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Xu M, Wang HX, Zu P, Jiang N, Bian JF, Xu JR, Luo W, Zhu P. Association Between Preeclampsia and Blood Pressure in Offspring: A Systematic Review and Meta-Analysis. Curr Hypertens Rep 2024; 26:325-337. [PMID: 38780756 DOI: 10.1007/s11906-024-01306-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE OF REVIEW Pregnancy-induced preeclampsia is a severe pregnancy complication and preeclampsia has been associated with an increased risk of chronic hypertension for offspring. However, the magnitude of the overall effect of exposure to preeclampsia in pregnancy on blood pressure (BP) in offspring is unknown. This systematic review and meta-analysis was sought to systematically assess the effects of preeclampsia on the BP of the offspring. RECENT FINDINGS Of 2550 publications identified, 23 studies were included. The meta-analysis indicated that preeclampsia increases the potential risk of hypertension in offspring. Systolic blood pressure (SBP) was 2.0 mm Hg (95% CI: 1.2, 2.8) and diastolic blood pressure (DBP) was 1.4 mm Hg (95% CI: 0.9, 1.9) higher in offspring exposed to pre-eclampsia in utero, compared to those born to normotensive mothers. The correlations were similar in stratified analyses of children and adolescents by sex, geographic area, ages, and gestational age. During childhood and young adulthood, the offspring of pregnant women with preeclampsia are at an increased risk of high BP. It is crucial to monitor their BP.
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Affiliation(s)
- Min Xu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
- Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, China
| | - Hai-Xia Wang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Ping Zu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Nan Jiang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Jing-Feng Bian
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Ji-Rong Xu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Wei Luo
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China
| | - Peng Zhu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China.
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China.
- Anhui Provincial Key Laboratory of Environment and Population health across the Life Course, Anhui Medical University, Hefei, China.
- Center for Big Data and Population Health of IHM, School of Public Health, Anhui Medical University, Hefei, China.
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El-Setouhy M, Safhi AM, Dallak MY, Ayoub AY, Suwaid OAH, Moafa AK, Al-Ahmed AM, Zaino M, Al Sayed A. Prevalence and associated factors of pediatric hypertension in Jazan region, south of the Kingdom of Saudi Arabia. A pilot cross-sectional study. PLoS One 2023; 18:e0287698. [PMID: 37428728 DOI: 10.1371/journal.pone.0287698] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
Hypertension (HTN) is a primary global health concern. Moreover, according to the 2010 Global Burden of Disease, hypertension accounted for roughly a quarter of cardiovascular disease fatalities and 1.9 percent of all deaths in Saudi Arabia in 2010. Also, hypertension is a significant risk factor for cardiovascular disease, morbidity, and mortality. However, assessing blood pressure (BP) and preventing hypertension among children and adolescents has become a global priority. This study aims to determine the prevalence of hypertension among children in the Jazan region of Saudi Arabia. Also, to determine the common risk factors associated with pediatric hypertension. We conducted this cross-sectional study among boys and girls aged 6-14 years visiting Al-Rashid Mall, one of the two main malls in Jazan city, the capital of Jazan region, Saudi Arabia, between November 2021 and January 2022. We included children willing to participate in the study after obtaining their parents' consent and children's assent. We used a standardized questionnaire to interview the parents to collect the children's data. We also measured the children's resting BP. Then we classified the measurements according to the updated International Pediatric Hypertension Association (IPHA) chart. We also measured the height and weight of the children and calculated their BMI. We used SPSS version 25 for the data entry and analysis. Our results showed that the prevalence of hypertension and prehypertension was insignificantly higher in females (11.84% and 12.65%) compared to males (11.52% and 11.52%), respectively. Our participants' main associated factors with prehypertension and hypertension were overweight, obesity, and family income. Pediatric hypertension and prehypertension were highly prevalent in Jazan region. Therefore, being overweight and obese should be considered risk factors for pediatric hypertension. Our study emphasizes the need for early intervention to prevent pediatric HTN, particularly among overweight and obese children.
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Affiliation(s)
- Maged El-Setouhy
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
- Department of Community Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Emergency Medicine, Faculty of Medicine, Maryland University, Baltimore, MD, United States of America
| | - Abdulrahman M Safhi
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Musab Y Dallak
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ahmed Y Ayoub
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Osama A H Suwaid
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ahmed K Moafa
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Alhassan M Al-Ahmed
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Mohammad Zaino
- Medical Laboratory Technology Department, Faculty of Applied Medical Science, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ahmed Al Sayed
- Department of Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
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Medeiros BM, Da Silva TLN, Bloch KV, Kuschnir MCC, Sbaraini M, Schaan BD, Cureau FV. Adolescent blood pressure classification curves and cardiometabolic risk factors: a comparison of the Brazilian and American references. J Hypertens 2023; 41:420-428. [PMID: 36728701 DOI: 10.1097/hjh.0000000000003349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The American Academy of Pediatrics (AAP) adolescent blood pressure (BP) percentiles were updated in 2017, and have been used as reference in Brazil since then. However, specific BP percentiles for Brazilian adolescents were recently proposed based on data from the Study of Cardiovascular Risk in Adolescents (ERICA). OBJECTIVES To compare the prevalence of arterial hypertension according to each reference, as well as to assess the cardiometabolic risk associated with the reclassification by Brazilian BP percentiles. METHODS Data from 73 399 adolescents aged 12-17 years who participated in the ERICA study were analyzed. To assess cardiometabolic risk, 6185 adolescents who were reclassified upwards by the Brazilian reference were 1 : 1 matched with adolescents that were normotensive by both references and were of the same age, sex and height percentile. The parameters evaluated were: overweight/obesity, waist circumference, total cholesterol, triglycerides, LDL-c, HDL-c, fasting glucose, HbA1c and HOMA-ir. RESULTS The classification according to Brazilian BP percentiles resulted in a higher prevalence of arterial hypertension (14%, 95% CI 13.2-14.8), when compared with the AAP percentiles (10.6%, 95% CI 10.0-11.2). The use of the Brazilian reference also resulted in higher prevalence of arterial hypertension in girls, teenagers ranging from 12 to 14 years, and those classified with adequate weight, overweight or obesity. In the case-control analysis, cardiometabolic risk factors were present more often in adolescents reclassified with arterial hypertension by the ERICA reference. DISCUSSION The use of the BP percentiles proposed by ERICA is a sensitive method for tracking Brazilian adolescents with hypertension and higher cardiometabolic risk.
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Affiliation(s)
- Brenda M Medeiros
- Graduate Program in Endocrinology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre
| | - Thiago L N Da Silva
- Institute of Studies in Collective Health, Universidade Federal do Rio de Janeiro
| | - Katia V Bloch
- Institute of Studies in Collective Health, Universidade Federal do Rio de Janeiro
| | - Maria C C Kuschnir
- Faculty of Medical Sciences, Universidade do Estado do Rio de Janeiro, Rio de Janeiro
| | - Mariana Sbaraini
- Graduate Program in Cardiology and Cardiovascular Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul
| | - Beatriz D Schaan
- Graduate Program in Endocrinology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre
- Graduate Program in Cardiology and Cardiovascular Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre
| | - Felipe V Cureau
- Graduate Program in Cardiology and Cardiovascular Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul
- Graduate Program in Physical Education, Universidade Federal do Rio Grande do Norte, Natal, Brazil
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Telencoe S, Singer A, Kosowan L, Dart AB. An analysis of sex differences and socioeconomic deprivation among Canadian children with high blood pressure: a retrospective, cross-sectional study. Pediatr Nephrol 2022:10.1007/s00467-022-05841-6. [PMID: 36534144 DOI: 10.1007/s00467-022-05841-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/02/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Understanding which children are at highest risk for high blood pressure (HBP) can inform surveillance and treatment. This study evaluated sex differences in childhood HBP and its associations with socioeconomic status. METHODS This retrospective cross-sectional study assessed 74,233 children with data from a national primary care electronic medical record database. Differences between sex and material and social deprivation scores for children with and without HBP were examined. Covariates included age, BMI z-score, diabetes, hyperlipidemia, and depression. HBP was defined as > 90th percentile for < 13-year-olds, and ≥ 120/80 for age ≥ 13 years on 2 separate occasions between 2010 and 2017. RESULTS The prevalence of HBP was 10.2% in males and 7.6% in females (p < 0.0001). Children with HBP had higher BMI z-scores (0.66 vs. 0.18, p < 0.0001), and higher rates of diabetes (1.31 vs. 0.54%, p < 0.0001), depression (9.89 vs. 7.11%, p < 0.0001), and hyperlipidemia (2.82 vs. 0.86%, p < 0.0001). In univariate regression analyses, boys in the most materially deprived quintile had increased odds of HBP (OR 1.24 (95% CI 1.08-1.43)), whereas females did not (OR 1.11 (95% CI 0.95-1.29)). In multivariate regression, male sex was associated with HBP with adjusted OR of 1.39 (95% CI 1.24-1.55). After statistical adjustment, material deprivation was no longer significant (aOR 1.05, 95% CI 0.94-1.17). CONCLUSIONS Male sex is associated with HBP in Canadian children. This study also suggests a possible association between material deprivation and HBP, particularly in boys. Further study is required to better understand this relationship. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Susan Telencoe
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Alexander Singer
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Leanne Kosowan
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Allison B Dart
- Department of Pediatrics and Child Health, Diabetes Research Envisioned and Accomplished, University of Manitoba, Children's Hospital Research Institute of Manitoba, FE-009 840 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada.
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Hao G, Halbert J, Su S, Bagi Z, Robinson V, Thayer J, Harshfield G, Kapuku G. Rapid decline of resting heart rate trajectories from childhood to young adulthood is paradoxically associated with increased cardiac mass. Acta Cardiol 2021; 76:1117-1123. [PMID: 33557704 DOI: 10.1080/00015385.2020.1871262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Little is known about the varied resting heart rate (RHR) trajectory patterns from childhood to young adulthood and their clinical significance. We aim to identify RHR trajectories from childhood to young adulthood, and to determine their relationship with left ventricular mass (LVM) index. METHODS RHR was measured up to 15 times over a 21-year period in 759 participants from childhood to young adulthood. LVM was measured using echocardiography and was normalised to body surface area to obtain LVM index in 546 participants. RESULTS Using latent class models, three trajectory groups in RHR from childhood to young adulthood were identified, including high-decreasing group (HDG), moderate-decreasing group (MDG), and low-decreasing group (LDG). We found that trajectory of RHR was a significant predictor of LVM index with faster decrease of RHR associated with higher levels of total peripheral resistance (P for trend <0.001) and LVM index (P for trend <0.001). Compared to the LDG, individuals in the HDG showed higher LVM index (β = 6.08, p < 0.001). In addition, the interactions between race and RHR trajectories for LVM index was significant (p < 0.05). CONCLUSION Our findings show an association between RHR trajectories from childhood to young adulthood with cardiac mass, suggesting that monitoring RHR may help identify subpopulation at high cardiovascular risk.
