Trends in blood pressure and body mass index among Chinese children and adolescents from 2005 to 2010

The effects of initial and subsequent overweight or obesity on hypertension in the middle age

The aims of our study were to examine whether initial or subsequent adiposity status had a greater effect on hypertension. We collected data in 1992 and again in 2007 from the same group of 597 individuals in the middle age. The subjects were classified into four groups: individuals with a normal body mass index (BMI) in 1992 and 2007 were in Group I; those with a normal BMI in 1992, but became overweight or obese in 2007 were in Group II; those who were overweight or obese in 1992, but had a normal BMI in 2007 were in Group III; and those who were overweight or obese in 1992 and 2007 were in Group IV. Their demographic data were recorded. The relationship between adiposity status and hypertension was analyzed using logistic regression model. The cumulative incidence of hypertension was 35.5%, 56.3%, 50.0%, and 65.1% for Group I to IV, respectively. Compared with Group I, after adjusted factors, the hazard ratio (HR) was 1.80 for Group II (P = .001), 1.40 for Group III (P = .150), and 2.31 for Group IV (P < .001). Adiposity status in 2007 could predict hypertension (OR = 2.5, P < .001), as opposed to the initial adiposity status (P = .148). Subsequently adiposity status could have major effects on hypertension. Our society is very short of public health resources, particularly in developing countries, we should pay more attention to current adiposity status and encourage middle-aged people to lose weight.

Decrease in the prevalence of hypertension in Spanish schoolchildren from 2010 to 2017: Cuenca Study

AIMS

To examine the secular trends in blood pressure measurements and normal or high blood pressure classification among Spanish schoolchildren from 2010 to 2017, to analyze the persistence in the blood pressure category reported in 2017 compared with 2013 in those children born in 2007-08 and to compare in this cohort the prevalence of high blood pressure using both definitions, the 2004 and 2017 guidelines.

METHODS AND RESULTS

The data for the prevalence/trend analysis were obtained from cross-sectional analyses conducted in 2010, 2013, and 2017 of 2709 schoolchildren aged 4-6 and 8-11 years from 22 schools in the province of Cuenca, Spain. The data for the longitudinal analysis were obtained from cross-sectional analyses of measurements gathered in 2013 and 2017 in the same cohort of children (n = 275). The prevalence of normal blood pressure increased by 5.4% in children aged 4-6 years from 2013 to 2017 and by 2.2% in children aged 8-11 from 2010 to 2017. This increase was mainly driven by a decrease in the children classified in any stage of hypertension by 4.2% and 2.3% in each age range, respectively. In the same birth cohort, there was an increase of 7.6% in normal blood pressure prevalence.

CONCLUSION

The high blood pressure prevalence in Spanish children has clearly decreased over the last decade, but is still important to detect this condition to design specific school-based interventions and the evaluation of children classified as hypertensive who might need medical supervision and treatment.

Effect of Comprehensive Interventions Including Nutrition Education and Physical Activity on High Blood Pressure among Children: Evidence from School-Based Cluster Randomized Control Trial in China

Childhood hypertension has increasingly become a public health problem globally. However, limited literature research examined the effect of comprehensive interventions including nutrition education and physical activity on blood pressure among children. A total of 6764 children aged 7–13 years were analyzed based on a multicenter randomized controlled trial for comprehensive interventions in 30 primary schools in China to evaluate the effects on blood pressure, which lasted for two semesters. The standards used for the diagnosis of high blood pressure were the cut-off points based on age and sex for Chinese children. Compared with the control group, the intervention effects were −0.5 mm Hg (95% confidence interval (CI): −1.1, 0; p = 0.064) for diastolic blood pressure and −0.9 mmHg (95% CI: −1.5, −0.3; p = 0.005) for systolic blood pressure. For the incidence of high blood pressure, the changes were −1.4% in the intervention group and 0.4% in the control group (1.8% difference between the two groups, p = 0.015) after trial. The school-based comprehensive interventions appeared to have moderate effects on high blood pressure prevention among children in China.

Hypertension in adolescents and young adults referred to a tertiary hypertension clinic in Cape Town, South Africa

To audit the young patients referred to the Hypertension Clinic at Groote Schuur Hospital that predominately serves the underprivileged communities of Cape Town.Folders of patients between the ages of 15 and 30 years over a 2 year period were reviewed. The data collected included demographic, clinical and laboratory data, investigations, causes of hypertension, and presence of hypertensive organ damage.Of the 110 patients reviewed, 61 (55.5%) were females, 22 (20%) Black African, and 88 (80%) of Mixed Ancestry. Eight (7.3%) were found to be normotensive, 16 (14.5%) had a secondary cause and 86 (78.2%) had essential hypertension. Thirty five (31.8%) were current or previous smokers, and 11 (10%) admitted to current or prior use of metamphetamines. A family history of hypertension in a first degree relative was present in 80 (72.7%) patients. Comorbidities present were diabetes in 7 (6.4%) patients, metabolic syndrome in 13 (11.8%), and obesity in 26 (23.6%), but 42.6% had a body mass index (BMI) <25 kg/m. Chronic kidney disease (CKD) was present in 29 (26.4%) patients and ECG left ventricular hypertrophy in 56 (50.9%). Overall organ damage was present in 72 (65.5%) patients.In this cohort of young hypertensives most patients had essential hypertension with a strong family history. Significant organ damage was identified. High risk behavior, including smoking and illicit drug use, and obesity were identified as contributing factors. Secondary causes were identified in 14.2%. These results suggest a targeted approach to the investigation of young hypertensives for secondary causes, and significant opportunities for lifestyle intervention.

Heritability and genetic correlations of obesity indices with ambulatory and office beat-to-beat blood pressure in the Oman Family Study

OBJECTIVE

To more precisely and comprehensively estimate the genetic and environmental correlations between various indices of obesity and BP.

METHODS

We estimated heritability and genetic correlations of obesity indices with BP in the Oman family study (n = 1231). Ambulatory and office beat-to-beat BP was measured and mean values for SBP and DBP during daytime, sleep, 24-h and 10 min at rest were calculated. Different indices were used to quantify obesity and fat distribution: BMI, percentage of body fat (%BF), waist circumference and waist-to-height ratio (WHtR). SOLAR software was used to perform univariate and bivariate quantitative genetic analyses adjusting for age, age, sex, age-sex and age--sex interactions.

RESULTS

Heritabilities of BP ranged from 30.2 to 38.2% for ambulatory daytime, 16.8--21.4% for sleeping time, 32.1--40.4% for 24-h and 22--24.4% for office beat-to-beat measurements. Heritabilities for obesity indices were 67.8% for BMI, 52.2% for %BF, 37.3% for waist circumference and 37.9% for WHtR. All obesity measures had consistently positive phenotypic correlations with ambulatory and office beat-to-beat SBP and DBP (r-range: 0.14--0.32). Genetic correlations of obesity indices with SBP and DBP were higher than environmental correlations (rG: 0.16--0.50; rE: 0.01--0.31).

CONCLUSION

The considerable genetic overlap between a variety of obesity indices and both ambulatory and office beat-to-beat BP highlights the relevance of pleiotropic genes. Future GWAS analyses should discover the specific genes both influencing obesity indices and BP to help unravel their shared genetic background.

