Men’s Health, Vanderbilt University, Nashville, Tennessee, USA
- Center for Medicine, Health and Society, Vanderbilt University, Nashville, Tennessee, USA
- Myrlie Evers-Williams Institute for the Elimination of Health Disparities, Jackson Mississippi, USA
| | - Bettina M Beech
- Myrlie Evers-Williams Institute for the Elimination of Health Disparities, Jackson Mississippi, USA
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Keith C Norris
- David C. Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Derek M Griffith
- Center for Research on Men’s Health, Vanderbilt University, Nashville, Tennessee, USA
- Center for Medicine, Health and Society, Vanderbilt University, Nashville, Tennessee, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Roland J Thorpe
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Baltimore, Maryland, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
28
|
Reevaluate secular trends of body size measurements and prevalence of hypertension among Chinese children and adolescents in past two decades. J Hypertens 2017; 34:2337-2343. [PMID: 27607456 DOI: 10.1097/hjh.0000000000001114] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This study reevaluated the secular trends of blood pressure and hypertension prevalence in Chinese children and adolescents by adjusting for growing body sizes. METHODS The study population was from the China Health and Nutrition Survey (1991-2011) and included 7358 boys and 6881 girls aged 8-17 years. Body size measurements and blood pressure were standardized into z-scores using national references to allow comparisons among different age groups and survey years. Prehypertension and hypertension rates were defined by using national and international age-specific and height-specific references. RESULTS SBP and DBP increased 0.07 and 0.09 SD per survey year, respectively. BMI, waist circumference, and height increased 0.14, 0.11, and 0.29 SD, respectively. The general obesity prevalence increased from 1.5 to 8.1% (Ptrends ≤ 0.0001), with an average annual increase (AAI) of 0.36 and 0.42% for urban and rural boys, respectively, and of 0.33 and 0.22% for urban and rural girls, respectively. The hypertension prevalence increased from 6.9 to 10.7% (Ptrends ≤ 0.0001). The overall AAI in hypertension was 0.19% and was three-fold higher among boys (0.29%) than among girls (0.09%), explaining the sex difference in the rural population. The area and sex differences in AAI remained after applying the international criteria. CONCLUSION By adjusting for height, the hypertension prevalence in Chinese children increased 0.19% per year on average over the last two decades, which is much less than that reported in previous studies. This trend appears regardless of sex and area and is consistent with the obesity trend.
Collapse
|
29
|
Lee RL, Lee PH, Sze DM, Chien WT. Anthropometric profile of Hong Kong children and adolescents: the Wellness Population of Youth Study. ACTA ACUST UNITED AC 2017; 11:196-203.e4. [DOI: 10.1016/j.jash.2017.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 01/10/2017] [Accepted: 01/29/2017] [Indexed: 11/26/2022]
|
30
|
Lechi A. The obesity paradox: is it really a paradox? Hypertension. Eat Weight Disord 2017; 22:43-48. [PMID: 27812911 DOI: 10.1007/s40519-016-0330-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/04/2016] [Indexed: 12/23/2022] Open
Abstract
This article is a narrative overview of the role of hypertension on the relationships between obesity, morbidity, and mortality. We used as sources MEDLINE/PubMed, CINAHL, EMBASE, and Cochrane Library, from inception to March 2016. Key words include overweight, obesity, visceral obesity, obesity paradox, and hypertension. In addition, we hand-searched references from the retrieved articles. This work is one of the works of the topical collection "Obesity Paradox". The positive association between overweight, obesity, and cardiovascular diseases is well established, though this relation is typically U shaped with an increased risk in low-weight subjects or even a beneficial effect of overweight and obesity, the so-called "obesity paradox". In addition, the relationship between obesity and arterial hypertension has been demonstrated in both children and adults by many epidemiological studies. Moreover, weight reduction is followed by a decrease in blood pressure in many patients and ameliorates the cardiovascular risk profile. Recent studies using more appropriate obesity indices raise some doubt about the real significance of obesity paradox and there are several studies that central obesity shows either no protective or even a worse effect. These observations raise the question: what kind of obesity is protective and what kind of obesity is harmful? The studies of obesity paradox suffer from several methodological limitations: most of these are retrospective analyses or were not specifically designed to study obesity paradox as a primary goal; a few studies have data on preceding unintentional weight loss and on some particular confounding variables. In conclusion, more prospective and accurate studies are necessary to better elucidate the clinical importance of obesity paradox. When weight loss is functional to reduce hypertension and cardiovascular risk, it should be encouraged, while an unintentional weight in a patient with chronic diseases may indicate an unfavorable course.