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Affiliation(s)
- Guang Hao
- Georgia Prevention Institute, Departments of Medicine, Pediatrics, and Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - James Halbert
- Georgia Prevention Institute, Departments of Medicine, Pediatrics, and Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Shayong Su
- Georgia Prevention Institute, Departments of Medicine, Pediatrics, and Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Zsolt Bagi
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Vincent Robinson
- Division of Cardiology, Department of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Julian Thayer
- Department of Psychology and Neurosciences, The Ohio State University, Columbus, OH, USA
| | - Gregory Harshfield
- Georgia Prevention Institute, Departments of Medicine, Pediatrics, and Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Gaston Kapuku
- Georgia Prevention Institute, Departments of Medicine, Pediatrics, and Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Division of Cardiology, Department of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Falkner B, Lurbe E. Primary Hypertension Beginning in Childhood and Risk for Future Cardiovascular Disease. J Pediatr 2021; 238:16-25. [PMID: 34391765 DOI: 10.1016/j.jpeds.2021.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Bonita Falkner
- Departments of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA.
| | - Empar Lurbe
- Department of Pediatrics, CIBER Fisiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, University of Valencia, Valencia, Spain
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Yuan WL, Kramer MS, Michael N, Sadananthan SA, Tint MT, Chen LW, Pang WW, Velan SS, Godfrey KM, Chong YS, Chong MFF, Choo JTL, Ling LH, Eriksson JG, Lee YS. Trajectories of Systolic Blood Pressure in Children: Risk Factors and Cardiometabolic Correlates. J Pediatr 2021; 236:86-94.e6. [PMID: 34019883 PMCID: PMC7611585 DOI: 10.1016/j.jpeds.2021.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify systolic blood pressure (SBP) percentile trajectories in children and to describe the early-life risk factors and cardiometabolic correlates of those trajectories. STUDY DESIGN Using age-, sex-, and height-specific SBP percentiles based on the American Academy of Pediatrics reference, we examined SBP trajectories using latent class mixed models from ages 3 to 8 years (n = 844) from the Growing Up in Singapore Towards healthy Outcomes-study, a Singaporean mother-offspring cohort study. We analyzed associations between SBP trajectories and early-life risk factors using multinomial logistic regression and differences across trajectories in cardiometabolic outcomes using multiple linear regression. RESULTS Children were classified into 1 of 4 SBP percentile trajectories: "low increasing" (15%), "high stable" (47%), "high decreasing" (20%), and "low stable" (18%). Maternal hypertension during early pregnancy was a predictor of the "high stable" and "low increasing" SBP trajectories. Rapid child weight gain in the first 2 years of life was only associated with the "high stable" trajectory. Compared with children in the "low stable" trajectory, children in the "high stable" SBP trajectory had greater body mass index z scores, sum of skinfold thicknesses, waist circumference from ages 3 to 8 years, and abdominal adipose tissue (milliliters) at 4.5 years (adjusted mean difference [95% CI]: superficial and deep subcutaneous abdominal adipose tissue: 115.2 [48.1-182.3] and 85.5 [35.2-135.8]). Their fat mass (kilograms) (1.3 [0.6-2.0]), triglyceride levels (mmol/L) (0.10 [0.02-0.18]), and homeostasis model assessment of insulin resistance (0.28 [0.11 0.46]) at age 6 years were also greater but not their arterial thickness and stiffness. CONCLUSIONS Reducing maternal blood pressure during pregnancy and infant weight gain in the first 2 years of life might help to prevent the development of high SBP.
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Affiliation(s)
- Wen Lun Yuan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Michael S Kramer
- Department of Paediatrics, Faculty of Medicine, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Navin Michael
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
| | - Suresh A Sadananthan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
| | - Mya T Tint
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
| | - Ling-Wei Chen
- HRB Centre for Health and Diet Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Wei Wei Pang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sendhil S Velan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
- Singapore Bioimaging Consortium, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit and National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital, Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Yap-Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
| | - Mary FF Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Lieng Hsi Ling
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Johan G Eriksson
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
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Al Salloum AA, El Mouzan MI, Al Sharqawi AH, Al Omar AA, Alqurashi MM, Al Herbish AS. Blood pressure standards for pre-school children in Saudi Arabia. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2021; 31:1281-1293. [PMID: 33565440 DOI: 10.4103/1319-2442.308337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The prevalence of hypertension (HTN) in children is increasing. Early detection of HTN in childhood may prevent the occurrence of complications in adult age. Blood pressure (BP) varies between populations according to ethnic and environmental factors. Based on these variations, reference norms developed for one particular population may not be applicable to others. Thus, this study aimed to provide age-, gender-, and height-related BP reference standards using oscillometric techniques for pre-school children in Saudi Arabia. A sub-sample of preschool children aged from 2 to 6 years was selected by multi-stage probability sampling of Saudi population. The samples represented Saudi children from the whole country. Data were collected through a house-to-house survey of all selected households in all 13 regions in the country. Oscillometric devices were used to measure the BP. Data were analyzed to study the distribution pattern of systolic (SBP) and diastolic BP (DBP) and to develop reference values based on age, gender, and height. The values for each age and height percentile were compared with the recent (2017) values of the North American children. A total of 2553 Saudi Arabian children (1299 boys and 1254 girls) aged 2-6 years with complete data on age, gender, height, SBP, and DBP were considered for analysis. Values for SBP and DBP were significantly higher in Saudi children than in the North American children. This study adds evidence to the BP variations between populations with influences such as genetic and environmental factors. The need of every population to define its normal BP standards is essential to avoid unnecessary investigations and anxiety in patients and their parents.
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Affiliation(s)
- Abdullah A Al Salloum
- Department of Pediatrics, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed I El Mouzan
- Department of Pediatrics, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad H Al Sharqawi
- Department of Biostatistics, Prince Naif Health Research Center, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad A Al Omar
- King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
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Serum 25-Hydroxyvitamin D Concentrations Are Associated with Mental Health and Psychosocial Stress in Young Adults. Nutrients 2020; 12:nu12071938. [PMID: 32629761 PMCID: PMC7400417 DOI: 10.3390/nu12071938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/14/2022] Open
Abstract
We aimed to test the hypothesis that serum 25-hydroxyvitamin D3 (25(OH)D) concentration is associated with mental health and life stress measures in young adults and investigate gender and racial disparities in these associations. This study comprised 327 black and white participants. Depression, trait anxiety, perceived stress, and hostility were measured by the following validated instruments: Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), and Cook–Medley Hostility Scale (CMHS). Linear regression was used to estimate correlations between serum 25(OH)D concentration and mental health measurements in the total population and in subgroups stratified by gender and race. In this sample (28.2 ± 3.1 years, 52% female, 53% black), serum 25(OH)D concentration was negatively related to BDI, STAI, PSS, total CMHS score, and the majority of CMHS subscale scores (p-values < 0.05). Stratified by gender, most of these associations remained significant only in women (p-values < 0.05). Stratified by race, higher 25(OH)D concentrations in white participants were significantly related to lower BDI, STAI, PSS, and CMHS-cynicism subscales (p-values < 0.05); 25(OH)D concentrations in the black participants were only inversely associated with CMHS and most CMHS subscales (p-values < 0.05) but not with BDI, STAI, and PSS. We present novel findings of consistent inverse relationships between serum 25(OH)D concentration and various measures of mental health and life stress. Long-term interventional studies are warranted in order to investigate the roles of vitamin D supplementation in the prevention and mitigation of depression, anxiety, and psychological stress in young adults.
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Obesity and insulin sensitivity effects on cardiovascular risk factors: Comparisons of obese dysglycemic youth and adults. Pediatr Diabetes 2019; 20:849-860. [PMID: 31301210 PMCID: PMC6786916 DOI: 10.1111/pedi.12883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/01/2019] [Accepted: 06/03/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Obesity and pubertal insulin resistance worsen cardiovascular (CV) risk factors in youth. It is unclear how the relationships of obesity and insulin resistance with CV risk compare to adults. SUBJECTS AND METHODS We evaluated 66 pubertal youth (mean ± SD: age 14.2 ± 2.0 years, body mass index [BMI] 36.6 ± 6.0 kg/m2 , hemoglobin A1c [HbA1c] 38.5 ± 6.1 mmol/mol) and 355 adults with comparable BMI (age 52.7 ± 9.4 years, BMI 35.1 ± 5.1 kg/m2 , HbA1c 39.8 ± 4.2 mmol/mol) participating in a multicenter study. Insulin sensitivity was quantified using hyperglycemic clamps. Assessment of CV risk factors was standardized across sites. Regression analyses compared the impact of insulin sensitivity and CV risk factors between youth and adults. RESULTS Obese pubertal youth were more insulin resistant than comparably obese adults (P < .001), but with similar slopes for the inverse relationship between insulin sensitivity and obesity. The impact of obesity on CV risk factors was explained by insulin sensitivity (P = NS after adjustment for sensitivity). The two age groups did not differ in relationships between insulin sensitivity and diastolic blood pressure, total cholesterol, and low-density lipoprotein (LDL) cholesterol, after adjusting for obesity. However, while systolic blood pressure (SBP) and high-density lipoprotein (HDL) cholesterol exhibited the expected direct and inverse relationships, respectively with insulin sensitivity in adults, these slopes were flat in youth across the range of insulin sensitivity (P ≤ .05 for group differences). CONCLUSIONS Effects of obesity on CV risk factors were attributable to insulin sensitivity in both groups. The relationships between insulin sensitivity and CV risk factors were similar in obese youth and adult groups except for SBP and HDL cholesterol. CLINICAL TRIAL REGISTRATION The RISE consortium studies are registered through Clinicaltrials.gov as NCT01779362 (Adult Medication Study); NCT01763346 (Adult Surgery Study); and NCT01779375 (Pediatric Medication Study). Clinical trial registration numbers: NCT01779362, NCT01779375 and NCT01763346 at clinicaltrials.gov.
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Affiliation(s)
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- RISE Coordinating Center, Rockville, Maryland
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11
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Cabral M, Fonseca MJ, González-Beiras C, Santos AC, Correia-Costa L, Barros H. Maternal Smoking: A Life Course Blood Pressure Determinant? Nicotine Tob Res 2019; 20:674-680. [PMID: 28575495 DOI: 10.1093/ntr/ntx117] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/30/2017] [Indexed: 01/03/2023]
Abstract
Introduction Exposure to maternal smoking early in life may affect blood pressure (BP) control mechanisms. We examined the association between maternal smoking (before conception, during pregnancy, and 4 years after delivery) and BP in preschool children. Methods We evaluated 4295 of Generation XXI children, recruited at birth in 2005-2006 and reevaluated at the age of 4. At birth, information was collected by face-to-face interview and additionally abstracted from clinical records. At 4-year follow-up, interviews were performed and children's BP measured. Linear regression models were fitted to estimate the association between maternal smoking and children's BP. Results Children of smoking mothers presented significantly higher BP levels. After adjustment for maternal education, gestational hypertensive disorders, and child's body mass index, children exposed during pregnancy to maternal smoking presented a higher systolic BP (SBP) z-score (β = 0.08, 95% confidence interval [CI] 0.04 to 0.14). In crude models, maternal smoking was associated with higher SBP z-score at every assessed period. However, after adjustment, an attenuation of the association estimates occurred (β = 0.08, 95% CI 0.03 to 0.13 before conception; β = 0.07, 95%CI 0.02 to 0.12; β = 0.04, 95%CI -0.02 to 0.10; and β = 0.06, 95%CI 0.00 to 0.13 for the first, second, and third pregnancy trimesters, respectively; and β = 0.07, 95%CI 0.02 to 0.12 for current maternal smoking). No significant association was observed for diastolic BP z-score levels. Conclusion Maternal smoking before, during, and after pregnancy was independently associated with systolic BP z-score in preschool children. This study provides additional evidence to the public health relevance of maternal smoking cessation programs if early cardiovascular health of children is envisaged. Implications Using observational longitudinal data from the birth cohort Generation XXI, this study showed that exposure to maternal smoking-before pregnancy, during pregnancy, and 4 years after delivery-was associated with a systolic BP-raising effect in children at the age of 4. The findings of this study add an important insight into the need to support maternal smoke-free environments in order to provide long-term cardiovascular benefit, starting as early as possible in life.