Association of breastfeeding duration, birth weight, and current weight status with the risk of elevated blood pressure in preschoolers

BACKGROUND/OBJECTIVES

Few studies have examined the effects of the weight status at birth and preschool age on the risk of elevated blood pressure (EBP) in early childhood, and whether the effects can be modified by breastfeeding duration remains unclear. We aimed to evaluate the effects of high birth weight (HBW) with overweight/obese or abdominal obesity on the risk of EBP in preschoolers, and further evaluate the effects classified by breastfeeding duration (<6 and ≥6 months).

SUBJECTS/METHODS

This cross-sectional study was conducted in 2018 in Zhuhai, China. Out of 2390 3-4-year-old preschoolers originally recruited, a total of 1899 were included in the analysis. Logistic regression analysis was performed to examine the effects of the weight status at the two age points and breastfeeding duration on the risk of EBP.

RESULTS

Preschoolers with current overweight/obese had a 1.13-fold increased risk of EBP than those with persistent normal weight, irrespective of their birth weight. However, the preschoolers with HBW had no increased risk of EBP, when they became normal weight (OR 1.70, 0.78-3.72). Similar results were found for the current abdominal obesity and the risk of EBP. In addition, the EBP risk of obese status was minimized if preschoolers were breastfed for ≥6 months.

CONCLUSIONS

Obesity status at preschool age can increase the risk of EBP, irrespective of birth weight. However, this EBP risk can be mitigated if HBW changes to current normal weight. Longer breastfeeding duration can partially offset the risk of EBP in preschoolers with obesity status.

Secular trends in hypertension and elevated blood pressure among Korean children and adolescents in the Korea National Health and Nutrition Examination Survey 2007-2015

The prevalence of elevated blood pressure (BP) among US children and adolescents has reportedly declined over the past decade. As no Korean data have been analyzed, we aimed to determine recent trends in BP levels among Korean children and adolescents. This study examines data from the Korea National Health and Nutrition Examination Survey segregated into 3 time periods (2007-2009, 2010-2012, and 2013-2015). A total of 7804 Korean children and adolescents aged 10-18 years were included in the analysis. Hypertension (≥95th percentile) and elevated BP (>90th percentile) were defined using the sex-, age-, and height-specific BP standards from 2017 American Academy of Pediatrics guidelines. Mean systolic BP from 2007-2009 to 2013-2015 increased by 3.9 mm Hg, and there was no significant change in diastolic BP. Body mass index (BMI) z-scores significantly increased in the total population from 2007-2009 to 2013-2015. In 2013-2015, the prevalence rates of elevated BP and hypertension were 8.8% and 9.0%, respectively. The prevalence of hypertension in 2013-2015 increased in the total population compared with those in 2007-2009, especially in the obese subgroup, in which the hypertension prevalence was 27.7% in 2013-2015. The prevalence of elevated BP increased during these time period. Associated factors were sex, age, BMI z-score, and survey period for elevated BP; and sex, age, and BMI z-score for hypertension. During our study, mean systolic BP increased, and the prevalence of hypertension in 2013-2015 increased in the pediatric population. A possible influencing factor is obesity, and further long-term data are necessary.

Spatial distribution and clusters of pancreatic cancer mortality in Shandong Province, China

This study aimed to explore the geographic distribution and risk clusters of pancreatic cancer mortality from 2011 to 2013 in Shandong, China, and to detect the differences between urban and rural areas. Our data were obtained from the Shandong Death Registration System (SDRS) and were adjusted according to the underreporting level. The distribution of mortality was displayed with GIS-based maps at the county level. The results showed an increasing trend in pancreatic cancer mortality from the western region to the eastern region of Shandong. Additionally, four significant risk clusters were detected, and the most likely cluster was focused in the northeastern and northern regions. Urban-rural differences in the mortality distribution and risk clusters were also detected. In conclusion, our study identified pancreatic cancer mortality clusters in Shandong in urban and rural areas; these results can contribute to the development of effective and targeted strategies to control pancreatic cancer in different areas.

The comparison of percent body fat estimated by different anthropometrics to predict the incidence of hypertension

Percent body fat (%BF) is associated with the development of hypertension. However, the power of %BF estimated by different anthropometrics to predict incident hypertension was unknown. This study was from the China Health and Nutrition Survey (CHNS). %BF was calculated using the equations with BMI, WC, and skinfold thickness and divided into low and high %BF according to ROC. Cox regression was employed to evaluate the power of different %BFs to predict the development of hypertension. When not adjusting for covariates, %BFs defined by BMI, WC, and ST were the significant predictors of the development of hypertension (all P < 0.0001; crude HR: 2.238, 3.243, and 1.574; and HR 95% CI: 2.098-2.387, 2.905-3.619, and 1.464-1.692). When three %BFs entered into model simultaneously, the significance in %BF estimated by ST disappeared (P = 0.0765; adjusted HR: 1.124; and HR 95% CI: 0.988-1.280). For males, %BFs by BMI, WC, and ST significantly affected the incidence of hypertension as they were separately analyzed (all P < 0.0001; crude HR: 2.445, 2.335, and 1.828; and HR 95% CI: 2.220-2.693, 2.011-2.712, and 1.636-2.042, respectively). For females, %BFs estimated by BMI, WC, and ST were the determinants of the development of hypertension whether covariates were adjusted or not (all P < 0.0001). In conclusion, there was a poor and ineffective association of %BF estimated by triceps skinfold thickness with the development of hypertension, especially when three %BFs were analyzed together. High %BFs estimated by BMI and WC were the true and effective predictors of the incidence of hypertension.

Effect of Overweight and Obesity on High Blood Pressure in Chinese Children and Adolescents

OBJECTIVE

This study aimed to compare the secular trends of high blood pressure (HBP) and the effects of overweight and obesity on HBP between Chinese ethnic minority and Han children and adolescents .

METHODS

Data were collected from 224,151 Chinese ethnic minority and 664,094 Han children and adolescents aged 7 to 18 years during three successive, national cross-sectional surveys (2005, 2010, and 2014). Logistic regression and population-attributable risk analyses were used to evaluate the association between HBP and overweight and obesity.

RESULTS

HBP prevalence in ethnic minorities increased from 4.8% in 2005 to 6.3% in 2014, which was significantly higher than the variable HBP trends (4.1% to 5.5%) in Han children and adolescents. Both ethnic minority and Han children and adolescents experienced a rapid increase in overweight and obesity, but the pace of growth for HBP, overweight, and obesity was faster in ethnic minorities than in their Han peers. Moreover, the effects of obesity on HBP in ethnic minorities showed a sustained increase over time but were stable for the Han.

CONCLUSIONS

Higher HBP prevalence, faster obesity increases, and a stronger impact of obesity on HBP in children and adolescents of Chinese ethnic minorities predict their looming burden of HBP, which suggests that attention to the cardiovascular disease risks in children and adolescents from ethnic minorities is indicated to reduce their future adult risk.

Validation of recommended definition in identifying elevated blood pressure in adolescents

Recently, the American Academy of Pediatrics (AAP) recommended 120/80 mm Hg as thresholds for identifying elevated blood pressure (BP) in adolescents aged 13-17 years. The authors aimed to compare the performance of the new definition in identifying elevated BP with traditional percentile-based definition. Data were obtained from the National Health and Nutrition Examination Survey 1999-2014, which included 7485 adolescents aged 13-17 years. Elevated BP was defined using the recommended (≥120/80 mm Hg) and traditional definition (≥90th percentile for sex, age, and height or 120/80 mm Hg) presented in AAP guideline. The prevalence of elevated BP was 15.7% and 17.2% using the recommended and traditional definition, respectively (P < .001). The recommended definition had high sensitivity (90.9%), perfect specificity (100.0%), perfect positive predictive value (100.0%), and very high negative predictive value (98.1%) compared with the traditional definition. The Kappa correlation coefficient between two definitions was 0.94 (P < .001). Similar results can be observed in subgroups across sex, age, and sex- and age-specific height percentile except for both sexes with young age and low height percentile. Generally, our results supported the use of the recommended definition for identifying elevated BP in adolescents.