Collapse
Affiliation(s)
- Alessandro Lechi
- Department of Medicine, University of Verona, 37100, Verona, Italy.
| |
Collapse
|
31
|
Roulet C, Bovet P, Brauchli T, Simeoni U, Xi B, Santschi V, Paradis G, Chiolero A. Secular trends in blood pressure in children: A systematic review. J Clin Hypertens (Greenwich) 2016; 19:488-497. [DOI: 10.1111/jch.12955] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/17/2016] [Accepted: 10/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Céline Roulet
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital (CHUV); Lausanne Switzerland
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital (CHUV); Lausanne Switzerland
| | - Thomas Brauchli
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital (CHUV); Lausanne Switzerland
| | - Umberto Simeoni
- Department of Pediatrics; Lausanne University Hospital; Lausanne Switzerland
| | - Bo Xi
- Department of Epidemiology; School of Public Health; Shandong University; Jinan China
| | - Valérie Santschi
- La Source, School of Nursing Sciences; University of Applied Sciences Western Switzerland; Lausanne Switzerland
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics, and Occupational Health; McGill University; Montreal Canada
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP); Lausanne University Hospital (CHUV); Lausanne Switzerland
- Department of Epidemiology, Biostatistics, and Occupational Health; McGill University; Montreal Canada
| |
Collapse
|
32
|
Wu KLH, Wu CW, Tain YL, Chao YM, Hung CY, Tsai PC, Wang WS, Shih CD. Effects of high fructose intake on the development of hypertension in the spontaneously hypertensive rats: the role of AT 1R/gp91 PHOX signaling in the rostral ventrolateral medulla. J Nutr Biochem 2016; 41:73-83. [PMID: 28063367 DOI: 10.1016/j.jnutbio.2016.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/11/2016] [Accepted: 11/29/2016] [Indexed: 02/07/2023]
Abstract
Both genetic and dietary factors determine the development of hypertension. Whether dietary factor impacts the development of hereditary hypertension is unknown. Here, we evaluated the effect of daily high-fructose diet (HFD) on the development of hypertension in adolescent spontaneously hypertensive rats (SHR). Six-week-old SHR were randomly divided into two groups to receive HFD or normal diet (ND) for 3 weeks. The temporal profile of systolic blood pressure, alongside the sympathetic vasomotor activity, in the SHR-HFD showed significantly greater increases at 9-12 weeks of age compared with the age-matched SHR-ND group. Immunofluorescence was used to identify the distribution of reactive oxygen species (ROS), oxidants and antioxidants in rostral ventrolateral medulla (RVLM) where sympathetic premotor neurons reside. In RVLM of SHR-HFD, the levels of ROS accumulation and lipid peroxidation were elevated. The changes in protein expression were measured by Western blot. NADPH oxidase subunit gp91phox and angiotensin II type I receptor were up-regulated in RVLM neuron. On the other hand, the expression of extracellular superoxide dismutase was suppressed. Both molecular and hemodynamic changes in the SHR-HFD were rescued by oral pioglitazone treatment from weeks 7 to 9. Furthermore, central infusion with tempol, a ROS scavenger, effectively ameliorated ROS accumulation in RVLM and diminished the heightened pressor response and enhanced sympathetic activity in the SHR-HFD. Together, these results suggest that HFD intake at adolescent SHR may impact the development of hypertension via increasing oxidative stress in RVLM which could be effectively attenuated by pioglitazone treatment.
Collapse
Affiliation(s)
- Kay L H Wu
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, Republic of China; Department of Senior Citizen Services, National Tainan Institute of Nursing, Tainan 700, Taiwan, Republic of China.
| | - Chih-Wei Wu
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, Republic of China
| | - You-Lin Tain
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, Republic of China; Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung 833, Taiwan, Republic of China
| | - Yung-Mei Chao
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, Republic of China
| | - Chun-Ying Hung
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, Republic of China
| | - Pei-Chia Tsai
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, Republic of China
| | - Wei-Sing Wang
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, Republic of China
| | - Cheng-Dean Shih
- Department of Pharmacy, Graduate Institute of Pharmaceutical Technology, Tajen University, Pingtung County 90741, Taiwan, Republic of China.
| |
Collapse
|
33
|
Thomason DL, Lukkahatai N, Kawi J, Connelly K, Inouye J. A Systematic Review of Adolescent Self-Management and Weight Loss. J Pediatr Health Care 2016; 30:569-582. [PMID: 26818905 DOI: 10.1016/j.pedhc.2015.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/13/2015] [Accepted: 11/30/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this review is to evaluate self-management interventions among overweight and obese adolescents to direct future research and practice. METHODS Studies published between 2008 and 2014 were identified by electronic database searches. The Jadad Scoring of Quality Reports of Randomized Clinical Trials was used to evaluate the quality of the studies with subsequent reviews. RESULTS Out of 69 studies, 10 randomized controlled trials were reviewed after all inclusion and exclusion criteria were met. Quality scores ranged from 7 to 11 out of 13 (M = 9.2, SD = 1.13). For the majority of studies, self-management strategies for weight loss were found to be significant for a mix of behavioral, psychological, anthropometric, and metabolic outcomes. DISCUSSION Findings indicated that interventions were most successful when incorporating family members. Self-management interventions that include a combination of appropriate diet, physical activity, and behavioral strategies with a family component are recommended.