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Affiliation(s)
- Maria Cabral
- EPIUnit, Institute of Public Health, University of Porto, Portugal
| | - Maria J Fonseca
- EPIUnit, Institute of Public Health, University of Porto, Portugal
| | | | - Ana C Santos
- EPIUnit, Institute of Public Health, University of Porto, Portugal
| | | | - Henrique Barros
- EPIUnit, Institute of Public Health, University of Porto, Portugal
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12
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Zhang Z, Ma J, Wang Z, Dong Y, Yang Z, Dong B, Ma Y. Parental smoking and blood pressure in children and adolescents: a national cross-sectional study in China. BMC Pediatr 2019; 19:116. [PMID: 30999873 PMCID: PMC6474055 DOI: 10.1186/s12887-019-1505-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/10/2019] [Indexed: 11/13/2022] Open
Abstract
Background Current evidence on the health effects of passive smoking on childhood blood pressure is limited and inconsistent. We investigated the associations between exposure to parental smoking and blood pressure in children and adolescents. Methods A cross-sectional analysis was performed in a national sample of 42,745 children and adolescents (50.2% boys) aged 7–18 years from seven provinces in China. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. Information on parental smoking was collected through questionnaire. Multivariable linear regression and logistic regression was used to investigate the associations of parental smoking with blood pressure and prevalent hypertension, respectively. Results The reported parental smoking rates were 49.7 and 50.2% in boys and girls, respectively. After adjustment for a range of potential confounders, exposure to parental smoking was associated with 0.44 [95% confidence interval (CI): 0.16, 0.72] mmHg and 0.26 (95% CI: 0.04, 0.47) mmHg higher SBP and DBP in girls. Girls exposed to parental smoking were also more likely to have hypertension compared with those without exposure (odds ratio = 1.11, 95% CI: 1.02, 1.20). No significant associations were found in boys. Conclusions Exposure to parental smoking was associated with increased blood pressure and higher prevalence of hypertension in girls, but not in boys. Urgent strategies are needed for the promotion of smoking-free environment, especially for children and adolescents. Electronic supplementary material The online version of this article (10.1186/s12887-019-1505-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zilong Zhang
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Xueyuan Road 38, Haidian District, Beijing, 100191, China.,Public Health Ontario, Toronto, ON, Canada
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Xueyuan Road 38, Haidian District, Beijing, 100191, China
| | - Zhenghe Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Xueyuan Road 38, Haidian District, Beijing, 100191, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Xueyuan Road 38, Haidian District, Beijing, 100191, China
| | - Zhaogeng Yang
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Xueyuan Road 38, Haidian District, Beijing, 100191, China
| | - Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Xueyuan Road 38, Haidian District, Beijing, 100191, China.
| | - Yinghua Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Xueyuan Road 38, Haidian District, Beijing, 100191, China.
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13
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Liang X, Su S, Hao G, Snieder H, Treiber F, Kapuku G, Wang X. Determinants of pulse wave velocity trajectories from youth to young adulthood: the Georgia Stress and Heart Study. J Hypertens 2019; 37:563-571. [PMID: 30234784 PMCID: PMC6355367 DOI: 10.1097/hjh.0000000000001933] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Increased arterial stiffness measured by pulse wave velocity (PWV) has been shown to be an important parameter of cardiovascular risk. Longitudinal development of PWV from youth to early adulthood and its possible sociodemographic, anthropometric, hemodynamic and behavioral moderators will be illustrated. METHODS Individual growth curves of carotid-distal PWV across age were created for 559 African American and European American men and women with a maximum of five assessments over an average of 7-year follow-up (mean age at participants' first assessment, 22.3 ± 3.4). RESULTS African Americans and men had significantly higher PWV than did European Americans and women (Ps < 0.01), respectively. A three-way interaction (P < 0.001) between age, sex and ethnicity was observed with African American men displaying a larger rate of increase in PWV with age than the other three ethnic and sex groups. The ethnicity and sex effects on PWV persisted when controlling for other moderators. Waist circumference was the strongest anthropometric predictor but its effect on PWV was only significant in women. Mean arterial pressure was the strongest hemodynamic predictor, marital status of parents was the strongest socioeconomic predictor and marijuana use was the strongest behavioral predictor of PWV. The best-fitting full model explained in total 59.4% of the between-subject variance in PWV with ethnicity, sex and age explaining 25.6%. CONCLUSION We observed significant ethnic and sex differences in longitudinal trajectories of PWV in youth and young adults. In addition, individual differences in PWV growth can largely be explained by mean arterial pressure, waist, marital status of parents and marijuana use.
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Affiliation(s)
- Xiaohua Liang
- Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China,
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA,
| | - Shaoyong Su
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA,
| | - Guang Hao
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA,
| | - Harold Snieder
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Frank Treiber
- College of Nursing, Medical University of South Carolina, Charleston, USA
| | - Gaston Kapuku
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA,
| | - Xiaoling Wang
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA,
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14
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El-Shafie AM, El-Gendy FM, Allhony DM, Abo El Fotoh WMM, Omar ZA, Samir MA, Bahbah WA, Abd El Naby SA, El Zayat RS, Abd El Hady NMS, El Gazar BA, Zannoun MA, Kasemy ZA, El-Bazzar AN, Abd El-Fattah MAEN, Abd El-Monsef AA, Kairallah AM, Raafet HM, Baz GM, Salah AG, Galab WS. Establishment of blood pressure nomograms representative for Egyptian children and adolescents: a cross-sectional study. BMJ Open 2018; 8:e020609. [PMID: 30049691 PMCID: PMC6067375 DOI: 10.1136/bmjopen-2017-020609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To define nomograms for blood pressure in Egyptian children and adolescents. METHODS AND STUDY DESIGN A total of 60 025 Egyptian children from birth to 19 years were enrolled in this cross-sectional randomised study from December 2015 to March 2017. They were selected from diverse geographical districts in Egypt. Healthy children who fulfilled the inclusion criteria, which included good nutritional history, absence of fever or documented underlying disease at the time of examination, no evidence of haemodynamically significant illness, and no antihypertensive drugs or other chronic drug administration, were included in the study. Body weight, recumbent length (for less than 24 months) and height (from 2 years to 19 years), and blood pressure were measured using standard mercury sphygmomanometers. RESULTS Blood pressure increases with age in both boys and girls. The 90th percentile of systolic and diastolic blood pressure among Egyptian children was different from other ethnic populations (American and Turkish children) in both sexes. Systolic and diastolic blood pressure showed a positive correlation with weight and height in both sexes (p<0.001). CONCLUSION We assumed that normal blood pressure curves should be used cautiously during childhood, and it is recommended that every population have its own normal standard curve to define measured blood pressure levels in children. These centiles increased our knowledge and awareness of normal blood pressure among Egyptian children and adolescents. The percentiles will distinguish children and young adolescents with increased blood pressure and will be of value to both medical practice and scientific research.
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Affiliation(s)
- Ali M El-Shafie
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Fady M El-Gendy
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Dalia M Allhony
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | | | - Zein A Omar
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Mohamed A Samir
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Wael A Bahbah
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | | | - Rania S El Zayat
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | | | - Basim A El Gazar
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Mohamed A Zannoun
- Department of Paediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Zeinab A Kasemy
- Department of Public Health and Community Epidemiology and Biostatistics Division, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
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15
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Abstract
Chronic kidney disease affects more than 10% of the population. Programming studies have examined the interrelationship between environmental factors in early life and differences in morbidity and mortality between individuals. A number of important principles has been identified, namely permanent structural modifications of organs and cells, long-lasting adjustments of endocrine regulatory circuits, as well as altered gene transcription. Risk factors include intrauterine deficiencies by disturbed placental function or maternal malnutrition, prematurity, intrauterine and postnatal stress, intrauterine and postnatal overnutrition, as well as dietary dysbalances in postnatal life. This mini-review discusses critical developmental periods and long-term sequelae of renal programming in humans and presents studies examining the underlying mechanisms as well as interventional approaches to "re-program" renal susceptibility toward disease. Clinical manifestations of programmed kidney disease include arterial hypertension, proteinuria, aggravation of inflammatory glomerular disease, and loss of kidney function. Nephron number, regulation of the renin-angiotensin-aldosterone system, renal sodium transport, vasomotor and endothelial function, myogenic response, and tubuloglomerular feedback have been identified as being vulnerable to environmental factors. Oxidative stress levels, metabolic pathways, including insulin, leptin, steroids, and arachidonic acid, DNA methylation, and histone configuration may be significantly altered by adverse environmental conditions. Studies on re-programming interventions focused on dietary or anti-oxidative approaches so far. Further studies that broaden our understanding of renal programming mechanisms are needed to ultimately develop preventive strategies. Targeted re-programming interventions in animal models focusing on known mechanisms will contribute to new concepts which finally will have to be translated to human application. Early nutritional concepts with specific modifications in macro- or micronutrients are among the most promising approaches to improve future renal health.
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Affiliation(s)
- Eva Nüsken
- Pediatric Nephrology, Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Jörg Dötsch
- Pediatric Nephrology, Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kai-Dietrich Nüsken
- Pediatric Nephrology, Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
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Zaniqueli D, Baldo MP, Sartório CL, de Sá Cunha R, de Oliveira Alvim R, Mill JG. Early sex differences in central arterial wave reflection are mediated by different timing of forward and reflected pressure waves. Clin Exp Pharmacol Physiol 2017; 45:166-173. [PMID: 28972675 DOI: 10.1111/1440-1681.12866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 11/29/2022]
Abstract
Non-invasive assessment of central arterial pulse wave augmentation has been proved to be useful in predicting cardiovascular adverse events. Previous studies have shown that pre-pubescent girls had greater central augmentation pressure compared with height-matched boys. This study sought to investigate which factors contribute to the body height-independent sexual differences in central arterial wave reflection observed in childhood. This cross-sectional study involved 819 children and adolescents (6-18 years of age) of both sexes. Phenotypes of central haemodynamic were obtained by radial applanation tonometry. Heart rate corrected augmentation index (Aix@75) was greater in girls compared with boys (2.9 ± 10.7 vs -1.7 ± 12.9%, P < .001) as well as the central augmented pressure (cAP; 1.3 ± 3.3 vs 0.1 ± 3.8 mm Hg, P < .001), even adjusting for age, heart rate and body height. Left ventricular ejection duration (ED) was longer (320 ± 26 vs 314 ± 24 ms, P = .004) and time to inflection point (Tr) was shorter in girls (139 ± 14 vs 141 ± 21 ms, P = .014). The reduction of Aix@75 with increasing body height was steeper in boys (-0.499 ± 0.030 vs -0.428 ± 0.036%/cm, P < .001) as well as the reduction of cAP with increasing body height (-0.108 ± 0.010 vs -0.066 ± 0.013 mm Hg/cm, P < .001). Body height-independent sexual differences observed in the pulse wave reflection indices from early adolescence were mediated by different timing of forward and reflected pressure waves.
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Affiliation(s)
- Divanei Zaniqueli
- Department of Physiological Sciences, Cardiovascular Investigation Clinic, Federal University of Espírito Santo, Vitória, Brazil
| | - Marcelo Perim Baldo
- Department of Pathophysiology, Montes Claros State University, Montes Claros, Brazil
| | - Carmem Luiza Sartório
- Department of Physiological Sciences, Cardiovascular Investigation Clinic, Federal University of Espírito Santo, Vitória, Brazil
| | - Roberto de Sá Cunha
- Department of Physiological Sciences, Cardiovascular Investigation Clinic, Federal University of Espírito Santo, Vitória, Brazil
| | - Rafael de Oliveira Alvim
- Department of Physiological Sciences, Cardiovascular Investigation Clinic, Federal University of Espírito Santo, Vitória, Brazil
| | - José Geraldo Mill
- Department of Physiological Sciences, Cardiovascular Investigation Clinic, Federal University of Espírito Santo, Vitória, Brazil
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Race, obesity, and the renin-angiotensin-aldosterone system: treatment response in children with primary hypertension. Pediatr Nephrol 2017; 32:1585-1594. [PMID: 28411317 DOI: 10.1007/s00467-017-3665-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pediatric primary hypertension (HTN) is increasingly recognized, but the effect of patient characteristics such as obesity and race on treatment outcomes is not well described. The renin-angiotensin-aldosterone system (RAAS) may also contribute to HTN. We hypothesized patient parameters of these factors, including baseline RAAS, influence blood pressure (BP) response to pharmacological treatment in HTN. METHODS This was a retrospective cohort of 102 consecutive patients with HTN. Primary outcomes were changes per year in systolic and diastolic BP (SBP, DBP). Secondary outcome was change per year in left ventricular mass index (LVMI). We evaluated whether baseline plasma renin activity (PRA), aldosterone, renin-to-aldosterone ratio, overweight/obesity, race, initial drug choice, and multidrug therapy were associated with the outcomes using general linear regression models adjusted for confounding variables. RESULTS Racially diverse (43% Hispanic, 28% black, 25% white) and predominantly overweight/obese (75%) patients were studied. Median length of follow-up was 14.5 months. Higher baseline aldosterone was associated with decreased SBP (-1.03 mmHg/year), DBP (-0.95 mmHg/year), and DBP z score (-0.07/year) during the study period. Higher baseline PRA was associated with decreased SBP z score (-0.04/year) and LVMI (-2.89 g/m2.7/year). Stratified analyses revealed the relationships between baseline aldosterone and PRA, and annual reductions in outcomes were strengthened in nonobese and white patients. CONCLUSIONS Pretreatment aldosterone and PRA predicted short-term follow-up BP and LVMI, especially in nonobese and white patients. The RAAS profile could guide treatment of HTN and suggests consideration of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers as first-line treatment options.