U-shaped relationship between birth weight and childhood blood pressure in China

Background

The relationship between birth weight and blood pressure has not been well explored in Chinese children and adolescents. The aim of this study was to investigate the relationship between birth weight and childhood blood pressure in China.

Methods

A total of 15324 children and adolescents (7919 boys and 7405 girls) aged 7–17 years were stratified into six birth weight groups. Analysis of covariance and binary logistic regression were used to analyse the relationship between birth weight and blood pressure while controlling for potential confounding factors, including age, gestational age, season of birth and area of residence.

Results

The group with birth weights from 2500 to 2999 g had the lowest prevalence of hypertension (8.9%). Lower birth weight children (< 2000 g) had significantly higher systolic blood pressure (SBP) (106.00 ± 0.72, P = 0.017), and children with heavier birth weights also had higher SBP (3500–3999 g, 105.13 ± 0.17, P < .001; ≥ 4000 g, 105.96 ± 0.27, P < .001). No significant relationship was found between birth weight and diastolic blood pressure (DBP). The overall rate of hypertension was 10.8% (12.1% in boys and 9.4% in girls). The median weight group (2500–2999 g) had the lowest rate of hypertension (8.9%). Compared with children in the median weight group, children with lower birth weight had a higher prevalence of hypertension (< 2000 g, OR = 1.85, 95% CI = 1.25–2.74; 2000–2499 g, OR = 1.57, 95% CI = 1.15–2.13), and groups with higher birth weights also had higher risks of hypertension (3500–3999 g, OR = 1.22, 95% CI = 1.02–1.45; ≥ 4000 g, OR = 1.42, 95% CI = 1.16–1.74).

Conclusions

Excluding the confounding effect of obesity, a U-shaped relationship between birth weight and risk of hypertension was found in children and adolescents in Chinese cities. Birth weight significantly influences SBP but has a minimal effect on DBP. Further basic research on foetal development and programming may shed light on this phenomenon.

National trends of pre-hypertension and hypertension among Iranian adolescents across urban and rural areas (2007-2011)

BACKGROUND

The current nationwide study, for the first time, aimed to assess and compare the trend of pre-hypertension and hypertension among urban and rural adolescents in Iran.

METHODS

This study has been conducted in the framework of the National Surveys of Risk Factors for Non-Communicable Diseases. To estimate pre-hypertension and hypertension prevalence among 9715 adolescents, aged 15-19 years, data collected in four repeated cross-sectional surveys (2007-2011) has been used. The prevalence trends of pre-hypertension and hypertension were examined across urban and rural areas of Iran. To calculate the adjusted prevalence ratios (PRs) of pre-hypertension and hypertension over cycles across area of residence and genders, a complex sample survey and multinomial logistic analysis were performed.

RESULTS

Using the definition of pre-hypertension and hypertension presented by the seventh Joint National Committee (JNC-VII) for adolescents, after adjusting for confounders, the prevalence of pre-hypertension changed in both urban (boys:28.96% to 29.24% and girls:18.33% to 20.06%) and rural (boys 31.58% to 32.05% and girls 22.25% to 24.13%) areas over the study duration. Non-significant rising prevalence of hypertension was also observed in boys and girls of both regions (urban 12.76% to 15.04% and 8.02% to 9.06%; rural 9.95% to 11.79% and 10.35% to 11.60%, for boys and girls respectively). The adjusted prevalence ratios (PRs) of pre-hypertension (2.16; 95% CI 1.68-2.79 and 1.92, 95% CI 1.57-2.34, in urban and rural, respectively) and hypertension (2.40; 95% CI 1.65-3.51 and 1.82, 95% CI 1.36-2.45, in urban and rural, respectively) were higher in boys than girls. Comparing the adjusted PRs of pre-hypertension and hypertension in urban versus rural areas, in both genders, showed higher PRs of pre-hypertension in rural girls (1.33, 95% CI 1.01-1.75).

CONCLUSION

The current results showed high constant trends of pre-hypertension and hypertension in Iranian boys and girls, residing in both urban and rural areas.

Differences in prevalence of prehypertension and hypertension in children and adolescents in the eastern, central and western regions of China from 1991-2011 and the associated risk factors

The present study aimed to estimate the differences in rates of prehypertension and hypertension in children and adolescents among three regions with different socioeconomic status in China, and explore the corresponding risk factors associated with prehypertension and hypertension to guide the prevention. Blood pressure measurements of 13 762 children and adolescents aged 6–17 years were obtained from a prospective national survey (the China Health and Nutrition Survey, 1991–2011). Prehypertension and hypertension were defined by age and gender, according to China’s standard criteria. Chi-square tests were used to compare the differences in the prevalence of prehypertension and hypertension among three regions. Trend chi-square tests were used to detect the trends in rates of prehypertension and hypertension over survey years. Logistic regression models were used to detect the potential risk factors of prehypertension and hypertension in children and adolescents. During the survey years, the overall prevalence of prehypertension and hypertension were 6.0% and 10.6%. The corresponding rates in the western region were lowest, but increased rapidly over the two decades (84.0% and 122.6% increases respectively, P<0.001). The overall hypertension rate remained high in the eastern region, despite the slower increase (24.2% increase). In the central region, although the prehypertension rate remained stable, the rate of hypertension had a 94.8% increase these years (P<0.0001). According to the results of logistic regression, age, body mass index (BMI) and waist/height ratio (WHtR) were associated with prehypertension and hypertension. Children and adolescents in the eastern region had the highest level of prehypertension and hypertension, while the rapid increase of blood pressure in the western and central regions were also supposed to concern. Improvement of the healthy lifestyle is urgent for prehypertension and hypertension prevention in children and adolescents.

Secular Trends in Blood Pressure and Overweight and Obesity in Chinese Boys and Girls Aged 7 to 17 Years From 1995 to 2014

The current study aimed to assess the secular trends in overweight and obesity status and high blood pressure (HBP) in Chinese children and adolescents for 2 decades. Data on 943 128 participants aged 7 to 17 years were obtained from the Chinese National Survey on Students' Constitution and Health from 1995 to 2014. The population attributable risk of overweight status for HBP was calculated. The prevalence of overweight increased from 4.3% in 1995 to 18.4% in 2014, whereas HBP prevalence fluctuated in the range of 4.4% to 6.4% during the same time period, the lowest in 2005. Within each survey year, blood pressure levels and HBP prevalence increased with higher body mass index. Notably, the population attributable risk of HBP because of being overweight steadily increased from 6.3% in 1995 to 19.2% in 2014. The same trends of linear growth for obesity, fluctuating blood pressure, and its sustained increasing population attributable risk for overweight also occurred among the domestic 29 provinces. Despite dramatic increases in overweight prevalence among Chinese children from 1995 to 2014, the HBP prevalence remained relatively stable, suggesting that other independent factors are affecting HBP trends to a greater extent. Yet, over time, the magnitude of the impact of being overweight or obese on HBP increased sharply, predicting looming heavy burden of HBP. Reductions in overweight status may aid in preventing HBP so as to prevent coronary risk in adulthood.