Collapse
|
34
|
Ma C, Wang R, Liu Y, Lu Q, Lu N, Tian Y, Liu X, Yin F. Performance of obesity indices for screening elevated blood pressure in pediatric population: Systematic review and meta-analysis. Medicine (Baltimore) 2016; 95:e4811. [PMID: 27684808 PMCID: PMC5265901 DOI: 10.1097/md.0000000000004811] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hypertension is closely related with obesity in pediatric population. Obesity indices were used for screening elevated blood pressure (BP) in children and adolescents. The present study was to perform a meta-analysis to assess the performance of obesity indices, body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), for identifying elevated BP in children and adolescents. METHODS Data sources were PubMed, EMBASE, Web of Science, Cochrane, and SCOPUS up to May 2016. Studies providing measures of diagnostic performance of obesity indices and using age-, sex-, and height-specific BP 95% as reference standard (the definition of United State Fourth Report) were included. We extracted available data on true-positive, false-positive, true-negative, and false-negative to construct a 2 × 2 contingency table and computed the pooled summary statistics for the sensitivities and specificities to estimate the diagnostic performance. RESULTS Nine eligible studies that evaluated 25,424 children and adolescents aged 6 to 18 years were included in the meta-analysis. The pooled sensitivities were 42% (BMI), 42% (WC), and 43% (WHtR). The pooled specificities were 80% (BMI), 75% (WC), and 77% (WHtR). The areas under the curve (AUCs) of obesity indices were 0.7780 (BMI), 0.7181 (WC), and 0.6697 (WHtR), respectively. In this meta-analysis, the BP measurements were based on 3 visits in only 1 study. The prevalence of hypertension may be overestimated in these studies. CONCLUSIONS The present meta-analysis showed that the performance of obesity indices for identifying elevated BP was poor. Our findings do not support the performance of WC and WHtR is superior to BMI to help identify children with elevated BP.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Fuzai Yin
- Department of Endocrinology, the First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China
- Correspondence: Fuzai Yin, Department of Endocrinology, the First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000 Hebei Province, China (e-mail: )
| |
Collapse
|
35
|
Abstract
Prevalence of hypertension is increasing in children and adolescents. Uncontrolled hypertension in children not only causes end organ damage but also increases the risk of adult hypertension and cardiovascular disease. Clinical trials have proven efficacy of antihypertensive medications in children. These medications are well tolerated by children with acceptable safety profile. The choice of agent is usually driven by underlying etiology of hypertension, profile of its side effects, and clinician's preference. This article will review currently available pediatric data on mechanism of action, common adverse effects, pediatric indication, recent clinical trial, and newer drugs in the common classes of antihypertensive medications.
Collapse
|
36
|
Thomason DL, Feng D. Reliability and Validity of the Physical Education Activities Scale. THE JOURNAL OF SCHOOL HEALTH 2016; 86:424-434. [PMID: 27122142 DOI: 10.1111/josh.12392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 10/04/2015] [Accepted: 01/09/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Measuring adolescent perceptions of physical education (PE) activities is necessary in understanding determinants of school PE activity participation. This study assessed reliability and validity of the Physical Education Activities Scale (PEAS), a 41-item visual analog scale measuring high school adolescent perceptions of school PE activity participation. METHODS Adolescents (N = 529) from the Pacific Northwest aged 15-19 in grades 9-12 participated in the study. Construct validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Measurement invariance across sex groups was tested by multiple-group CFA. Internal consistency reliability was analyzed using Cronbach's alpha. Inter-subscale correlations (Pearson's r) were calculated for latent factors and observed subscale scores. RESULTS Exploratory factor analysis suggested a 3-factor solution explaining 43.4% of the total variance. Confirmatory factor analysis showed the 3-factor model fit the data adequately (comparative fit index [CFI] = 0.90, Tucker-Lewis index [TLI] = 0.89, root mean squared error of approximation [RMSEA] = 0.063). Factorial invariance was supported. Cronbach's alpha of the total PEAS was α = 0.92, and for subscales α ranged from 0.65 to 0.92. Independent t-tests showed significantly higher mean scores for boys than girls on the total scale and all subscales. CONCLUSION Findings provide psychometric support for using the PEAS for examining adolescent's psychosocial and environmental perceptions to participating in PE activities.