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Fuller-Rowell TE, Curtis DS, Klebanov PK, Brooks-Gunn J, Evans GW. Racial Disparities in Blood Pressure Trajectories of Preterm Children: The Role of Family and Neighborhood Socioeconomic Status. Am J Epidemiol 2017; 185:888-897. [PMID: 28449023 DOI: 10.1093/aje/kww198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 04/22/2016] [Indexed: 12/22/2022] Open
Abstract
Racial disparities in cardiovascular disease mortality in the United States remain substantial. However, the childhood roots of these disparities are not well understood. In the current study, we examined racial differences in blood pressure trajectories across early childhood in a sample of African-American and European-American low-birth-weight preterm infants. Family and neighborhood socioeconomic status (SES), measured at baseline, were also examined as explanations for subsequent group disparities. Analyses focused on 407 African-American and 264 European-American children who participated in the Infant Health and Development Program, a US longitudinal study of preterm children born in 1985. Blood pressure was assessed on 6 occasions between the ages of 24 and 78 months, in 1987-1992. Across this age range, the average rate of change in both systolic and diastolic blood pressure was greater among African-American children than among European-American children. Neighborhood SES explained 29% and 24% of the racial difference in the average rate of change in systolic and diastolic blood pressure, respectively, whereas family SES did not account for group differences. The findings show that racial differences in blood pressure among preterm children emerge in early childhood and that neighborhood SES accounts for a portion of racial disparities.
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White MS, Addison CC, Jenkins BWC, Bland V, Clark A, LaVigne DA. Optimistic Bias, Risk Factors, and Development of High Blood Pressure and Obesity among African American Adolescents in Mississippi (USA). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E209. [PMID: 28230728 PMCID: PMC5334763 DOI: 10.3390/ijerph14020209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/17/2017] [Indexed: 01/09/2023]
Abstract
Childhood obesity has reached epidemic proportions and is linked to hypertension among African American youth. Optimistic bias influences behavior of youth causing them to underestimate their susceptibility to negative health outcomes. This study explored adolescent behaviors and prevalence of high blood pressure and obesity in a school district. We examined the relationship between individual health risk practices and optimistic bias on health outcomes; 433 African American high school students were administered a survey and had their obesity and blood pressure measured by the school nurse. Canonical correlational analyses were used to examine relationships between health risk practices and descriptive statistics for optimistic bias and health outcomes. Engaging in moderate exercise for at least 30 min in the last 7 days and lower blood pressure was the only statistically significant relationship. Two-thirds of the students did not perceive themselves to be at risk of developing cardiovascular disease with males at greater risk than females, despite the presence of clinical risk factors for hypertension and obesity. Reducing health optimistic bias is an effective way of motivating young people to adopt more positive behaviors using educational institutions to implement intervention programs that promote positive health behavior as a way to reduce health disparities.
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Affiliation(s)
- Monique S White
- Center of Excellence in Minority Health and Health Disparities, School of Public Health, Jackson State University, Jackson, MS 39213, USA.
- Jackson Heart Study Community Outreach Center, School of Public Health, Jackson State University, Jackson, MS 39213, USA.
| | - Clifton C Addison
- Center of Excellence in Minority Health and Health Disparities, School of Public Health, Jackson State University, Jackson, MS 39213, USA.
- Jackson Heart Study Community Outreach Center, School of Public Health, Jackson State University, Jackson, MS 39213, USA.
- Jackson Heart Study Graduate Training and Education Center, School of Public Health, Jackson State University, Jackson, MS 39213, USA.
| | - Brenda W Campbell Jenkins
- Center of Excellence in Minority Health and Health Disparities, School of Public Health, Jackson State University, Jackson, MS 39213, USA.
- Jackson Heart Study Community Outreach Center, School of Public Health, Jackson State University, Jackson, MS 39213, USA.
| | - Vanessa Bland
- Jackson Heart Study Graduate Training and Education Center, School of Public Health, Jackson State University, Jackson, MS 39213, USA.
| | - Adrianne Clark
- Jackson Heart Study Community Outreach Center, School of Public Health, Jackson State University, Jackson, MS 39213, USA.
| | - Donna Antoine LaVigne
- Center of Excellence in Minority Health and Health Disparities, School of Public Health, Jackson State University, Jackson, MS 39213, USA.
- Jackson Heart Study Community Outreach Center, School of Public Health, Jackson State University, Jackson, MS 39213, USA.
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Hao G, Wang X, Treiber FA, Harshfield G, Kapuku G, Su S. Blood Pressure Trajectories From Childhood to Young Adulthood Associated With Cardiovascular Risk: Results From the 23-Year Longitudinal Georgia Stress and Heart Study. Hypertension 2017; 69:435-442. [PMID: 28093467 DOI: 10.1161/hypertensionaha.116.08312] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 08/22/2016] [Accepted: 11/18/2016] [Indexed: 01/12/2023]
Abstract
The purpose of this study is to identify subgroups of individuals with similar trajectories in blood pressure (BP) from childhood to young adulthood and to determine the relationship of BP trajectories with carotid intima-media thickness (IMT) and left ventricular mass index (LVMI). BP was measured ≤16 times during a 23-year period in 683 participants from childhood to young adulthood. IMT and LVMI were measured in 551 participants and 546 participants, respectively. Using latent class models, 3 trajectory groups in BP from childhood to young adulthood were identified, including high-increasing, moderate-increasing, and low-increasing groups. We found that trajectory of systolic BP was a significant predictor of both IMT and LVMI with increased rate of growth in systolic BP associated with higher levels of IMT and LVMI (Pfor trend <0.001). Similar to the BP trajectory groups from childhood to young adulthood, 3 trajectory groups in BP during childhood (≤18 years) were identified, and participants in the high-increasing group had thicker IMT (P<0.001) and increased LVMI (P=0.043) in comparison with those in the low-increasing group. Results were similar for mid-BP trajectories but not for diastolic BP trajectories. Our results suggested that different BP trajectories exist from childhood to young adulthood, and the trajectories were independently associated with IMT and LVMI. We, for the first time, reported the association between systolic BP trajectories derived from childhood with subclinical cardiovascular risk in young adulthood, indicating that monitoring trajectories of BP from childhood may help identify a high cardiovascular risk population in early life.
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Affiliation(s)
- Guang Hao
- From the Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta University (G.H., X.W., G.H., G.K., S.S.); and Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.)
| | - Xiaoling Wang
- From the Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta University (G.H., X.W., G.H., G.K., S.S.); and Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.)
| | - Frank A Treiber
- From the Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta University (G.H., X.W., G.H., G.K., S.S.); and Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.)
| | - Gregory Harshfield
- From the Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta University (G.H., X.W., G.H., G.K., S.S.); and Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.)
| | - Gaston Kapuku
- From the Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta University (G.H., X.W., G.H., G.K., S.S.); and Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.)
| | - Shaoyong Su
- From the Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta University (G.H., X.W., G.H., G.K., S.S.); and Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.).
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Hao G, Wang X, Treiber FA, Davis H, Leverett S, Su S, Kapuku G. Growth of Carotid Intima-Media Thickness in Black and White Young Adults. J Am Heart Assoc 2016; 5:JAHA.116.004147. [PMID: 27998916 PMCID: PMC5210407 DOI: 10.1161/jaha.116.004147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background There are few longitudinal studies that have comprehensively examined the intima‐media thickness (IMT) growth pattern and its determinants among racial population groups. Methods and Results Mean and maximum IMT were measured by B‐mode ultrasonography up to 3 times in 253 white and 268 black participants, aged 13 to 36 years (mean age±standard deviation 24±3.2 years old). The development of IMT was assessed using individual growth curve modeling. A total of 521 participants with 1015 IMT measurements were eligible for this study. We found higher IMT in both left and right sides in blacks compared to whites (P<0.001) in young adulthood. Both whites and blacks showed a strong linear increase in mean IMT with age. Body mass index and father's education level were associated with mean IMT, and only body mass index was associated with maximum IMT (P<0.05). We did not observe an interaction between age and race/ethnicity on the growth of IMT, suggesting that blacks and whites developed IMT in similar patterns. Interestingly, we found a faster increase in mean left‐side IMT than mean right‐side IMT (χ2=11.5, P<0.001) in both black and white subjects as well as in males and females. Conclusions Our findings provide compelling prospective evidence that blacks may have thicker IMT compared to whites as young adults. These racial differences could not be explained by traditional risk factors. This implies that differences in this precursor of atherosclerosis may explain racial disparity in cerebrovascular disease.
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Affiliation(s)
- Guang Hao
- Department of Pediatrics, Medical College of Georgia, Georgia Prevention Institute, Augusta University, Augusta, GA
| | - Xiaoling Wang
- Department of Pediatrics, Medical College of Georgia, Georgia Prevention Institute, Augusta University, Augusta, GA
| | - Frank A Treiber
- Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston, SC
| | - Harry Davis
- Department of Pediatrics, Medical College of Georgia, Georgia Prevention Institute, Augusta University, Augusta, GA
| | - Sharika Leverett
- Department of Pediatrics, Medical College of Georgia, Georgia Prevention Institute, Augusta University, Augusta, GA
| | - Shaoyong Su
- Department of Pediatrics, Medical College of Georgia, Georgia Prevention Institute, Augusta University, Augusta, GA
| | - Gaston Kapuku
- Department of Pediatrics, Medical College of Georgia, Georgia Prevention Institute, Augusta University, Augusta, GA
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Gupta-Malhotra M, Hashmi SS, Barratt MS, Milewicz DM, Shete S. Childhood-Onset Essential Hypertension and the Family Structure. J Clin Hypertens (Greenwich) 2016; 18:431-8. [PMID: 26435293 PMCID: PMC4821812 DOI: 10.1111/jch.12701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 07/31/2015] [Accepted: 08/07/2015] [Indexed: 11/28/2022]
Abstract
The prevalence and effect of single-parent families in childhood-onset essential hypertension (EH) is unknown. Children with EH and age-, sex-, and ethnicity-matched controls were enrolled. Family structure data were obtained by in-person interview. A total of 148 families (76 hypertension probands, 72 control probands; median 14 years) were prospective-ly enrolled in the study. Single-parent status was seen in 42% of the families--with and without EH (38% vs 46%, P=.41; odds ratio, 0.7; 95% confidence interval, 0.4-1.4). After multivariable analysis, a statistically significant sociofamilial contributor to the development of childhood-onset EH was not identified. A significant number of single-parent families (42%), the majority with single mothers, were found in our pedigree study. Sociofamilial factors are known to contribute to the expression of adult-onset EH, but findings in our study suggest that they appear to contribute less in the expression of childhood-onset EH.