Elevated blood pressure among primary school children in Dar es salaam, Tanzania: prevalence and risk factors

Background

Whilst the burden of non-communicable diseases is increasing in developing countries, little data is available on blood pressure among Tanzanian children. This study aimed at determining the blood pressure profiles and risk factors associated with elevated blood pressure among primary school children in Dar es Salaam, Tanzania.

Methods

We conducted a cross sectional survey among 446 children aged 6–17 years from 9 randomly selected primary schools in Dar es Salaam. We measured blood pressure using a standardized digital blood pressure measuring machine (Omron Digital HEM-907, Tokyo, Japan). We used an average of the three blood pressure readings for analysis. Elevated blood pressure was defined as average systolic or diastolic blood pressure ≥ 90th percentile for age, gender and height.

Results

The proportion of children with elevated blood pressure was 15.2% (pre-hypertension 4.4% and hypertension 10.8%). No significant gender differences were observed in the prevalence of elevated BP. Increasing age and overweight/obese children were significantly associated with elevated BP (p = 0.0029 and p < 0.0001) respectively. Similar associations were observed for age and overweight/obesity with hypertension. (p = 0.0506 and p < 0.0001) respectively. In multivariate analysis, age above 10 years (adjusted RR = 3.63, 95% CI = 1.03–7.82) was significantly and independently associated with elevated BP in this population of school age children.

Conclusions

We observed a higher proportion of elevated BP in this population of school age children. Older age and overweight/obesity were associated with elevated BP. Assessment of BP and BMI should be incorporated in school health program in Tanzania to identify those at risk so that appropriate interventions can be instituted before development of associated complications.

Elevated blood pressure is associated with higher prevalence of low visual acuity among adolescent males in Northeast China

The purpose of this study is to track the trends of low visual acuity (VA) from 2005 to 2014, and to investigate its associations with systemic blood pressure (BP) components among adolescents in Northeast China. A total of 55320 students of Han nationality aged 13 to 18 years were included. There has been a significant increase in the prevalence of low VA, with 31.3% in 2005, 40.2% in 2010 and 43.4% in 2014. In multivariable-adjusted logistic regression models, each 1-mm Hg increment in systolic BP (SBP) was associated with 0.8% (95% confidence interval [CI]: 0.1–1.6%), 0.5% (95% CI: 0.1–0.9%) and 1.1% (95% CI: 0.6–1.6%) increased odds of low VA for males in 2005, 2010 and 2014; each 1-mm Hg increment in pulse pressure (PP) was associated with 1.6% (95% CI: 0.7–2.5%), 0.8% (95% CI: 0.4–1.2%) and 1.2% (95% CI: 0.7–1.7%) increased odds of low VA. Higher PP categories had greater odds for low VA compared with the reference group. Similar associations were not observed for females. We conclude that higher prevalence of low VA was significantly associated with higher SBP and PP in males. Furthermore, there was a dose-dependent association between the prevalence of low VA and the levels of PP.

Divergent secular trends in blood pressure and body mass index in children and adolescents in Hong Kong

Secular trends in blood pressure (BP) and body mass index (BMI) during childhood and adolescence are sentinels for the future population cardiovascular disease burden. We examined trends in BP z-score (ages 9-18 years from 1999 to 2014) and BMI z-score (ages 6-18 years from 1996 to 2014) in Hong Kong, China. Overall, BP z-score fell, systolic BP from 0.08 to -0.01 in girls and from 0.31 to 0.25 in boys. However, the trends were not consistent, for both sexes, systolic BP z-score was stable from 1999, decreased slightly from 2002 to 2005 and increased slightly to 2014, diastolic BP z-score decreased slightly from 1999 to 2004 and then remained stable to 2014. In contrast, BMI z-score rose from -0.15 to -0.01 in girls and from 0.14 to 0.34 in boys, mainly during 1997 to 2010. The upper tail of the systolic (except boys) and diastolic BP distribution shifted downwards, whereas the entire BMI distribution shifted upward. BP declined slightly whereas BMI rose in Hong Kong children and adolescents during the last 20 years, with systolic BP and BMI in boys above the reference. This warrants dual action in tackling rising BMI and identifying favorable determinants of BP, particularly targeting boys.

Trends in cardiometabolic parameters among Spanish children from 2006 to 2010: The Cuenca study

OBJECTIVE

The aim of this study was to examine the trends in cardiometabolic risk factors among schoolchildren in Cuenca, Spain, from 2006 to 2010.

METHODS

Data were taken from two cross-sectional surveys conducted in 2006 and 2010 among schoolchildren aged 8-12 years from 20 public schools in the province of Cuenca. The final sample consisted of 2148 participants with measured anthropometric variables, biochemical assessment, and blood pressure.

RESULTS

We observed an increase in mean serum total cholesterol (8.5 mg/dL and 10.7 mg/dL), LDL-cholesterol (13.7 mg/dL and 17.3 md/dL), triglycerides (3.6 mg/dL and 2.6 md/dL), fasting insulin (1.2 µU/mL and 0.3 µU/mL) and HOMA-IR (0.2 and 0.02) and a decrease in mean serum HDL-cholesterol (4.4 mg/dL and 5.7 mg/dL), systolic blood pressure (3.8 mmHg and 5.4 mmHg) and diastolic blood pressure (0.8 mmHg and 2.0 mmHg) in both sexes. In girls, mean arterial pressure (3.2 mmHg) also decreased in this period. In addition, we found an increase in the prevalence of adverse total cholesterol concentration (≥200 mg/dL) (7.8% and 8.9%), HDL-cholesterol concentration (<40 mg/dL) (1.9% in boys and 3.5% in girls) and LDL cholesterol concentration (≥130mg/dL) (4.8% and 5.8%) in boys and girls, respectively.

CONCLUSIONS

There has been a worsening of the lipid profile in schoolchildren from Cuenca, independent of weight status and age.

Associations among cardiorespiratory endurance, body mass index and blood pressure in Han Chinese children: results from the 2010 Chinese National Survey On Students' Constitution and Health

The associations among cardiorespiratory endurance (CRE), body mass index (BMI) and blood pressure (BP) in children are still unclear. This study aimed to examine the relationships among CRE, BMI and BP in Chinese children. Data were derived from the 2010 Chinese National Survey on Students' Constitution and Health. An endurance run test was used to determine CRE and children were stratified into low and high/moderate CRE groups. BMI was dichotomized into non-overweight and overweight. Among overweight children aged 7-12 years, the risk of high BP (HBP) was significantly higher in the low CRE group than in the high/moderate CRE group (in boys, odds ratio=1.13, 95% confidence interval: 1.03-1.24, P=0.010; in girls, odds ratio=1.18, 95% confidence interval: 1.04-1.33, P=0.010) after adjusting for age, BMI, socioeconomic status and area of residence. However, among all children aged 13-18 years and non-overweight children aged 7-12 years, we did not observe similar results. Higher CRE is associated with lower BP. Overweight children have a significantly higher risk of HBP and low CRE may increase the risk of HBP, independently of BMI, among 7- to 12-year-old overweight children.