Collapse
Affiliation(s)
- Diane L Thomason
- School of Nursing, University of Nevada, Las Vegas, PO Box 453018, Las Vegas, NV 89154-3018.
| | - Du Feng
- School of Nursing, University of Nevada, Las Vegas, PO Box 453018, Las Vegas, NV 89154-3018.
| |
Collapse
|
37
|
Dietary and lifestyle patterns in relation to high blood pressure in children: the GRECO study. J Hypertens 2016; 33:1174-81. [PMID: 25715091 DOI: 10.1097/hjh.0000000000000536] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the present study was to investigate possible associations of dietary patterns with high blood pressure (BP) in a nationwide cross-sectional sample of 10-12 years old Greek schoolchildren. METHODS Anthropometric measurements and information on dietary (by a semi-quantitative food frequency questionnaire) and physical activity habits were obtained from the children. BPs was measured in a single occasion using a standard protocol. Data from 2024 normal energy reporting children were included in the analysis. Principal component analysis was applied to identify dietary patterns. RESULTS Seven dietary components (patterns) were extracted explaining 55% of the total variation in intake. Multiple logistic regression analysis revealed that predictors of high BP (75th percentile of SBP and/or DBP) were a pattern mainly characterized by the high consumption of cheese and red processed meat [odds ratio (OR) 1.15; 95% confidence intervals (CI) 1.03-1.30], being overweight (OR 2.10; 95% CI 1.61-2.73) or obese (OR 3.84; 95% CI 2.44-6.06) and breakfast frequency (OR 0.95; 95% CI 0.90-0.99). After controlling for sodium intake levels, the dietary pattern did not remain a significant predictor of high BP, indicating the potential mediating effect of sodium in the association. CONCLUSION A dietary pattern that is characterized by high cheese and red processed meat consumption increases the likelihood of having high BP in children, probably through increasing dietary sodium intake. These findings could guide future interventions or public health initiatives to prevent the increasing rates of childhood elevated BP levels.
Collapse
|
38
|
Stein DR, Ferguson MA. Evaluation and treatment of hypertensive crises in children. Integr Blood Press Control 2016; 9:49-58. [PMID: 27051314 PMCID: PMC4803257 DOI: 10.2147/ibpc.s50640] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Hypertensive crises in children are medical emergencies that must be identified, evaluated, and treated promptly and appropriately to prevent end-organ injury and even death. Treatment in the acute setting typically includes continuous intravenous antihypertensive medications with monitoring in the intensive care unit setting. Medications commonly used to treat severe hypertension have been poorly studied in children. Dosing guidelines are available, although few pediatric-specific trials have been conducted to facilitate evidence-based therapy. Regardless of what medication is used, blood pressure should be lowered gradually to allow for accommodation of autoregulatory mechanisms and to prevent cerebral ischemia. Determining the underlying cause of the blood pressure elevation may be helpful in guiding therapy.
Collapse
Affiliation(s)
- Deborah R Stein
- Division of Nephrology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael A Ferguson
- Division of Nephrology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
39
|
Parker ED, Sinaiko AR, Kharbanda EO, Margolis KL, Daley MF, Trower NK, Sherwood NE, Greenspan LC, Lo JC, Magid DJ, O’Connor PJ. Change in Weight Status and Development of Hypertension. Pediatrics 2016; 137:e20151662. [PMID: 26908707 PMCID: PMC4771125 DOI: 10.1542/peds.2015-1662] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the association of BMI percentile and change in BMI percentile to change in blood pressure (BP) percentile and development of hypertension (HTN). METHODS This retrospective cohort included 101 606 subjects age 3 to 17 years from 3 health systems across the United States. Height, weight, and BPs were extracted from electronic health records, and BMI and BP percentiles were computed with the appropriate age, gender, and height charts. Mixed linear regression estimated change in BP percentile, and proportional hazards regression was used to estimate risk of incident HTN associated with BMI percentile and change in BMI percentile. RESULTS The largest increases in BP percentile were observed among children and adolescents who became obese or maintained obesity. Over a median 3.1 years of follow-up, 0.3% of subjects developed HTN. Obese children ages 3 to 11 had twofold increased risk of developing HTN compared with healthy weight children. Obese children and adolescents had a twofold increased risk of developing HTN, and severely obese children had a more than fourfold increased risk. Compared with those who maintained a healthy weight, children and adolescents who became obese or maintained obesity had a more than threefold increased risk of incident HTN. CONCLUSIONS We observed a strong, statistically significant association between increasing BMI percentile and increases in BP percentile, with risk of incident HTN associated primarily with obesity. The adverse impact of weight gain and obesity in this cohort over a short period underscores the early need for effective strategies for prevention of overweight and obesity.