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Affiliation(s)
- Monesha Gupta-Malhotra
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, TX
| | - Syed Shahrukh Hashmi
- Pediatric Research Center, Department of Pediatrics, The University of Texas Health Science Center, Houston, TX
| | - Michelle S Barratt
- Divisions of Community and General Pediatrics and Adolescent Medicine, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, TX
| | - Dianna M Milewicz
- Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX
| | - Sanjay Shete
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas Health Science Center, Houston, TX
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24
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Stiefel EC, Field L, Replogle W, McIntyre L, Igboechi O, Savoie FH. The Prevalence of Obesity and Elevated Blood Pressure in Adolescent Student Athletes From the State of Mississippi. Orthop J Sports Med 2016; 4:2325967116629368. [PMID: 26962540 PMCID: PMC4765822 DOI: 10.1177/2325967116629368] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Over the past 30 years, there has been a dramatic increase in the prevalence of childhood obesity and hypertension in the United States. The prevalence of these diagnoses among individuals participating in school-sanctioned sports has not been clearly defined. Purpose: To identify the prevalence of obesity and elevated blood pressure (BP) among student athletes and investigate associations between race, sex, type and number of sports played, and the prevalence of these diseases. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Pre–sports participation medical examinations (N = 7705) performed between 2009 and 2013 were reviewed to identify the prevalence of obesity and elevated BP and examine relationships between the type of sports played, participation in multiple sports versus a single sport, and the athlete’s body weight and body mass index (BMI). Results: The prevalence of obesity was 23.5%. There was a significant association (P < .001) between the number of sports played by the student and BMI. The risk of obesity among single-sport athletes was more than 2-fold the risk (relative risk [RR], 2.13) compared with ≥3-sport athletes and 1.42 times greater compared with 2-sport athletes (RR, 1.42). The prevalence of elevated BP was 21.2%. There was a significant association (P < .001) between the number of sports played by the student and elevated BP. The risk of elevated BP among single-sport athletes was 1.59 times greater (RR, 1.59) than ≥3-sport athletes and 1.30 times greater compared with 2-sport athletes (RR, 1.30). Finally, obese students were 2.40 times more likely to have elevated BP compared with nonobese students (P < .001). Conclusion: The result of this study confirms the progressive nature of the obesity epidemic and identifies the contribution of obesity to the worsening cardiometabolic profiles in student athletes. The study also identifies that participation in multiple sports and running sports decreases the individual’s risk for obesity and hypertension. Clinical Relevance: The present study emphasizes the importance of screening for obesity and elevated blood pressure during the athlete’s preparticipation physical examination.
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Affiliation(s)
| | - Larry Field
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, USA
| | - William Replogle
- University of Mississippi Medical Center, Department of Family Medicine, Jackson, Mississippi, USA
| | - Louis McIntyre
- Westchester Shoulder and Knee Center, White Plains, New York, USA
| | - Oduche Igboechi
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Felix H Savoie
- Tulane University School of Medicine, New Orleans, Louisiana, USA
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Abstract
PURPOSE To describe a health and weight management intervention for children who are African American. METHODS Body mass index (BMI), blood pressure, and fitness levels were measured in 222 students (kindergarten-eighth grade) from 2 schools (control and intervention). Baseline and outcome data were collected over the course of 2 academic years. The intervention group received education on good nutrition and active lifestyle. Intervention students were also given the Body Figure Perception Questionnaire. RESULTS Students in the intervention group who were obese/overweight were more likely to be less physically fit. The greater the intervention students' BMI, the larger the difference between their ideal and real body images. Intervention students' BMIs were maintained. The intervention group's posttest scores of knowledge about active lifestyle and good nutrition were significantly higher than their pretest scores and higher than the control group's scores. CONCLUSIONS Weight gain prevention holds promise for reducing risk of overweight/obesity in the African-American population.
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26
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Kelly RK, Thomson R, Smith KJ, Dwyer T, Venn A, Magnussen CG. Factors Affecting Tracking of Blood Pressure from Childhood to Adulthood: The Childhood Determinants of Adult Health Study. J Pediatr 2015; 167:1422-8.e2. [PMID: 26342719 DOI: 10.1016/j.jpeds.2015.07.055] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/26/2015] [Accepted: 07/28/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine the modifiable factors that alter the trajectory of blood pressure (BP) from childhood to adulthood. STUDY DESIGN This study investigated the BP of 798 participants (53% female) from the Childhood Determinants of Adult Health Study who had BP measured when aged 9, 12, or 15 years, and at follow-up 20 years later. BP was classified as normal or elevated (prehypertensive or hypertensive) in childhood and adulthood. BP trajectory groups (persistently normal, resolution, incident elevated, persistently elevated) were established according to these classifications. Potentially modifiable factors measured at both examinations included body mass index, fruit and vegetable intake, physical activity, cardiorespiratory fitness, alcohol consumption, smoking, and socioeconomic status. RESULTS Spearman correlation coefficients for BP tracking from childhood to adulthood were 0.31 (P < .001) for systolic BP and 0.16 (P < .001) for diastolic BP. Children with elevated BP had a 35% increased risk of elevated BP in adulthood compared with those with normal BP (relative risk 1.35, 95% CI 1.18-1.55, P < .001). Relative to those with persistently elevated BP, participants in the resolution group significantly decreased their body mass index z-score, decreased their alcohol consumption z-score, and increased their vegetable consumption z-score between childhood and adulthood. The proportion of participants with upwardly mobile socioeconomic status was significantly higher in the resolution group (41.2%) compared with the persistently elevated group (27.5%). CONCLUSIONS Resolution of elevated BP in the transition from childhood to adulthood appeared to be partially determined by modifiable factors associated with a healthy lifestyle.
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Affiliation(s)
- Rebecca K Kelly
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Russell Thomson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Kylie J Smith
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Terence Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; The George Institute for Global Health/Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
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27
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Tucker AM, Lincoln AE, Vogel RA, Black HR, Dunn RE, Wilson PW, Pellman EJ. Lack of blood pressure difference by race in professional American football players. ACTA ACUST UNITED AC 2015; 9:370-4. [DOI: 10.1016/j.jash.2015.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/27/2015] [Accepted: 02/27/2015] [Indexed: 11/17/2022]
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28
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Howe LD, Tilling K, Lawlor DA. Studying the life course health consequences of childhood adversity: challenges and opportunities. Circulation 2015; 131:1645-7. [PMID: 25858195 DOI: 10.1161/circulationaha.115.016251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Laura D Howe
- From MRC Integrative Epidemiology Unit and School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Kate Tilling
- From MRC Integrative Epidemiology Unit and School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Debbie A Lawlor
- From MRC Integrative Epidemiology Unit and School of Social and Community Medicine, University of Bristol, United Kingdom.
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29
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Su S, Wang X, Pollock JS, Treiber FA, Xu X, Snieder H, McCall WV, Stefanek M, Harshfield GA. Adverse childhood experiences and blood pressure trajectories from childhood to young adulthood: the Georgia stress and Heart study. Circulation 2015; 131:1674-81. [PMID: 25858196 DOI: 10.1161/circulationaha.114.013104] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 02/13/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND The purposes of this study were to assess the long-term effect of adverse childhood experiences (ACEs) on blood pressure (BP) trajectories from childhood to young adulthood and to examine whether this relation is explained by childhood socioeconomic status (SES) or risk behaviors that are associated with ACEs. METHODS AND RESULTS Systolic and diastolic BPs were measured up to 16 times (13 times on average) over a 23-year period in 213 African Americans and 181 European Americans 5 to 38 years of age. Retrospective data on traumatic experiences before 18 years of age were collected, including abuse, neglect, and household dysfunction. Individual growth curve modeling within a multilevel framework was used to examine the relation between exposure to ACEs and BP development. No main effect of ACEs on average BP levels was found. However, a significant interaction of ACE score with age(3) was observed (systolic BP, P=0.033; diastolic BP, P=0.017). Subjects who experienced multiple traumatic events during childhood showed a faster rise in BP levels after 30 years of age than those without ACEs. As expected, a graded association of ACEs with childhood socioeconomic status and negative health behaviors was observed (P<0.001). The ACE-systolic BP relation was not explained by these factors, whereas the ACE-diastolic BP relation was partially mediated by illicit drug use. CONCLUSION In this novel longitudinal study, we observed that participants who were exposed to multiple ACEs displayed a greater increase in BP levels in young adulthood compared with their counterparts without ACEs.
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Affiliation(s)
- Shaoyong Su
- From Georgia Prevention Institute, Medical College of Georgia (S.S., X.W., X.X., G.A.H.), Department of Psychiatry and Health Behavior (W.V.M.), and Department of Psychological Sciences, College of Science and Mathematics (M.S.), Georgia Regents University, Augusta; Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham (J.S.P.); Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.); and Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands (H.S.).
| | - Xiaoling Wang
- From Georgia Prevention Institute, Medical College of Georgia (S.S., X.W., X.X., G.A.H.), Department of Psychiatry and Health Behavior (W.V.M.), and Department of Psychological Sciences, College of Science and Mathematics (M.S.), Georgia Regents University, Augusta; Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham (J.S.P.); Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.); and Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands (H.S.)
| | - Jennifer S Pollock
- From Georgia Prevention Institute, Medical College of Georgia (S.S., X.W., X.X., G.A.H.), Department of Psychiatry and Health Behavior (W.V.M.), and Department of Psychological Sciences, College of Science and Mathematics (M.S.), Georgia Regents University, Augusta; Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham (J.S.P.); Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.); and Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands (H.S.)
| | - Frank A Treiber
- From Georgia Prevention Institute, Medical College of Georgia (S.S., X.W., X.X., G.A.H.), Department of Psychiatry and Health Behavior (W.V.M.), and Department of Psychological Sciences, College of Science and Mathematics (M.S.), Georgia Regents University, Augusta; Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham (J.S.P.); Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.); and Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands (H.S.)
| | - Xiaojing Xu
- From Georgia Prevention Institute, Medical College of Georgia (S.S., X.W., X.X., G.A.H.), Department of Psychiatry and Health Behavior (W.V.M.), and Department of Psychological Sciences, College of Science and Mathematics (M.S.), Georgia Regents University, Augusta; Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham (J.S.P.); Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.); and Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands (H.S.)
| | - Harold Snieder
- From Georgia Prevention Institute, Medical College of Georgia (S.S., X.W., X.X., G.A.H.), Department of Psychiatry and Health Behavior (W.V.M.), and Department of Psychological Sciences, College of Science and Mathematics (M.S.), Georgia Regents University, Augusta; Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham (J.S.P.); Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.); and Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands (H.S.)
| | - W Vaughn McCall
- From Georgia Prevention Institute, Medical College of Georgia (S.S., X.W., X.X., G.A.H.), Department of Psychiatry and Health Behavior (W.V.M.), and Department of Psychological Sciences, College of Science and Mathematics (M.S.), Georgia Regents University, Augusta; Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham (J.S.P.); Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.); and Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands (H.S.)
| | - Michael Stefanek
- From Georgia Prevention Institute, Medical College of Georgia (S.S., X.W., X.X., G.A.H.), Department of Psychiatry and Health Behavior (W.V.M.), and Department of Psychological Sciences, College of Science and Mathematics (M.S.), Georgia Regents University, Augusta; Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham (J.S.P.); Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.); and Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands (H.S.)
| | - Gregory A Harshfield
- From Georgia Prevention Institute, Medical College of Georgia (S.S., X.W., X.X., G.A.H.), Department of Psychiatry and Health Behavior (W.V.M.), and Department of Psychological Sciences, College of Science and Mathematics (M.S.), Georgia Regents University, Augusta; Cardio-Renal Physiology & Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham (J.S.P.); Technology Applications Center for Healthful Lifestyles, Colleges of Nursing and Medicine, Medical University of South Carolina, Charleston (F.A.T.); and Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands (H.S.)
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30
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Kelly RK, Magnussen CG. Epidemiology of elevated blood pressure in youth and its utility for predicting adulthood outcomes: A review. World J Hypertens 2014; 4:29-36. [DOI: 10.5494/wjh.v4.i4.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/29/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
Elevated blood pressure has been demonstrated to track from youth to adulthood and some have demonstrated an association between early-life blood pressure and subsequent atherosclerosis and cardiovascular disease. In addition, reports regarding the strength of tracking are inconsistent and the modifiable risk factors that affect the trajectory of blood pressure from youth to adulthood remain unclear. This paper comprehensively evaluated the existing classifications of youth hypertension and the current trends of youth hypertension. Further, evidence for the consequences of hypertension in youth has been comprehensively evaluated. Importantly, a review of the studies examining tracking from youth to adulthood has been performed and a number of studies investigating the factors affecting tracking has also been investigated. The overall consideration of this body of literature highlights the vital importance of identifying hypertension in youth to prevent complications in adulthood. Adiposity is regarded to be a factor affecting the progression of hypertension from youth to adulthood yet there is little evidence available for other modifiable factors. It is apparent that further research is necessary within this field in order to create effective preventative strategies to target youth hypertension.
