The degree of blood pressure evaluation and end organ damage with severe hypertension: a case-control study

Longitudinal changes in blood pressure during weight loss and regain of weight in obese boys and girls

OBJECTIVE

To investigate blood pressure (BP) in relation to changes in body mass index (BMI) in obese children during weight loss and subsequent weight regain.

DESIGN

A longitudinal study of obese boys and girls investigated through a 12-week weight loss intervention with follow-up investigations spanning 28 months. Results shown are from baseline; day 14, 33, and 82 during weight loss; and at months 10, 16 and 28 during follow-up.

PATIENTS

One hundred and fifteen obese children, 53 boys and 62 girls (8-15 years) with a median BMI standard deviation score (SDS) at baseline of 2.78 in boys, and 2.70 in girls. Ninety children completed the weight loss programme and 68 children entered the follow-up programme.

METHODS

Height, weight, systolic blood pressure (SBP), and diastolic BP (DBP) were recorded and analysed using a general linear mixed model.

RESULTS

Fifty-one percent of the obese children were pre or hypertensive at baseline. Both DBP and SBP declined significantly with weight loss, but a divergent response was found in the timing of the rebound in hypertension during the weight regain phase, that is DBP increased during weight regain, whereas SBP remained lower than baseline during 28 months of continuous weight regain.

CONCLUSION

The effect of weight reduction upon obesity-associated hypertension is noticeable and suggests the importance of an intensified childhood obesity treatment strategy in order to reduce the burden of future cardiovascular disease.

Asymptomatic hypertension in the emergency department: a matter of critical public health importance

Asymptomatic hypertension (HTN) is commonly encountered in the emergency department (ED), but in most circumstances little is done about it. While many factors may contribute to this, the failure to recognize asymptomatic HTN as a public health problem is particularly important. Given the established long-term consequences of elevated blood pressure (BP), a reconsideration of methods that could enhance surveillance and intervention in the ED is needed. In this article, we discuss the relevant epidemiology of asymptomatic HTN and present a novel approach using a modified version of the Haddon's matrix to systematically address the challenges that contribute to ineffective screening and suboptimal outcomes.