Collapse
Affiliation(s)
- Emily D. Parker
- HealthPartners Institute for Education and Research, HealthPartners, Minneapolis, Minnesota
| | | | - Elyse O. Kharbanda
- HealthPartners Institute for Education and Research, HealthPartners, Minneapolis, Minnesota
| | - Karen L. Margolis
- HealthPartners Institute for Education and Research, HealthPartners, Minneapolis, Minnesota
| | - Matt F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Nicole K. Trower
- HealthPartners Institute for Education and Research, HealthPartners, Minneapolis, Minnesota
| | - Nancy E. Sherwood
- HealthPartners Institute for Education and Research, HealthPartners, Minneapolis, Minnesota;,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Louise C. Greenspan
- Department of Pediatrics, Kaiser Permanente San Francisco, San Francisco, California; and
| | - Joan C. Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - David J. Magid
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Patrick J. O’Connor
- HealthPartners Institute for Education and Research, HealthPartners, Minneapolis, Minnesota
| |
Collapse
|
40
|
Adil MM, Beslow LA, Qureshi AI, Malik AA, Jordan LC. Hypertension is Associated With Increased Mortality in Children Hospitalized With Arterial Ischemic Stroke. Pediatr Neurol 2016; 56:25-29. [PMID: 26746784 DOI: 10.1016/j.pediatrneurol.2015.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/31/2015] [Accepted: 11/01/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Recently a single-center study suggested that hypertension after stroke in children was a risk factor for mortality. Our goal was to assess the association between hypertension and outcome after arterial ischemic stroke in children from a large national sample. METHODS Using the Healthcare Cost and Utilization Project Kids' Inpatient Database, children (1-18 years) with a primary diagnosis of ischemic stroke (International Classification of Diseases, Ninth Revision [ICD-9] codes 433-437.1) who also had a diagnosis of elevated blood pressure (ICD-9 code 796.2) or hypertension (ICD-9 codes 401 and 405) from 2003, 2006, and 2009 were identified. Clinical characteristics, discharge outcomes, and length of stay were assessed. Multivariable logistic regression was used to assess the relationship between hypertension and in-hospital mortality or discharge outcomes. RESULTS Of 2590 children admitted with arterial ischemic stroke, 156 (6%) also had a diagnosis of hypertension. Ten percent of children with hypertension also had renal failure. Among patients with arterial ischemic stroke, hypertension was associated with increased mortality (7.4% vs. 2.8%; P = 0.01) and increased length of stay (mean 11 ± 17 vs. 7 ± 12 days; P = 0.004) compared with those without hypertension. After adjusting for age, sex, intubation, presence of a fluid and electrolyte disorder, and renal failure, children with hypertension had an increased odds of in-hospital death (odds ratio 1.2, 95% confidence interval [1.1-3.3, P = 0.04]). CONCLUSION Hypertension was associated with an increased risk of in-hospital death for children presenting with arterial ischemic stroke. Further prospective study of blood pressure in children with stroke is needed.
Collapse
Affiliation(s)
- Malik M Adil
- Department of Neurology, Ochsner Neuroscience Institute, Ochsner Clinic Foundation, New Orleans, Louisiana; Zeenat Qureshi Stroke Institute, St Cloud, Minnesota.
| | - Lauren A Beslow
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Ahmed A Malik
- Zeenat Qureshi Stroke Institute, St Cloud, Minnesota
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
41
|
Yang Q, Zhong Y, Merritt R, Cogswell ME. Trends in High Blood Pressure among United States Adolescents across Body Weight Category between 1988 and 2012. J Pediatr 2016; 169:166-73.e3. [PMID: 26563532 PMCID: PMC8886792 DOI: 10.1016/j.jpeds.2015.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/31/2015] [Accepted: 10/02/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine trends in pre-high blood pressure (BP [HBP]) and HBP among US adolescents by body weight category during 1988-2012. STUDY DESIGN We estimated pre-HBP and HBP prevalence among 14,844 participants aged 12-19 years using National Health and Nutrition Examination Surveys from 1988-1994, 1999-2002, 2003-2006, and 2007-2012. Pre-HBP and HBP were defined based on age-sex-height-specific BP percentiles. We examined the temporal trends in pre-HBP and HBP across category of body weight (normal weight vs overweight/obese), adjusted for potential explanatory factors, and estimated the number of adolescents with pre-HBP and HBP. RESULTS Between 1988 and 2012, the prevalence of HBP decreased and pre-HBP did not change. Among normal weight adolescents, multivariable adjusted pre-HBP prevalence was 11.0% during 1988-2012, and 10.9% during 2007-2012 (P = .923 for trend); adjusted HBP prevalence increased from 1988-1994 (0.9%) to 1999-2002 (2.3%), then declined significantly to 1.4% during 2007-2012 (P = .049). Among overweight/obese adolescents, adjusted pre-HBP prevalence was 17.5% during 1988-2012, and 20.9% during 2007-2012 (P = .323); adjusted HBP prevalence declined significantly from 7.2% during 1988-1994 to 3.2% during 2007-2012 (P = .018). Because of population growth, estimated number of adolescents with pre-HBP or HBP increased, from 4.18 million during 1988-1994 to 5.59 million during 2007-2012. CONCLUSIONS Between 1988 and 2012, pre-HBP prevalence was consistently higher among overweight/obese adolescent than those of normal weight, and the pattern remain unchanged. HBP prevalence declined significantly, especially among overweight/obese adolescent that are not completely explained by sociodemographic or lifestyle characteristics.