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31
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Riese H, Muñoz LM, Hartman CA, Ding X, Su S, Oldehinkel AJ, van Roon AM, van der Most PJ, Lefrandt J, Gansevoort RT, van der Harst P, Verweij N, Licht CMM, Boomsma DI, Hottenga JJ, Willemsen G, Penninx BWJH, Nolte IM, de Geus EJC, Wang X, Snieder H. Identifying genetic variants for heart rate variability in the acetylcholine pathway. PLoS One 2014; 9:e112476. [PMID: 25384021 PMCID: PMC4226560 DOI: 10.1371/journal.pone.0112476] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 10/15/2014] [Indexed: 11/19/2022] Open
Abstract
Heart rate variability is an important risk factor for cardiovascular disease and all-cause mortality. The acetylcholine pathway plays a key role in explaining heart rate variability in humans. We assessed whether 443 genotyped and imputed common genetic variants in eight key genes (CHAT, SLC18A3, SLC5A7, CHRNB4, CHRNA3, CHRNA, CHRM2 and ACHE) of the acetylcholine pathway were associated with variation in an established measure of heart rate variability reflecting parasympathetic control of the heart rhythm, the root mean square of successive differences (RMSSD) of normal RR intervals. The association was studied in a two stage design in individuals of European descent. First, analyses were performed in a discovery sample of four cohorts (n = 3429, discovery stage). Second, findings were replicated in three independent cohorts (n = 3311, replication stage), and finally the two stages were combined in a meta-analysis (n = 6740). RMSSD data were obtained under resting conditions. After correction for multiple testing, none of the SNPs showed an association with RMSSD. In conclusion, no common genetic variants for heart rate variability were identified in the largest and most comprehensive candidate gene study on the acetylcholine pathway to date. Future gene finding efforts for RMSSD may want to focus on hypothesis free approaches such as the genome-wide association study.
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Affiliation(s)
- Harriëtte Riese
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail: (HR); (HS)
| | - Loretto M. Muñoz
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Catharina A. Hartman
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Xiuhua Ding
- Departments of Biostatistics & Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky, United States of America
| | - Shaoyong Su
- Georgia Prevention Institute, Department of Pediatrics, Georgia Regents University, Augusta, Georgia, United States of America
| | - Albertine J. Oldehinkel
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arie M. van Roon
- Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter J. van der Most
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joop Lefrandt
- Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ron T. Gansevoort
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Niek Verweij
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | | | - Dorret I. Boomsma
- Department of Biological Psychology, EMGO institute for Health and Care research, VU University & VU Medical Center, Amsterdam, The Netherlands
| | - Jouke-Jan Hottenga
- Department of Biological Psychology, EMGO institute for Health and Care research, VU University & VU Medical Center, Amsterdam, The Netherlands
| | - Gonneke Willemsen
- Department of Biological Psychology, EMGO institute for Health and Care research, VU University & VU Medical Center, Amsterdam, The Netherlands
| | | | - Ilja M. Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eco J. C. de Geus
- Department of Biological Psychology, EMGO institute for Health and Care research, VU University & VU Medical Center, Amsterdam, The Netherlands
| | - Xiaoling Wang
- Georgia Prevention Institute, Department of Pediatrics, Georgia Regents University, Augusta, Georgia, United States of America
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail: (HR); (HS)
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Martin L, Oepen J, Reinehr T, Wabitsch M, Claussnitzer G, Waldeck E, Ingrisch S, Stachow R, Oelert M, Wiegand S, Holl R. Ethnicity and cardiovascular risk factors: evaluation of 40,921 normal-weight, overweight or obese children and adolescents living in Central Europe. Int J Obes (Lond) 2014; 39:45-51. [PMID: 25214149 DOI: 10.1038/ijo.2014.167] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 08/09/2014] [Accepted: 09/02/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular disease (CVD) is a major global health problem and the leading cause of death in Europe. Risk factors such as obesity and hypertension that accelerate the development of CVD begin in childhood. Ethnicity is a known risk factor for CVD in adults. The aim of this study is to explore differences in the prevalence of hypertension and dyslipidemia among overweight/obese and normal-weight children/adolescents of three different ethnic origins living in Central Europe. METHODS AND PROCEDURES Prevalence of hypertension and dyslipidemia was calculated among obese/overweight children/adolescents (n = 25,986; mean age 12.7 ± 3.0 years; range: 0-18 years; 46% males) documented in the German-Austrian-Swiss APV (Prospective Documentation of Overweight Children and Adolescents) registry and among normal-weight subjects (n = 14,935; mean age: 8.8 ± 5.1 years; range 0-18 years; 51% males) from the population-based cross-sectional German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study. In both cohorts, subjects were categorized into three ethnic groups (Central European: Germany, Austria, Switzerland; Southeastern European: Turkish; Southern European: Spain, Portugal, Italy, Greece, Cyprus, Malta) based on the country of birth of both parents. Regression models were used to examine ethnic differences after adjustment for age and gender and body mass index (BMI) category. RESULTS Age-, gender- and BMI category-adjusted prevalence of hypertension were 38% and 39% for the ethnic minority groups, compared with 35% among German/Austrian/Swiss counterparts. Turkish ethnicity was significantly associated with hypertension (odds ratio (OR) 1.14; 95% confidence interval: 1.02-1.27; P = 0.0446). No significant ethnic differences were found in lipid levels. Prevalence of hypertension found among normal-weight subjects (Central European vs Southeastern vs Southern European: 6.8% vs 6.3% vs 7.2%) did not differ significantly. CONCLUSIONS Turkish obese/overweight children/adolescents showed a significantly higher prevalence of hypertension relative to their peers of Central European descent. No significant ethnic difference in the prevalence of hypertension was found among normal-weight children/adolescents. The high prevalence of hypertension among Turkish obese/overweight children/adolescents indicates the need for greater preventive and therapeutic efforts to reduce cardiovascular risk factors among vulnerable populations.
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Affiliation(s)
- L Martin
- Department of Pediatric Endocrinology and Diabetology, Charité Children's Hospital, Charité University Medicine, Berlin, Germany
| | - J Oepen
- Viktoriastift Bad Kreuznach, Rehabilitation Clinic for Children and Adolescents, Bad Kreuznach, Germany
| | - T Reinehr
- Vestische Children's Hospital, University of Witten/Herdecke, Datteln, Germany
| | - M Wabitsch
- Divison of Pediatric Endocrinology, Diabetes and Obesity Unit, University Children's Hospital, University of Ulm, Ulm, Germany
| | - G Claussnitzer
- Spessart-Klinik, Rehabilitation Clinic for Children and Adolescents, Bad Orb, Germany
| | - E Waldeck
- Edelsteinklinik, Rehabilitation Clinic for Children and Adolescents, Bruchweiler, Germany
| | - S Ingrisch
- Fachklinik Gaißach, Rehabilitation Clinic, Gaißach, Germany
| | - R Stachow
- Fachklinik Sylt, Rehabilitation Clinic for Children and Adolescents, Westerland, Germany
| | - M Oelert
- Katholisches Kinderkrankenhaus Wilhelmstift, Wilhelmstift Catholic Children's Hospital, Hamburg, Germany
| | - S Wiegand
- Department of Pediatric Endocrinology and Diabetology, Charité Children's Hospital, Charité University Medicine, Berlin, Germany
| | - R Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
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Mota J, Silva-Santos S, Barros M, Farias Júnior JC, Vale S. Influence of different behavioural factors and obesity status on systolic blood pressure among pre-school children. Ann Hum Biol 2014; 41:506-10. [PMID: 24827858 DOI: 10.3109/03014460.2014.909884] [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: 11/13/2022]
Abstract
AIM The aim of this study was to examine the association between sleeping time (SLT), time spent using screen (ST) and weight status with Systolic Blood Pressure (SBP) among pre-school children. SUBJECTS AND METHODS The sample comprised 628 pre-school children (50% female), aged 3-6 years-old. SLT and ST were reported by parents. BMI values were categorized according to IOTF. SBP cut points were based on SBP percentiles for age, sex and height. ST was dichotomized according to the following criteria: ≤1 hour vs >1 hour and SLT: ≤10.5 hours vs >10.5 hours. Participants were then categorized into one of four category profiles: Low ST/High SLT; High ST/Low SLT; Low ST/Low SLT and High ST/High SLT. RESULTS Children assigned to the High ST/Low SLT group were 2-times more likely to have high SBP values compared to those who were assigned to the Low ST/High SLT group (OR = 2.4; 95% CI = 1.1-5.1). Furthermore, those who were assigned as overweight and obese were more likely to be classified as having elevated BP (OR = 1.8; 95% CI = 1.1-3.2 for overweight and OR = 3.1; 95% CI = 1.6-5.8 for obese, respectively). CONCLUSION The data showed that high ST exposure time and low SLT are associated with enhanced blood pressure in children at pre-school.
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Affiliation(s)
- J Mota
- Research Centre in Physical Activity Health and Leisure, Faculty of Sport Sciences, University of Porto , Porto , Portugal
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Sieverdes JC, Mueller M, Gregoski MJ, Brunner-Jackson B, McQuade L, Matthews C, Treiber FA. Effects of Hatha yoga on blood pressure, salivary α-amylase, and cortisol function among normotensive and prehypertensive youth. J Altern Complement Med 2014; 20:241-50. [PMID: 24620850 DOI: 10.1089/acm.2013.0139] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Evidence is accumulating, predominantly among clinical trials in adults, that yoga improves blood pressure (BP) control, with downregulation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS) projected as underlying mechanisms. This pilot study assessed whether Hatha yoga has the potential to reduce BP among youth and whether dampening of the SNS and/or HPA activity is a likely pathway of change. DESIGN Thirty-one seventh graders were randomly assigned to a Hatha yoga program (HYP) or attention control (AC) music or art class. Baseline and 3-month evaluations included resting BP; overnight urine samples; and saliva collected at bedtime, upon awakening, and at 30 and 60 minutes after awakening for α-amylase and cortisol assays. RESULTS Twenty-eight (14 in the HYP group and 14 in the AC group) students were assessed both before and after the intervention. BP changes from pre- to post-intervention were -3.0/-2.0 mmHg for the HYP group and -0.07/-0.79 mmHg for the AC group (p=0.30 and 0.57, respectively). Changes in systolic BP (SBP)/diastolic BP (DBP) for the prehypertensive (75th-94th percentiles for SBP) subgroup analyses were -10.75/-8.25 mmHg for the HYP group (n=4) versus 1.8/1.0 mmHg for the AC group (n=5) (p for SBP=0.02; p for DBP=0.09). Although no statistically significant group differences were observed with changes in SNS or HPA awakening curves (area under curve for α-amylase and cortisol, respectively), a small to moderate effect size was seen favoring a reduction of α-amylase activation for the HYP group (Cohen d=0.34; prehypertensive d=0.20). CONCLUSIONS A school-based Hatha yoga program demonstrated potential to decrease resting BP, particularly among prehypertensive youth. Reduced SNS drive may be an underlying neurohormonal pathway beneficially affected by the program. A large-scale efficacy/effectiveness randomized clinical trial is warranted.
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Affiliation(s)
- John C Sieverdes
- 1 Medical University of South Carolina , Technology Applications Center for Healthful Lifestyles, Charleston, SC
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Abstract
Over the last two decades, essential hypertension has become common in adolescents, yet remains under-diagnosed in absence of symptoms. Diagnosis is based on normative percentiles that factor in age, sex and height. Evaluation is more similar to adult essential hypertension than childhood secondary hypertension. Modifiable risk factors such as obesity, sodium consumption and low exercise should be addressed first. Many anti-hypertensive medications now have specific regulatory approval for children. Sports participation need not be limited in mild or well-controlled cases. Primary care physicians play an important role in reduction of cardiovascular mortality by early detection and referral when needed.