Role of waist measures in addition to body mass index to assess the hypertension risk in children

AIM

This study aimed to evaluate whether waist measures, including waist circumference (WC) and waist-to-height ratio (WHtR), can improve the ability of body mass index (BMI) to assess the hypertension risk when used as continuous variables.

METHODS

In this cross-sectional study, 82 432 Chinese children aged 9-17 years were included. Elevated BP was defined using age-sex-and-height-specific references. Logistic regression model and area under the receiver operating characteristic curve (AUC) were performed after BMI and waist measures were converted into age-and-sex-based z-scores.

RESULTS

WHtR, but not WC, was associated with elevated BP after adjusting for BMI, with the odds ratios ranging between 1.14 (95% confidence interval: 1.04, 1.25) and 1.30 (1.21, 1.39) for one unit increase in WHtR z-score. Combined use of BMI and WHtR z-scores showed a significantly larger AUC than BMI alone (p < 0.05), while joint use of BMI and WC was not better than BMI alone.

CONCLUSION

WHtR, rather than WC, provided further information on hypertension risk beyond that provided by BMI alone when used as a continuous variable. This study suggests WHtR, in addition to BMI, should be included for the assessment of childhood adiposity in routine paediatric practice.

The importance of blood lipids in the association between BMI and blood pressure among Chinese overweight and obese children

We aimed to examine the contribution of blood lipids to the association between BMI and blood pressure (BP) in children with overweight and obesity. Data were collected in elementary and high schools of Chaoyang District, Beijing, China in 2012. Participants' weight, height, BP and fasting plasma lipid profile were measured by standard protocols. Mediation analysis was used to examine the mediation role of blood lipids on the relation between BMI and BP, with age included as a covariate. We found that in boys 8·29 % (mediation effect=0·106, P=0·012) of the association between BMI and systolic BP was mediated through TAG. TAG mediated 12·53 % (mediation effect=0·093, P=0·018) and LDL-cholesterol mediated 7·75 % (mediation effect=0·57, P=0·046) of the association between BMI and diastolic BP was mediated by TAG and LDL-cholesterol, respectively. However, blood lipids did not show the mediation effect in girls. Our findings suggested that there was a sex difference in the contribution of blood lipids to the association between BMI and BP. Controlling TAG or LDL-cholesterol may be beneficial for reducing the risk of the BMI-related high BP in overweight boys; however, this outcome is not the case when controlling TAG or LDL-cholesterol in girls. This study may provide clues to explore the underlying mechanism of the association between obesity and hypertension.

Pediatric Blood Pressure and Adult Preclinical Markers of Cardiovascular Disease

A high blood pressure level in adults is considered the single most important modifiable risk factor for global disease burden, especially those of cardiovascular (CV) origin such as stroke and ischemic heart disease. Because blood pressure levels have been shown to persist from childhood to adulthood, elevations in pediatric levels have been hypothesized to lead to increased CV burden in adulthood and, as such, might provide a window in the life course where primordial and primary prevention could be focused. In the absence of substantive data directly linking childhood blood pressure levels to overt adult CV disease, this review outlines the available literature that examines the association between pediatric blood pressure and adult preclinical markers of CV disease.

Relationship between body mass index changes and blood pressure changes from childhood to adulthood in a general Chinese population: a 26 year cohort follow-up study

The aim of this study was to estimate the relationship between body mass index (BMI) and blood pressure (BP) in a Chinese population with 26 year follow-up. The study included 4211 schoolchildren aged 6-17 years in Hanzhong, Shaanxi Province, China. Body weight, height, waist circumference, and BP were measured in 1987, 1989, 1992, 1995 and 2013. Cox proportional hazards model were fitted to examine the effect of BMI on BP. At the 26 year follow-up, 6.93% of male and 3.43% of female subjects had high SBP, and 12.8% of male and 4.56% of female had high DBP. The average age of subjects with high SBP was 40.3 years in males and 41.4 years in females; while the average age with high DBP was 38.1 years in males and 38.9 years in females. Obese subjects were 2.96 times and 2.88 times more likely to have high SBP and high DBP than normal weight counterparts, respectively; while overweight subjects were 1.81 times and 2.03 times more likely to have high SBP and high DBP, respectively. These findings underscore the urgent need to prevent increasing body weight. Targeting intervention in adolescence may be a critical method for preventing high BP in later life.

Trends in Elevated Blood Pressure Among US Children and Adolescents: 1999-2012

BACKGROUND

The prevalence of elevated blood pressure (BP) has been reported to increase significantly among the US children and adolescents from 1988-1994 to 1999-2008. We aimed to examine the recent trends in BP levels and prevalence of elevated BP, as well as related influencing factors among US children and adolescents.

METHODS

Data of National Health and Nutrition Examination Survey (NHANES) 1999-2012 were combined into 3 time periods (1999-2002, 2003-2008, and 2009-2012) for the analysis. A total of 14,270 US children and adolescents aged 8-17 years were included in the current analysis. The sex-, age-, and height-BP standards recommended by the US Fourth Report were used to define high BP and elevated BP (including pre-HBP and HBP).

RESULTS

Mean systolic BP (SBP) and diastolic BP (DBP) decreased by 0.7 and 4.2mm Hg from 1999-2002 to 2009-2012, respectively. In 2009-2012, the prevalence of elevated BP and HBP in children and adolescents were 9.6% and 1.6%, with the absolute reduction of 2.8% and 1.3% from 1999-2002 to 2009-2012, respectively. In addition, daily intakes of total energy, carbohydrate, total saturated fatty acids, and caffeine decreased during the period between 1999-2002 and 2009-2012 (all P < 0.05), whereas daily intake of total polyunsaturated fatty acids and dietary fiber increased (P < 0.05).

CONCLUSIONS

Mean BP levels as well as the prevalence of elevated BP and HBP among US children and adolescents have declined during the past decade. In addition, there might be an associated change in dietary factors.

Understanding trends in blood pressure and their associations with body mass index in Chinese children, from 1985 to 2010: a cross-sectional observational study

OBJECTIVE

Understanding trends in blood pressure (BP) in childhood is crucial to addressing and reducing the burden of adulthood hypertension and associated mortality in the future. In view of growing obesity in Chinese children, we sought to investigate the trends in BP and the influence of body mass index (BMI) on them.

DESIGN, SETTING AND PARTICIPANTS

We included 1,010,153 children aged 8-17 years, with completed records from a large national successive cross-sectional survey, the Chinese National Survey on Students' Constitution and Health, between 1985 and 2010.

MAIN OUTCOME MEASUREMENTS

BP was measured according to the recommendation of the National High Blood Pressure Education Program Working Group, and the elevated BP was based on sex-, age- and height-specific 95th centile of the recommendation.

RESULTS

The adjusted mean systolic BP in boys and girls decreased by 3.9 and 5.6 mm Hg between 1985 and 2005, and increased by 1.3 and 1.0 mm Hg between 2005 and 2010, respectively. Corresponding adjusted prevalence of elevated systolic BP in boys and girls declined from 5.1% and 5.5% to 3.5% and 2.5% between 1985 and 2005, and increased to 4.9% and 3.5% in 2010, respectively. Adjusted mean BMI of boys and girls in 2010 was 2.0 and 1.2 kg/m(2) higher than those in 1985, respectively. The prevalence of obesity rose from 0% to 3.4% in boys and 0.9% in girls. Further adjusting for BMI did not change these trends in systolic BP. A similar pattern was also observed in diastolic BP.