Collapse
Affiliation(s)
- Quanhe Yang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
| | | | | | | |
Collapse
|
42
|
Xi B, Zhang T, Zhang M, Liu F, Zong X, Zhao M, Wang Y. Trends in Elevated Blood Pressure Among US Children and Adolescents: 1999-2012. Am J Hypertens 2016; 29:217-25. [PMID: 26158854 DOI: 10.1093/ajh/hpv091] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/18/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The prevalence of elevated blood pressure (BP) has been reported to increase significantly among the US children and adolescents from 1988-1994 to 1999-2008. We aimed to examine the recent trends in BP levels and prevalence of elevated BP, as well as related influencing factors among US children and adolescents. METHODS Data of National Health and Nutrition Examination Survey (NHANES) 1999-2012 were combined into 3 time periods (1999-2002, 2003-2008, and 2009-2012) for the analysis. A total of 14,270 US children and adolescents aged 8-17 years were included in the current analysis. The sex-, age-, and height-BP standards recommended by the US Fourth Report were used to define high BP and elevated BP (including pre-HBP and HBP). RESULTS Mean systolic BP (SBP) and diastolic BP (DBP) decreased by 0.7 and 4.2mm Hg from 1999-2002 to 2009-2012, respectively. In 2009-2012, the prevalence of elevated BP and HBP in children and adolescents were 9.6% and 1.6%, with the absolute reduction of 2.8% and 1.3% from 1999-2002 to 2009-2012, respectively. In addition, daily intakes of total energy, carbohydrate, total saturated fatty acids, and caffeine decreased during the period between 1999-2002 and 2009-2012 (all P < 0.05), whereas daily intake of total polyunsaturated fatty acids and dietary fiber increased (P < 0.05). CONCLUSIONS Mean BP levels as well as the prevalence of elevated BP and HBP among US children and adolescents have declined during the past decade. In addition, there might be an associated change in dietary factors.
Collapse
Affiliation(s)
- Bo Xi
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China
| | - Tao Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China
| | - Meixian Zhang
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Fangchao Liu
- Fuwai Hospital, National Center of Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xinnan Zong
- Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China
| | - Youfa Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA.
| |
Collapse
|
43
|
Abstract
Hypertension in children is common, and the prevalence of primary hypertension is increasing with the obesity epidemic and changing dietary choices. Careful measurement of blood pressure is important to correctly diagnose hypertension, as many factors can lead to inaccurate blood pressure measurement. Hypertension is diagnosed based on comparison of age-, sex-, and height-based norms with the average systolic and diastolic blood pressures on three separate occasions. In the absence of hypertensive target organ damage (TOD), stage I hypertension is managed first by diet and exercise, with the addition of drug therapy if this fails. First-line treatment of stage I hypertension with TOD and stage II hypertension includes both lifestyle changes and medications. First-line agents include angiotensin-converting enzyme (ACE) inhibitors, thiazide diuretics, and calcium-channel blockers. Hypertensive emergency with end-organ effects requires immediate modest blood pressure reduction to alleviate symptoms. This is usually accomplished with IV medications. Long-term reduction in blood pressure to normal levels is accomplished gradually. Specific medication choice for outpatient hypertension management is determined by the underlying cause of hypertension and the comparative adverse effect profiles, along with practical considerations such as cost and frequency of administration. Antihypertensive medication is initiated at a starting dose and can be gradually increased to effect. If ineffective at the recommended maximum dose, an additional medication with a complementary mechanism of action can be added.
Collapse
Affiliation(s)
- Jason Misurac
- Department of Pediatrics, Section of Pediatric Nephrology, Indiana University School of Medicine, 699 Riley Hospital Dr., Room 230, Indianapolis, IN, 46202, USA.
| | - Kristen R Nichols
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN, USA
- Department of Pharmacy, Riley Hospital for Children, Indiana University Health, Indianapolis, IN, USA
| | - Amy C Wilson
- Department of Pediatrics, Section of Pediatric Nephrology, Indiana University School of Medicine, 699 Riley Hospital Dr., Room 230, Indianapolis, IN, 46202, USA
| |
Collapse
|
44
|
Webb NJA, Wells T, Tsai M, Zhao Z, Juhasz A, Dudkowski C. Single-dose pharmacokinetics and safety of azilsartan medoxomil in children and adolescents with hypertension as compared to healthy adults. Eur J Clin Pharmacol 2016; 72:447-57. [PMID: 26725367 PMCID: PMC4792355 DOI: 10.1007/s00228-015-1987-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/22/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE This open-label, multicenter, single-dose study characterized the pharmacokinetics and short-term safety of azilsartan medoxomil (AZL-M) in hypertensive pediatric subjects (12-16 years [cohort 1a; n = 9]; 6-11 years [cohort 2; n = 8]; 4-5 years [cohort 3; n = 3]). METHODS Model-based simulations were performed to guide dosing, especially in 1-5-year olds, who were difficult to enroll. AZL-M was dosed according to body weight (20-60-mg tablet, cohorts 1a and 2; 0.66 mg/kg granule suspension, cohort 3). In cohort 1, gender-matched healthy adults (cohort 1b; n = 9) received AZL-M 80 mg. RESULTS Exposure to AZL (active moiety of AZL-M), measured by dose-/body weight-normalized C max and AUC0-∞, was ∼15-30 % lower in pediatric subjects versus adults. In simulations, exposure with 0.66 mg/kg AZL-M in pediatric subjects weighing 8-25 kg approximated to AZL-M 40 mg (typical starting dose) in adults. The simulations suggest that 25-50-kg subjects require half the adult dose (10-40 mg), whereas 50-100-kg subjects can use the same dosing as adults. Adverse events were mild in intensity, apart from one moderate event (migraine). CONCLUSIONS This dosing strategy should be safe in pediatric patients, as AZL exposure would not exceed that seen in adults with the highest approved AZL-M dose (80 mg).