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Ayoola OO, Omotade OO, Gemmell I, Clayton PE, Cruickshank JK. The impact of malaria in pregnancy on changes in blood pressure in children during their first year of life. Hypertension 2013; 63:167-72. [PMID: 24126169 DOI: 10.1161/hypertensionaha.113.02238] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We established a maternal birth cohort in Ibadan, Nigeria, where malaria is hyperendemic, to assess how intrauterine exposure to malaria affected infant blood pressure (BP) development. In a local maternity hospital, healthy pregnant women had regular blood films for malaria parasites from booking to delivery. Growth and BP were measured on 318 babies, all followed from birth to 3 and 12 months. Main outcomes were standardized measures of anthropometry and change in BP to 1 year. Babies exposed to maternal malaria were globally smaller at birth, and boys remained smaller at 3 months and 1 year. Change in systolic BP (SBP) during the year was greater in boys than in girls (20.9 versus 15.7 mm Hg; P=0.002) but greater in girls exposed to maternal malaria (18.7 versus 12.7 mm Hg; 95% confidence interval, 1-11 mm Hg; P=0.02). Eleven percent of boys (greater than twice than expected) had a SBP ≥95th percentile (hypertensive, US criteria), of whom 68% had maternal malaria exposure. On regression analysis (β coefficients, mm Hg), sex (boys>girls; β=4.4; 95% confidence interval, 1.1-7.7; P=0.01), maternal malaria exposure (3.64; 0.3-6.9; P=0.03), and weight change (2.4; 0.98-3.8/1 standard deviation score; P=0.001) all independently increased SBP change to 1 year, whereas increase in length decreased SBP (-1.98; -3.6 to -0.40). In conclusion, malaria-exposed boys had excess hypertension, whereas malaria-exposed girls a greater increase in SBP. Intrauterine exposure to malaria had sex-dependent effects on BP, independent of infant growth. Because infant-child-adult BP tracking is powerful, a malarial effect may contribute to the African burden of hypertension.
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Affiliation(s)
- Omolola O Ayoola
- Cardiovascular Medicine Group, Division of Diabetes and Nutrition, 4th floor, Franklin-Wilkins Bldg, 150 Stamford St, King's College & King's Health Partners, London SE1 9RN, United Kingdom.
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Li LJ, Lee YS, Wong TY, Cheung CYL. Can the retinal microvasculature offer clues to cardiovascular risk factors in early life? Acta Paediatr 2013; 102:941-6. [PMID: 23682621 DOI: 10.1111/apa.12294] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 05/15/2013] [Indexed: 11/29/2022]
Abstract
UNLABELLED Adulthood cardiovascular diseases (CVD) burdening in adulthood have been suggested to have possible predisposition early in life. We aimed to systematically review the literatures on retinal microvasculature among paediatric population in relation to a range of environmental and systemic changes. Papers with quantitative retinal vascular assessment and epidemiological design were reviewed. CONCLUSION This review supports the theory that major vascular diseases have pathological predisposition early in life by providing morphological evidence on retinal microcirculation in vivo.
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Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Center; Singapore; Singapore
| | - Yung-Seng Lee
- Department of Paediatrics; National University of Singapore; Singapore; Singapore
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Magriples U, Boynton MH, Kershaw TS, Rising SS, Ickovics JR, Magriples U. Blood pressure changes during pregnancy: impact of race, body mass index, and weight gain. Am J Perinatol 2013; 30:415-24. [PMID: 23059493 PMCID: PMC3938313 DOI: 10.1055/s-0032-1326987] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the effect of race, body mass index (BMI), and weight gain on blood pressure in pregnancy and postpartum. STUDY DESIGN Secondary analysis of pregnant women aged 14 to 25 who received prenatal care at a university-affiliated public clinic in New Haven, Connecticut and delivered singleton term infants (n = 418). Longitudinal multivariate analysis was used to evaluate blood pressure trajectories from pregnancy through 12 weeks postpartum. RESULTS Obese and overweight women had significantly higher blood pressure readings as compared with women with normal BMI (all p < 0.05). African American women who had high pregnancy weight gain had the greatest increase in mean arterial and diastolic blood pressures in pregnancy and postpartum. CONCLUSION Blood pressure trajectories in pregnancy and postpartum are significantly affected by race, BMI, and weight gain. Given the young age of this cohort, targeted efforts must be made for postpartum weight reduction to reduce cardiovascular risk.
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Affiliation(s)
- Urania Magriples
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520, USA.
| | | | | | | | | | - Urania Magriples
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
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Biologic Measures as Epidemiological Indicators of Risk for the Development of Hypertension in an African American Adolescent Population. J Cardiovasc Nurs 2012; 27:476-84. [DOI: 10.1097/jcn.0b013e31822f7971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Appel LJ. ASH position paper: Dietary approaches to lower blood pressure. ACTA ACUST UNITED AC 2012; 3:321-31. [PMID: 20409975 DOI: 10.1016/j.jash.2009.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 11/06/2008] [Indexed: 01/11/2023]
Abstract
A substantial body of evidence has implicated several aspects of diet in the pathogenesis of elevated blood pressure (BP). Well-established risk factors for elevated BP include excess salt intake, low potassium intake, excess weight, high alcohol consumption, and suboptimal dietary pattern. African Americans are especially sensitive to the BP-raising effects of excess salt intake, insufficient potassium intake, and suboptimal diet. In this setting, dietary changes have the potential to substantially reduce racial disparities in BP and its consequences. In view of the age-related rise in BP in both children and adults, the direct, progressive relationship of BP with cardiovascular-renal diseases throughout the usual range of BP, and the worldwide epidemic of BP-related disease, efforts to reduce BP in nonhypertensive as well as hypertensive individuals are warranted. In nonhypertensives, dietary changes can lower BP and delay, if not prevent, hypertension. In uncomplicated stage I hypertension, dietary changes serve as initial treatment before drug therapy. In hypertensive individuals already on drug therapy, lifestyle modifications can further lower BP. The current challenge is designing and implementing effective clinical and public health interventions that lead to sustained dietary changes among individuals and more broadly in the general population.
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Affiliation(s)
- Lawrence J Appel
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Wang X, Zhu H, Dong Y, Treiber FA, Snieder H. Effects of Angiotensinogen and Angiotensin II Type I Receptor Genes on Blood Pressure and Left Ventricular Mass Trajectories in Multiethnic Youth. Twin Res Hum Genet 2012. [DOI: 10.1375/twin.9.3.393] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe objective of this study was to evaluate the impact of variations of the angiotensinogen (AGT) and angiotensin II type I receptor (AGTR1) genes on progression of blood pressure (BP) and left ventricular mass (LVM) in multiethnic youth. The study was longitudinal involving 581 European American (EA) and African American (AA) youth with 12 assessments over a 15-year period. AGT M235T and three AGTR1 polymorphisms (C-521T, L191L and A1166C) were genotyped and individual growth curve modeling analyses were conducted. Single nucleotide polymorphism (SNP) analyses found a significant 3-way interaction between M235T, ethnicity and gender on BP levels. Systolic BP (SBP) levels were 5.8 mmHg (p = .00003) and diastolic BP (DBP) levels were 2.6 mmHg (p = .005) lower in carriers versus noncarriers of the M235 allele in AA males only. Furthermore, the AGTR1 L191 allele showed a SBP lowering effect in subjects with a high socioeconomic status (SES; p = .048) and a DBP lowering effect in AAs (p = .038). Haplotype analyses identified a protective haplotype (C-521, 191L and A1166) for LVM levels (p = .03). LVM in individuals homozygous for this haplotype was 12.9 g lower than those homozygous for the most common haplotype (–521T, 191L and A1166). No significant interactions were found between the AGT M235T polymorphism and any of the single SNPs or haplotypes of the AGTR1 gene. Our results in multiethnic youth uncover an ethnicity and gender-specific effect of the AGT M235T polymorphism and a SES or ethnicity-specific effect of the AGTR1 L191L polymorphism on the progression of hypertension risk. A protective AGTR1 haplotype for LVM was also identified.
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Differential Impact of Stress Reduction Programs upon Ambulatory Blood Pressure among African American Adolescents: Influences of Endothelin-1 Gene and Chronic Stress Exposure. Int J Hypertens 2011; 2012:510291. [PMID: 22164329 PMCID: PMC3227499 DOI: 10.1155/2012/510291] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 08/17/2011] [Accepted: 09/06/2011] [Indexed: 11/17/2022] Open
Abstract
Stress-activated gene × environment interactions may contribute to individual variability in blood pressure reductions from behavioral interventions. We investigated effects of endothelin-1 (ET-1) LYS198ASN SNP and discriminatory stress exposure upon impact of 12-week behavioral interventions upon ambulatory BP (ABP) among 162 prehypertensive African American adolescents. Following genotyping, completion of questionnaire battery, and 24-hour ABP monitoring, participants were randomized to health education control (HEC), life skills training (LST), or breathing awareness meditation (BAM). Postintervention ABP was obtained. Significant three-way interactions on ABP changes indicated that among ET-1 SNP carriers, the only group to show reductions was BAM from low chronic stress environments. Among ET-1 SNP noncarriers, under low chronic stress exposure, all approaches worked, especially BAM. Among high stress exposure noncarriers, only BAM resulted in reductions. If these preliminary findings are replicated via ancillary analyses of archival databases and then via efficacy trials, selection of behavioral prescriptions for prehypertensives will be edging closer to being guided by individual's underlying genetic and environmental factors incorporating the healthcare model of personalized preventive medicine.
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Influence of common variants in FTO and near INSIG2 and MC4R on growth curves for adiposity in African- and European-American youth. Eur J Epidemiol 2011; 26:463-73. [PMID: 21544599 PMCID: PMC3115048 DOI: 10.1007/s10654-011-9583-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 04/08/2011] [Indexed: 01/08/2023]
Abstract
Recent genome-wide association (GWA) studies identified several common variants for obesity: rs9939609 in FTO, rs7566605 near INSIG2 and both rs17782313 and rs17700633 near the MC4R gene. This study aimed to assess the influence of these polymorphisms on development of adiposity in European- (EA) and African-American (AA) youth in two ongoing longitudinal studies including 986 and 606 participants with age ranges of 10-25.8 and 4.0-23.9 years, respectively. Individual growth curve modeling was conducted separately in the two studies. We tested the effect of the SNPs on levels and increase with age (i.e., slope) of weight, body mass index (BMI), waist circumference and skinfolds from childhood to adulthood, and potential moderation by ethnicity or gender. Beta coefficients computed in the two studies were pooled using meta-analysis. Rs9939609 was associated with logtransformed levels of BMI (β = 0.021, P = 0.01), weight (β = 0.019, P = 0.04) and waist circumference (β = 0.012, P = 0.04). Rs17782313 was associated with triceps (β = 0.05, P = 0.02). Significant interactions of rs17700633 with gender were observed on subscapular-, suprailiac- and sum of skinfolds, with significant associations limited to males (P < 0.05). No significant interactions with ethnicity were found. Only one effect on the slope was observed, rs17700633 showed a significant interaction with age on triceps (β = 0.004, P = 0.04). In two longitudinal studies of EA and AA youth, we replicated the effect of FTO and common variants near MC4R on general and central adiposity. These variants did not affect the increase with age of adiposity from childhood to adulthood with one exception. Common variants for obesity identified in GWA studies have detectable but modest effects on growth curves for adiposity in EA and AA youth.