CONCLUSIONS

After declining for 20 years, BP levels in Chinese children started to climb upwards. These trends in BP cannot be fully explained by BMI. The investigation of other determinants of BP may provide additional opportunity to curb the current upward BP trend in Chinese children.

Familial aggregation and childhood blood pressure

There is growing concern about elevated blood pressure (BP) in children. The evidence for familial aggregation of childhood BP is substantial. Twin studies have shown that a large part of the familial aggregation of childhood BP is due to genes. The first part of this review provides the latest progress in gene finding for childhood BP, focusing on the combined effects of multiple loci identified from the genome-wide association studies on adult BP. We further review the evidence on the contribution of the genetic components of other family risk factors to the familial aggregation of childhood BP including obesity, birth weight, sleep quality, sodium intake, parental smoking, and socioeconomic status. At the end, we emphasize the promise of using genomic-relatedness-matrix restricted maximum likelihood (GREML) analysis, a method that uses genome-wide data from unrelated individuals, in answering a number of unsolved questions in the familial aggregation of childhood BP.

The emerging epidemic of hypertension in Asian children and adolescents

Hypertension has become a serious global public health burden because of its high incidence and concomitant risk of cardiovascular disease. Many studies have verified that risk factors, such as hypertension and obesity which are responsible for cardiovascular disease, start in early childhood. In Asian countries, the prevalence of hypertension in the pediatric age group has become more prevalent than ever before with the increasing obesity epidemic. To tackle the epidemic of cardiovascular disease, a leading cause of death and disability of non-communicable diseases in Asian countries, population-based measures aiming at reducing harmful environmental factors to blood pressure and body weight must be applied to individuals in their early childhood, as early as the fetal stage. This review focused on the prevalence of pediatric hypertension in Asian countries and outlined several considerations for accurate blood pressure (BP) measurement and evaluation, along with an overview of pathophysiology of fetal programming and obesity related with childhood hypertension.

Change in the association of body mass index and systolic blood pressure in Germany - national cross-sectional surveys 1998 and 2008-2011

Background

A recent weakening and even decoupling of the association of body mass index (BMI) and systolic blood pressure (SBP) in population data was reported, i. a. for Western Europe.

Methods

The association of BMI and SBP in recent cross-sectional population data from Germany was investigated in participants aged 18–79 years with BMI 17.5-40 kg/m² from national health examination surveys 1998 (n = 6,931) and 2008–2011 (n = 6,861) in Germany. The association was analyzed both in the overall samples and in participants without antihypertensive medication.

Results

From 1998 to 2008–11, age- and sex-standardized mean SBP decreased from 129.0 (CI 128.2-129.7) to 124.1 (123.5-124.6) mmHg in all participants and from 126.0 (125.4-126.7) to 122.3 (121.7-122.8) mmHg among persons not on antihypertensive medication. The proportion of persons treated with antihypertensives augmented from 19.2 % (17.7-20.8) to 25.3 % (24.0-26.6). Mean BMI remained constant at around 27 kg/m² with a slight increase in obesity prevalence. BMI was positively associated with SBP both in 1998 and 2008–11, yet the association tended to level out with increasing BMI suggesting a non-linear association. The strength of the BMI-SBP-association decreased over time in all and untreated men. In women, the association weakened in the overall sample, but remained similarly strong in untreated women. The unadjusted linear regression models were used to estimate the increase in SBP within 5-unit BMI increases. E. g. for men in 1998, SBP was higher by 7.0 mmHg for a BMI increase from 20 to 25 kg/m² and by 3.6 mmHg for BMI 30 to 35 kg/m². The corresponding values for 2008–11 were 3.8 mmHg and 1.7 mmHg.

Conclusions

The cross-sectional association of BMI and SBP decreased between 1998 and 2008–11 in Germany, however it did not disappear and it is in part explained by improvements in the diagnosis and treatment of high blood pressure.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2023-8) contains supplementary material, which is available to authorized users.

Population attributable risk of overweight and obesity for high blood pressure in Chinese children

OBJECTIVE

Little is known about whether eliminating overweight and obesity could effectively reduce the prevalence of high blood pressure (HBP) in Chinese children. This study aimed to estimate the magnitude of contribution of overweight and obesity associated with HBP in Chinese children, and assess the theoretical HBP prevalence if overweight and obesity were eliminated.

METHODS

Data on 197,191 participants aged 7-17 years with complete records from the Chinese National Survey on Students' Constitution and Health conducted in 2010 were included. The population attributable risk of overweight and obesity for HBP was calculated.

RESULTS

The prevalence of HBP was 6.8% and 5.8% for boys and girls, respectively. HBP in about 22.9% (95% CI 21.5, 24.2%) of boys and 14.7% (95% CI 13.5, 15.8%) of girls could be attributable to overweight and obesity. If both overweight and obesity were eliminated, the prevalence of HBP theoretically could be reduced to 5.2% in boys and 5.0% in girls. Similar results were found in different age and urban/rural area groups.

CONCLUSION

Eliminating overweight and obesity could theoretically lead to a moderate reduction in the prevalence of HBP in Chinese children.

Breast Cancer Challenges and Screening in China: Lessons From Current Registry Data and Population Screening Studies

BACKGROUND

As one of its responses to the increasing global burden of breast cancer (BC), China has deployed a national registration and BC screening campaign. The present report describes these programs and the initial results of these national BC control strategies, highlighting the challenges to be considered.

MATERIALS AND METHODS

The primary BC incidence and prevalence data were obtained from the Chinese National Central Cancer Registry. MapInfo software was used to map the geographic distribution and variation. The time trends were estimated by the annual percentage of change from 2003 to 2009. The description of the screening plans and preliminary results were provided by the Ministry of Health.

RESULTS

Chinese cancer registries were primarily developed and activated in the East and Coastal regions of China, with only 12.5% of the registries located in West China. Geographic variation was noted, with the incidence of BC higher in North China than in South China and in urban areas compared with rural areas. Of great interest, these registries reported that the overall BC incidence has been increasing in China, with an earlier age of onset compared with Western countries and a peak incidence rate at age 50. In response to this increasing incidence and early age of onset, BC screening programs assessed 1.46 million women aged 35-59 years, using clinical breast examinations and ultrasound as primary screening tools between 2009 and 2011. The diagnostic rate for this screening program was only 48.0/10(5) with 440 cases of early stage BC. Early stage BC was detected in nearly 70% of screened patients. Subsequently, a second-generation screening program was conducted that included older women aged 35-64 years and an additional 6 million women were screened.

CONCLUSION

The cancer registration system in China has been uneven, with a greater focus on East rather than West China. The data from these registries demonstrate regional variation, an increasing BC incidence, and an early age of onset. The 2009 to 2011 BC screening program targeting women aged 35-59 years had a low detection rate that resulted in a second-generation screening program that extended the cohort size and ages screened to 35-64 years.

IMPLICATIONS FOR PRACTICE

Cancer registration has been active in China for decades; however, a national survey of registries has not been routinely reported. This study used MapInfo to describe the reported data and found asymmetric registration activities, geographic variations in breast cancer (BC) burdens, and an increasing incidence with a peak at age 50. The initial Chinese BC screening programs focused on a relatively young population of women aged 35-59 years and had a low detection rate, but 69.7% of patients had early stage BC. Older women were included in the second-generation screening programs, and an additional 6 million women were screened. Consideration of regional variations and age is necessary to optimize the efficiency and utility of BC screening in China, with the ultimate goal to reduce BC mortality.