Collapse
Affiliation(s)
- Nicholas J A Webb
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK. .,Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
| | - Thomas Wells
- University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Max Tsai
- Takeda Development Center Americas, Inc., Deerfield, IL, USA
| | - Zhen Zhao
- Takeda Development Center Americas, Inc., Deerfield, IL, USA
| | | | | |
Collapse
|
45
|
Clark BR, White ML, Royer NK, Burlis TL, DuPont NC, Wallendorf M, Racette SB. Obesity and Aerobic Fitness among Urban Public School Students in Elementary, Middle, and High School. PLoS One 2015; 10:e0138175. [PMID: 26378914 PMCID: PMC4574739 DOI: 10.1371/journal.pone.0138175] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/26/2015] [Indexed: 12/26/2022] Open
Abstract
Aims and Objectives To assess the prevalence of cardiovascular disease risk among urban public school students through a collaborative school district and university partnership. Methods Children and adolescents in grades K-12 from 24 urban public schools participated in measurements of height, weight, and other health metrics during the 2009–2010 school year. Body mass index (BMI) percentiles and z-scores were computed for 4673 students. President’s Challenge 1-mile endurance run was completed by 1075 students ages 9–19 years. Maximal oxygen consumption (⩒O2max) was predicted using an age-, sex-, and BMI-specific formula to determine health-related fitness. Resting blood pressure (BP) was assessed in 1467 students. Regression analyses were used to compare BMI z-scores, fitness, and age- and sex-specific BP percentiles across grade levels. Chi-square tests were used to explore the effect of sex and grade-level on health-related outcomes. Results Based on BMI, 19.8% were categorized as overweight and 24.4% were obese. Included in the obese category were 454 students (9.7% of sample) classified with severe obesity. Using FITNESSGRAM criteria, 50.2% of students did not achieve the Healthy Fitness Zone (HFZ); the proportion of students in the Needs Improvement categories increased from elementary to middle school to high school. Male students demonstrated higher fitness than female students, with 61.4% of boys and only 35.4% of girls meeting HFZ standards. Elevated BP was observed among 24% of 1467 students assessed. Systolic and diastolic BP z-scores revealed low correlation with BMI z-scores. Conclusions A community-university collaboration identified obesity, severe obesity, overweight, and low aerobic fitness to be common risk factors among urban public school students.
Collapse
Affiliation(s)
- B. Ruth Clark
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
- * E-mail:
| | - M. Leanne White
- Saint Louis Public Schools, St. Louis, Missouri, United States of America
| | - Nathaniel K. Royer
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Tamara L. Burlis
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Nicholas C. DuPont
- Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Michael Wallendorf
- Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Susan B. Racette
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| |
Collapse
|
46
|
|
47
|
Falkner B. Is there a bend in the upward trend of high blood pressure in childhood? ACTA ACUST UNITED AC 2015; 9:668-9. [DOI: 10.1016/j.jash.2015.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 04/08/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
|
48
|
Bruce MA, Beech BM, Griffith DM, Thorpe RJ. Weight Status and Blood Pressure among Adolescent African American Males: The Jackson Heart KIDS Pilot Study. Ethn Dis 2015; 25:305-12. [PMID: 26672894 DOI: 10.18865/ed.25.3.305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Obesity had not been considered a significant factor contributing to high levels of hypertension among African American males until recently. Epidemiologic research on heart disease among males has primarily focused on adults; however, the significant rise in obesity and hypertension prevalence among African American boys indicates that studies examining the relationship between excess body weight and elevated blood pressure among this high-risk population are critically needed. The purpose of our study was to examine the degree to which weight status has implications for elevated blood pressure among young African American males. METHODS The data for this cross-sectional study were drawn from adolescent males (N=105), aged 12-19 years and who participated in the Jackson Heart KIDS Pilot Study - an offspring cohort study examining cardiovascular disease risks among adolescent descendants of Jackson Heart Study participants. Blood pressure was the primary outcome of interest and weight status was a key independent variable. Other covariates were fruit and vegetable consumption, physical activity, sleep, and stress. RESULTS Approximately 49% of adolescent males in the study were overweight or obese. Bivariate and multiple variable analyses suggest that obesity may be correlated with elevated diastolic blood pressure (DBP) levels among African American boys. Results from ordinary least squared regression analysis indicate that the DBP for boys carrying excess weight was 4.2 mm Hg (P<.01) higher than the corresponding DBP for their normal weight counterparts, after controlling for age, fruit and vegetable consumption, physical activity, and sleep. CONCLUSIONS Additional studies are needed to specify the manner through which excess weight and weight gain can accelerate the development and progression of CVD-related diseases among African American males over the life course, thereby providing evidenced-based information for tailored interventions that can reduce risks for premature morbidity, disability, and mortality among this group.