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Wright LB, Gregoski MJ, Tingen MS, Barnes VA, Treiber FA. Impact of Stress Reduction Interventions on Hostility and Ambulatory Systolic Blood Pressure in African American Adolescents. JOURNAL OF BLACK PSYCHOLOGY 2011; 37:210-233. [PMID: 22485058 PMCID: PMC3319013 DOI: 10.1177/0095798410380203] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the impact of breathing awareness meditation (BAM), life skills (LS) training, and health education (HE) interventions on self-reported hostility and 24-hour ambulatory blood pressure (ABP) in 121 African American (AA) ninth graders at increased risk for development of essential hypertension. They were randomly assigned to BAM, LS, or HE and engaged in intervention sessions during health class for 3 months. Before, after, and 3 months following intervention cessation, self-reported hostility and 24-hour ABP were measured. Results indicated that between pre- and postintervention, BAM participants displayed significant reductions in self-reported hostility and 24-hour systolic ABP. Reductions in hostility were significantly related to reductions in 24-hour systolic ABP. Between postintervention and follow-up, participants receiving LS showed a significant reduction in hostility but not in 24-hour ABP. Significant changes were not found for the HE group in 24-hour ABP or self-reported hostility, but these change scores were significantly correlated. The implications of the findings are discussed with regard to behavioral stress reduction programs for the physical and emotional health of AAs.
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Primary versus secondary hypertension in children followed up at an outpatient tertiary unit. Pediatr Nephrol 2011; 26:441-7. [PMID: 21174218 DOI: 10.1007/s00467-010-1712-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 11/01/2010] [Accepted: 11/05/2010] [Indexed: 11/27/2022]
Abstract
Childhood hypertension has classically been recognized as a secondary disease. However, primary hypertension also occurs in children. The aim of this study was to compare clinical features of pediatric patients with elevated blood pressure, which were referred to an outpatient tertiary unit, and to detect variables associated with the identification of primary hypertension. The records of 220 patients with hypertension followed between 1996 and 2006 were analyzed. The variable of interest was primary hypertension. Logistic regression analysis was applied to identify clinical variables that were independently associated with primary hypertension. Of 220 patients, 33 (15%) had primary hypertension, and 187 (85%) exhibited secondary hypertension. No statistically significant differences were detected in gender, race, age at diagnosis, and systolic/diastolic blood pressure levels between both groups. After adjustment, four variables at baseline remained independently associated with primary hypertension: absence of signs/symptoms (OR 18.87, 95% CI 6.32-56.29), normal serum creatinine (OR 0.02, 95% CI 0.00-0.27), family history of hypertension (OR 3.03, 95% CI 1.04-8.79), and elevated body weight (OR 1.06, 95% CI 1.02-1.10). The absence of signs/symptoms, normal serum creatinine, family history of hypertension, and overweight/obesity at admission are clues to diagnose primary hypertension in childhood.
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Simonetti GD, Schwertz R, Klett M, Hoffmann GF, Schaefer F, Wühl E. Determinants of blood pressure in preschool children: the role of parental smoking. Circulation 2011; 123:292-8. [PMID: 21220729 DOI: 10.1161/circulationaha.110.958769] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertension is the leading risk factor for cardiovascular disease. Although accumulating evidence suggests tracking of blood pressure from childhood into adult life, there is little information regarding the relative contributions of genetic, prenatal, biological, behavioral, environmental, and social determinants to childhood blood pressure. METHODS AND RESULTS Blood pressure and an array of potential anthropometric, prenatal, environmental, and familial risk factors for high blood pressure, including parental smoking habits, were determined as part of a screening project in 4236 preschool children (age 5.7 ± 0.4 years). Smoking was reported by 28.5% of fathers and 20.7% of mothers, and by both parents 11.9%. In addition to classic risk factors such as body mass index, prematurity, low birth weight, and parental hypertension, both systolic (+1.0 [95% confidence interval, +0.5 to +1.5] mm Hg; P=0.0001) and diastolic blood pressure (+0.5 [+0.03 to +0.9] mm Hg; P=0.03) were higher in children of smoking parents. Parental smoking independently affected systolic blood pressure (P=0.001) even after correction for other risk factors, such as body mass index, parental hypertension, or birth weight, increasing the likelihood of having a systolic blood pressure in the top 15% of the population by 21% (2% to 44%; P=0.02). CONCLUSIONS In healthy preschool children, parental smoking is an independent risk factor for higher blood pressure, adding to other familial and environmental risk factors. Implementing smoke-free environments at home and in public places may provide a long-term cardiovascular benefit even to young children.
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Affiliation(s)
- Giacomo D Simonetti
- Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany.
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Gregoski MJ, Barnes VA, Tingen MS, Harshfield GA, Treiber FA. Breathing awareness meditation and LifeSkills Training programs influence upon ambulatory blood pressure and sodium excretion among African American adolescents. J Adolesc Health 2011; 48:59-64. [PMID: 21185525 PMCID: PMC3026442 DOI: 10.1016/j.jadohealth.2010.05.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 05/20/2010] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the effect of breathing awareness meditation (BAM), Botvin LifeSkills Training (LST), and health education control (HEC) on ambulatory blood pressure and sodium excretion in African American adolescents. METHODS Following 3 consecutive days of systolic blood pressure (SBP) screenings, 166 eligible participants (i.e., SBP >50th-95th percentile) were randomized by school to either BAM (n = 53), LST (n = 69), or HEC (n = 44). In-school intervention sessions were administered for 3 months by health education teachers. Before and after the intervention, overnight urine samples and 24-hour ambulatory SBP, diastolic blood pressure, and heart rate were obtained. RESULTS Significant group differences were found for changes in overnight SBP and SBP, diastolic blood pressure, and heart rate over the 24-hour period and during school hours. The BAM treatment exhibited the greatest overall decreases on these measures (Bonferroni adjusted, ps < .05). For example, for school-time SBP, BAM showed a change of -3.7 mmHg compared with no change for LST and a change of -.1 mmHg for HEC. There was a nonsignificant trend for overnight urinary sodium excretion (p = .07), with the BAM group displaying a reduction of -.92 ± 1.1 mEq/hr compared with increases of .89 ± 1.2 mEq/hr for LST and .58 ± .9 mEq/hr for HEC group. CONCLUSION BAM appears to improve hemodynamic function and may affect sodium handling among African American adolescents who are at increased risk for development of cardiovascular disease.
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Affiliation(s)
- Mathew J. Gregoski
- Medical University of South Carolina, College of Nursing and Medicine, Charleston, South Carolina
| | - Vernon A. Barnes
- Department of Pediatrics, Georgia Institute for Prevention of Human Diseases and Accidents, Medical College of Georgia, Augusta, Georgia
| | - Martha S. Tingen
- Department of Pediatrics, Georgia Institute for Prevention of Human Diseases and Accidents, Medical College of Georgia, Augusta, Georgia
| | - Gregory A. Harshfield
- Department of Pediatrics, Georgia Institute for Prevention of Human Diseases and Accidents, Medical College of Georgia, Augusta, Georgia
| | - Frank A. Treiber
- Medical University of South Carolina, College of Nursing and Medicine, Charleston, South Carolina
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A longitudinal study of blood pressure variability in African-American and European American youth. J Hypertens 2010; 28:715-22. [PMID: 20075746 DOI: 10.1097/hjh.0b013e328336ed5b] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES High blood pressure variability is increasingly used as a predictor of target-organ damage and cardiovascular events. However, little is known about blood pressure variability changes with age and its possible sociodemographic, anthropometric, and genetic moderators. METHODS Twenty-four-hour ambulatory blood pressure was measured up to 12 times over a 15-year period in 344 European Americans and 297 African-Americans with an average age of 14 years at the initial visit. Blood pressure variability was indexed by the weighted 24-h standard deviation of ambulatory blood pressure recordings. RESULTS Both systolic and diastolic blood pressure variability increased with age and ambulatory blood pressure mean values. Men had higher levels of blood pressure variability (P < 0.001) and showed steeper linear increase rates with age than women. African-Americans showed higher values of blood pressure variability (P < 0.05) than European Americans. Body mass index and waist circumference were also associated with higher blood pressure variability levels (P < 0.001). Individuals with higher father's education level showed lower blood pressure variability. In the full model which included all the above factors, ethnic difference in systolic blood pressure variability was no longer significant. CONCLUSION The results of the present study suggest that men and African-Americans have higher blood pressure variability than women and European Americans. Apart from these ethnicity and sex effects, blood pressure variability increases with increases in age (especially in men), ambulatory blood pressure mean values and adiposity as well as decreased socioeconomic status.
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49
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Levine DA, Lewis CE, Williams OD, Safford MM, Liu K, Calhoun DA, Kim Y, Jacobs DR, Kiefe CI. Geographic and demographic variability in 20-year hypertension incidence: the CARDIA study. Hypertension 2010; 57:39-47. [PMID: 21135358 DOI: 10.1161/hypertensionaha.110.160341] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although the variability of cardiovascular disease mortality by geography, race, and sex is well known, less is known about risk factor variation. We assessed 20-year incidence of hypertension, a cardiovascular disease risk factor, across 4 US urban areas and by race-sex. Among 3436 eligible adults 18 to 30 years of age when recruited in 1985 to 1986 in the community-based Coronary Artery Risk Development in Young Adults (CARDIA) cohort, we examined 20-year cumulative incidence of hypertension (systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg or antihypertensive medication use at any examination) by site and race-sex, adjusting for baseline and time-dependent covariates with Cox regression. Twenty-year incidence, when the mean age was ≈ 45 years, was 34.5% in black men (n = 617), 37.6% in black women (n = 965), 21.4% in white men (n = 856), and 12.3% in white women (n = 998; P<0.001). Incidence was 33.6% in Birmingham, Ala, 23.4% in Chicago, Ill, 19% in Minneapolis, Minn, and 27.4% in Oakland, Calif (P<0.001). After adjustment for age, race, sex, heart rate, body mass index, smoking, family history, education, uric acid, alcohol use, physical activity, and baseline systolic blood pressure, hazard ratios (95% CI) compared with Birmingham were 0.72 (0.59 to 0.87) for Chicago, 0.60 (0.50 to 0.74) for Minneapolis, and 0.73 (0.61 to 0.87) for Oakland. Race-sex differences persisted after adjustment for site, especially for black women. From young adulthood to middle age, hypertension incidence varies significantly across urban areas. Independent of geography, blacks, especially women, are at markedly higher risk of hypertension. Hypertension incidence may contribute to geographic and racial differences in cardiovascular disease mortality, including stroke.
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Affiliation(s)
- Deborah A Levine
- Ann Arbor VA Healthcare System, Departments of Medicine and Neurology, University of Michigan, Ann Arbor, Mich 48109, USA.
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50
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Wang X, Ding X, Su S, Harshfield G, Treiber F, Snieder H. Genetic influence on blood pressure measured in the office, under laboratory stress and during real life. Hypertens Res 2010; 34:239-44. [PMID: 21068740 DOI: 10.1038/hr.2010.218] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
To determine to what extent the genetic influences on blood pressure (BP) measured in the office, under psychologically stressful conditions in the laboratory and during real life are different from each other. Office BP, BP during a video game challenge and a social stressor interview, and 24-h ambulatory BP were measured in 238 European American and 186 African American twins. BP values across the two tasks were averaged to represent stress levels. Genetic model fitting showed no ethnic or gender differences for any of the measures. The model fitting resulted in heritability estimates of 63, 75 and 71% for office, stress and 24-h systolic BP (SBP) and 59, 67 and 69% for diastolic BP (DBP), respectively. Up to 81% of the heritability of office SBP and 71% of office DBP were attributed to genes that also influenced stress BP. However, only 45% of the heritability of 24-h SBP and 49% of 24-h DBP were attributed to genes that also influence office BP. Similarly, about 39% of the heritability of 24-h SBP and 42% of 24-h DBP were attributed to genes that also influence stress BP. Substantial overlap exists between genes that influence BP measured in the office, under laboratory stress and during real life. However, significant genetic components specific to each BP measurement also exist. These findings suggest that partly different genes or sets of genes contribute to BP regulation in different conditions.
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Affiliation(s)
- Xiaoling Wang
- Department of Pediatrics, Medical College of Georgia, Georgia Prevention Institute, Augusta, GA, USA.
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