Blood Pressure after Surgery among Obese and Nonobese Children with Obstructive Sleep Apnea

Objectives

Treating obstructive sleep apnea in children is found to be associated with blood pressure decreases. However, exactly how adenotonsillectomy (T&A) affects blood pressure in obese and nonobese children remains unclear. This study assesses how obesity affects blood pressure in children with sleep apnea after T&A.

Study Design

Case series with chart review.

Setting

A tertiary referral center.

Subjects and Methods

From 2010 to 2012, a total of 78 children were included. Based on propensity score methods (age, sex, and preoperative apnea-hypopnea index matched), children were assigned to either the obese group (n = 39) or the nonobese group (n = 39). All children received adenotonsillectomy. We recorded clinical symptoms, preoperative overnight polysomnography (PSG), and subsequent PSG within 3 months after T&A. We measured blood pressure 3 times before PSG (nocturnal blood pressure) and after PSG (morning blood pressure) in a sleep laboratory.

Results

Following surgery, the nonobese group had a significantly decreased nocturnal diastolic blood pressure (DBP) index (–12.0 to −18.8, P = .018), morning systolic blood pressure (SBP; 111.1 to 105.8 mm Hg, P = .014), SBP index (–5.4 to −10.9, P = .008), and DBP (–12.0 to −18.7, P = .023). Nevertheless, all blood pressure parameters in the obese group were not significantly changed postoperatively. The nonobese group improved more than obese group in nocturnal and morning DBP and DBP index by 2-way analysis of variance.

Conclusion

Among the children receiving T&A as treatment for OSA, nonobese children improved more than obese children did in terms of blood pressure, allowing us to infer that obese children with OSA may benefit less from T&A in cardiovascular morbidities.

Interactions between obesity-related copy number variants and dietary behaviors in childhood obesity

Copy number variants (CNVs) have been implicated as an important genetic marker of obesity, and gene-environment interaction has been found to modulate risk of obesity. To evaluate the associations between CNVs and childhood obesity, as well as the interactions between CNVs and dietary behaviors, we recruited 534 obese children and 508 controls from six cities in China and six candidate CNVs were screened through published genome-wide studies (GWAS) on childhood obesity. We found three loci (10q11.22, 4q25 and 11q11) to be significantly associated with obesity after false discovery rate (FDR) correction (all the p ≤ 0.05). Cumulative effect of the three positive loci was measured by the genetic risk score (GRS), showing a significant relationship with the risk of obesity (Ptrend < 0.001). The OR of obesity increased to 21.38 (95% CI = 21.19-21.55) among the 10q11.22 deletion carriers who had meat-based diets, indicating prominent multiplicative interaction (MI) between deletions of 10q11.22 and preference for a meat-based diet. Simultaneous deletions of 5q13.2 and duplications of 6q14.1 had significant MI with a preference for salty foods. Our results suggested that CNVs may contribute to the genetic susceptibility of childhood obesity, and the CNV-diet interactions modulate the risk of obesity.

PARENTAL AND SIBLING MIGRATION AND HIGH BLOOD PRESSURE AMONG RURAL CHILDREN IN CHINA

This study examines the associations between parental and sibling rural-to-urban migration and blood pressure (BP) of rural left-behind children (LBC) in rural China. Analysis was based on the 2000, 2004, 2006 and 2009 waves of longitudinal data from the China Health and Nutrition Survey, which is an ongoing prospective survey covering nine provinces with an individual-level response rate of 88%. Blood pressure levels were measured by trained examiners at three consecutive times on the same visit and the means of three measurements were used as the final BP values. An ordinal BP measure was then created using a recently validated age-sex-specified distribution for Chinese children and adolescents, distinguishing normal BP, pre-hypertension and hypertension. Random effect modelling was performed. Different migration circumstances play different roles in LBC's BP with mother-only and both-parent migration being particularly detrimental and father-only and sibling-only migration either having no association or a negative association with LBC's BP levels or odds of high BP. In conclusion, the link between family migration and left-behind children's blood pressure is complex, and depends on who is the person out-migrating.

Gene-smoking interactions identify several novel blood pressure loci in the Framingham Heart Study

BACKGROUND

Cardiovascular diseases are among the most significant health problems in the United States. Blood pressure (BP) variability has a genetic component, and most of the genetic variance remains to be identified. One promising strategy for gene discovery is genome-wide analysis of interactions between single nucleotide polymorphisms (SNPs) and environmental factors related to cardiovascular diseases.

METHODS

We investigated SNP-smoking interaction effects on BP in genome-wide data in 6,889 participants from the Framingham Heart Study. We performed the standard 1 degree of freedom (df) test of the interaction effect and the joint 2 df test of main and interaction effects. Three smoking measures were used: cigarettes per day (CPD), pack years of smoking, and smoking status.

RESULTS

We identified 7 significant and 21 suggestive BP loci. Identified through the joint 2 df test, significant SBP loci include: rs12149862 (P = 3.65×10(-9)) in CYB5B, rs2268365 (P = 4.85×10(-8)) in LRP2, rs133980 (P = 1.71×10(-8) with CPD and P = 1.07×10(-8) with pack-years) near MN1, and rs12634933 (P = 4.05×10(-8)) in MECOM. Through 1 df interaction analysis, 1 suggestive SBP locus at SNP rs8010717 near NRXN3 was identified using all 3 smoking measures (P = 3.27×10(-7) with CPD, P = 1.03×10(-7) with pack-years, and P = 1.19×10(-7) with smoking status).

CONCLUSIONS

Several of these BP loci are biologically plausible, providing physiological connection to BP regulation. Our study demonstrates that SNP-smoking interactions can enhance gene discovery and provide insight into novel pathways and mechanisms regulating BP.

Effectiveness of physical exercise to reduce cardiovascular risk factors in youths: a randomized clinical trial

Background

The aim of the current study was to test the effectiveness of a physical activity and exercise-based program in a clinical context to reduce cardiovascular risk factors in children and adolescents.

Methods

A randomized clinical trial was conducted in a pediatric preventive outpatient clinic. Intervention was 14 weeks of exercise for the intervention group or general health advice for the control group. The primary and the secondary outcomes were reduction of cardiovascular risk factors and the feasibility and the effectiveness of clinical advice plan to practice physical exercises at home.

Results

A total of 134 children were screened; 26 met eligibility criteria. Of these, 10 were allocated in the exercise intervention group and nine were included in the control group until the end of the intervention. Those patients who discontinued the intervention had the lowest scores of z-BMI (P = 0.033) and subscapular skin fold (P = 0.048). After 14 weeks of intervention, no statistical differences were found between the groups. High-density lipoprotein cholesterol (HDL-C) was higher in the exercise group, with a mild tendency to be significant (P = 0.066). Patients who adhere to treatment had diastolic blood pressure decreased from baseline to the end of the follow-up period in the control group (P = 0.013). Regardless of this result, the other comparisons within the group were not statistically different between T0 and T14.

Conclusion

A low-cost physical activity advice intervention presented many barriers for implementation in routine clinical care, limiting its feasibility and evaluation of effectiveness to reduce cardiovascular risk factors.