Collapse
Affiliation(s)
- Marino A Bruce
- 1. Center for Health of Minority Males, Myrlie Evers-Williams Institute for the Elimination of Health Disparities, Jackson, Miss. ; 2. Department of Sociology and Criminal Justice, Jackson State University, Jackson, Miss
| | - Bettina M Beech
- 1. Center for Health of Minority Males, Myrlie Evers-Williams Institute for the Elimination of Health Disparities, Jackson, Miss. ; 3. Departments of Pediatrics and Family Medicine, University of Mississippi Medical Center, Jackson, Miss
| | - Derek M Griffith
- 4. Institute for Research on Men's Health, Vanderbilt University, Nashville, Tenn. ; 5. Center for Medicine, Health, and Society, Vanderbilt University, Nashville, Tenn
| | - Roland J Thorpe
- 6. Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Baltimore, Md. ; 7. Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| |
Collapse
|
49
|
Racial Differences of Pediatric Hypertension in Relation to Birth Weight and Body Size in the United States. PLoS One 2015; 10:e0132606. [PMID: 26176843 PMCID: PMC4503635 DOI: 10.1371/journal.pone.0132606] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 06/16/2015] [Indexed: 11/26/2022] Open
Abstract
Background The prevalence of hypertension is known to differ by racial group in adults in the United States (US), but findings in children are scarce and inconsistent. The objective of this study was to assess the racial differences in pediatric hypertension and to explore whether these differences, if any, can be explained by low birth weight (LBW) and obesity. Methods Analyses were performed for participants aged 8–17 years (N = 9,250) included in the 1999–2010 National Health and Nutrition Examination Survey. Multivariate logistic regressions and weighted analysis were carried out considering the complex survey design. Results Compared to non-Hispanic White youth, the crude prevalence of hypertension was significantly higher in non-Hispanic Blacks (7.1% vs. 5.6%; P = 0.04), but not in Mexican Americans (5.4% vs. 5.6%; P = 0.77). Blacks also had higher rates of LBW (14.6% vs. 5.9%; P <0.001) and obesity (22.9% vs. 15.8%; P <0.001) than Whites. In stratified analysis by age-sex groups, the Black-White difference in hypertension prevalence was only significant in boys aged 13–17 (9.6% vs. 6.6%). After controlling for age, Black boys had a 51% higher odds of having hypertension (Odds ratio = 1.51; 95% confidence interval: 1.03, 3.43; P = 0.04) compared to White youth at ages 13–17. This racial difference persisted with additional adjustment for birth weight (odds ratio (OR) = 2.00; P = 0.02) and for current body mass index (OR = 1.50; P = 0.04). Mexican American youth had no difference in hypertension prevalence as compared to White youth after adjusting for age, sex, birth weight and obesity (Odds ratio = 0.82; P = 0.16) and in age-sex stratified subgroups. Conclusions Non-Hispanic Black adolescent boys have a significantly higher hypertension rate than their non-Hispanic White counterparts in the US. This racial difference cannot be explained by LBW and current obesity status within the Black population.
Collapse
|
50
|
Dong B, Wang Z, Wang HJ, Ma J. Population attributable risk of overweight and obesity for high blood pressure in Chinese children. Blood Press 2015; 24:230-6. [PMID: 26083724 DOI: 10.3109/08037051.2015.1030904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Little is known about whether eliminating overweight and obesity could effectively reduce the prevalence of high blood pressure (HBP) in Chinese children. This study aimed to estimate the magnitude of contribution of overweight and obesity associated with HBP in Chinese children, and assess the theoretical HBP prevalence if overweight and obesity were eliminated. METHODS Data on 197,191 participants aged 7-17 years with complete records from the Chinese National Survey on Students' Constitution and Health conducted in 2010 were included. The population attributable risk of overweight and obesity for HBP was calculated. RESULTS The prevalence of HBP was 6.8% and 5.8% for boys and girls, respectively. HBP in about 22.9% (95% CI 21.5, 24.2%) of boys and 14.7% (95% CI 13.5, 15.8%) of girls could be attributable to overweight and obesity. If both overweight and obesity were eliminated, the prevalence of HBP theoretically could be reduced to 5.2% in boys and 5.0% in girls. Similar results were found in different age and urban/rural area groups. CONCLUSION Eliminating overweight and obesity could theoretically lead to a moderate reduction in the prevalence of HBP in Chinese children.
Collapse
Affiliation(s)
- Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center , Beijing , PR China
| | | | | | | |
Collapse
|