Recent clinical and translational advances in pediatric hypertension

Epidemiological reports describe a child population increase in BP level and an increase in prevalence of hypertension, that is largely, but not entirely, driven by a concurrent increase in childhood obesity. Given current estimates, ≈10% of adolescents have hypertension or prehypertension. In addition to obesity, dietary salt intake and waist circumference, a marker of visceral obesity, are found to be independently associated with the rise in BP among children and adolescents. Dietary salt intake in urban children is well above recommended levels largely because of consumption of processed and fast foods. Childhood exposures, such as stress,52 salt, and fructose, as well as lifestyles, including food sources, sleep patterns, and reductions in physical activity may have a role in obesity-high BP associations. In addition, clinical and translational evidence is mounting that intrauterine exposures alter can effect changes in fetal development that have an enduring effect on cardiovascular and metabolic function later in life. These effects can be detected even in children who are products of a term otherwise normal pregnancy. Hypertension in childhood has been defined statistically (BP ≥ 95th percentile) because of lack of outcome data that links a BP level with heightened risk for future cardiovascular events. Therefore, primary hypertension had been considered a risk factor for later hypertension in adulthood. Intermediate markers of TOD, including cardiac hypertrophy, vascular stiffness, and increases in cIMT, are detectable in adolescents with primary hypertension. Evidence that vascular injury is present in the early phase of hypertension and even in prehypertension warrants consideration on the current definition of pediatric hypertension. With further studies on TOD and other risk factors in addition to high BP, it may be possible to shift from a statistical definition to a definition of childhood hypertension that is evidence based. Preventing or reducing childhood obesity would have substantial benefit in countering the documented increase in BP levels and prevalence of high BP in childhood. Weight control in overweight and obese children, along with dietary changes 53 and increases in physical activity,54 has benefit on BP levels in childhood. Prevention of childhood obesity and BP risk will require multiple levels of intervention, including public health, health policy, and attention to food supply to foster the necessary lifestyle changes to prevent and reduce childhood obesity.

The association between resting heart rate and blood pressure among children and adolescents with different waist circumferences

Resting heart rate (RHR) is an accessible index of sympathetic activity. The objective of this study was to assess the associations between blood pressure (BP) and RHR in children with different waist circumferences (WCs). The data of the Chinese National Survey on Students' Constitution and Health in 2010 were used. A total of 91,762 participates aged 9 to 18 years with complete records were included. RHR was categorised into quintile groups and WC was stratified into small (<-1.035), medium (≥-1.035 and <1.035) and large (≥1.035) groups respectively, after they were converted into age- and sex-specific z-score. Multivariate linear regression revealed that the association between RHR z-score and BP was similar before and after WC was adjusted for. With 1 standard deviation variation in RHR, BP changed from 2.22 (95 % confidence interval (CI): 1.51, 2.93) to 3.58 mmHg (95 % CI: 2.54, 4.62) in small WC group and 1.83 (95 % CI: 1.10, 2.56) to 4.23 mmHg (95 % CI: 3.38, 5.09) in large WC group respectively.

CONCLUSIONS

This study revealed that BP was positively associated with RHR among children with different WCs, which implied the positive association between sympathetic activity and BP in children regardless of the amount of abdominal fat.

Blood pressure-to-height ratio for screening prehypertension and hypertension in Chinese children

The diagnosis of hypertension in children is complicated because of the multiple age-, sex- and height-specific thresholds. To simplify the process of diagnosis, blood pressure-to-height ratio (BPHR) was employed in this study. Data were obtained from a Chinese national survey conducted in 2010, and 197 191 children aged 7-17 years were included. High normal and elevated blood pressure (BP) were defined according to the National High Blood Pressure Education Program (NHBPEP) Working Group definition. The optimal thresholds were selected by Youden's index. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and area under the curve (AUC) were assessed for the performance of these thresholds. The systolic and diastolic BPHR thresholds for identifying high normal BP were 0.84/0.55, 0.78/0.50 and 0.75/0.46 for children aged 7-8 years, 9-11 years and 12-17 years, respectively. The corresponding thresholds for identifying elevated BP were 0.87/0.57, 0.81/0.53 and 0.76/0.49, respectively. These proposed thresholds revealed high sensitivity and NPVs, all above 0.96, moderate to high specificity and AUCs, and low PPVs. Our finding suggested the proposed BPHR thresholds were accurate for identifying children without high normal or elevated BP, and could be employed to simplify the procedure of screening prehypertension and hypertension in children.

Severity of Childhood Obstructive Sleep Apnea and Hypertension Improved after Adenotonsillectomy

Objective

To report improvements in childhood obstructive sleep apnea (OSA) and hypertension after adenotonsillectomy.

Study Design

Case series with planned data collection.

Setting

Tertiary referral center.

Subjects and Methods

Fifty consecutive patients (36 boys and 14 girls; median age, 7.0 years) who underwent plasma knife–assisted total tonsillectomy and adenoidectomy for OSA between January 2010 and March 2013 were assessed with the body mass index z score, apnea-hypopnea index (AHI), systolic blood pressure (BP), and diastolic BP at baseline and at ≥6 months postoperatively. Changes in these parameters were statistically analyzed using nonparametric tests with the bootstrap approach.

Results

The median follow-up period was 9.6 months. Postoperatively, the median AHI significantly reduced from 9.8 to 1.6 ( P < .001). Although the median systolic BP and diastolic BP insignificantly changed in the overall group, both were significantly reduced in children with preoperative hypertension (systolic: from 119.0 to 113.0 [ P = .038]; diastolic: from 79.0 to 68.0 [ P = .005]). Accordingly, the hypertension rate significantly reduced from 34% to 14% ( P = .006). However, the change in OSA severity was not well correlated with the change in hypertension severity. In multiple logistic regression analysis with forward selection, a combination of preoperative hypertension and severe OSA was a significant predictor of postoperative hypertension (relative risk, 15.4; 95% confidence interval, 3.7-64.3; P < .001).

Conclusion

The decreased hypertension rate indicates that a reduction of the AHI is not all that matters after adenotonsillectomy in childhood OSA. However, patients with preoperative severe OSA and hypertension need careful management of their elevated BP despite surgical treatment.

High rates of child hypertension associated with obesity: a community survey in China, India and Mexico

BACKGROUND

Hypertension is a significant risk factor for cardiovascular disease, and epidemiological evidence suggests that it is increasing in parallel with obesity in children and adolescents in low- and middle-income countries.

AIM

To identify and determine the relationship between overweight, obesity and hypertension in a community sample of school children.

METHODS

Anthropometric data were collected from 12,730 school children aged 12-18 years in China, India and Mexico as part of the Community Interventions for Health programme, an international study evaluating community interventions to reduce non-communicable disease by addressing the three main risk factors of tobacco use, unhealthy diets and physical inactivity. Logistic regression was used to examine the association of body mass index and gender and hypertension.

RESULTS

Prevalence rates of hypertension were 5.2% in China, 10.1% in India and 14.1% in Mexico, and pre-hypertension rates in China, India and Mexico were 13.4%, 9.4% and 11.2%, respectively. Overweight and obesity prevalence rates varied by country and were 16.6% in China, 4.1% in India and 37.1% in Mexico. In all countries there was a significant association between overweight and obesity and rates of hypertension. Overweight children were 1.7-2.3 times more likely to be hypertensive and obese children 3.5-5.5 more likely to show hypertension than those of normal weight.

CONCLUSIONS

Rates of hypertension and overweight and obesity are high in school children in China, India and Mexico, and increased bodyweight is a significant risk factor for hypertension.