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Karpettas N, Nasothimiou E, Kollias A, Vazeou A, Stergiou GS. Ambulatory and home blood pressure monitoring in children and adolescents: diagnosis of hypertension and assessment of target-organ damage. Hypertens Res 2013; 36:285-92. [PMID: 23344131 DOI: 10.1038/hr.2012.220] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The prevalence of elevated blood pressure in children and adolescents is more common than previously believed and often represents the early onset of essential hypertension, particularly in adolescents. The definition of hypertension in children is based on distribution criteria and normalcy tables that provide blood pressure percentiles for each measurement method (office, ambulatory and home) according to the individual's age, gender and body size. Owing to the white coat and masked hypertension phenomena, ambulatory blood pressure monitoring is indispensable for the diagnosis of hypertension in children. Home blood pressure monitoring in children has been less well studied, and at present, treatment decisions should not be based solely on such measurements. Hypertension-induced preclinical target-organ damage (mainly echocardiographic left ventricular hypertrophy) is not uncommon in children and should be evaluated in all hypertensive children. Other indices of target-organ damage, such as carotid intima-media thickness, pulse wave velocity and microalbuminuria, remain under investigation in pediatric hypertension.
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Affiliation(s)
- Nikos Karpettas
- Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece
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Lu X, Shi P, Luo CY, Zhou YF, Yu HT, Guo CY, Wu F. Prevalence of hypertension in overweight and obese children from a large school-based population in Shanghai, China. BMC Public Health 2013; 13:24. [PMID: 23305064 PMCID: PMC3556073 DOI: 10.1186/1471-2458-13-24] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/07/2013] [Indexed: 01/26/2023] Open
Abstract
Background The ongoing rise in the prevalence of hypertension in children and adolescents is considered to be accompanied with the epidemic of childhood overweight and obesity. In this study, we established a large scale cross-sectional study in Shanghai, China, which presented a new evidence for the correlation of hypertension prevalence with overweight and obesity stages in Chinese children and adolescents. Methods A school-based cross-sectional study was conducted during February to December 2009 in Shanghai, China, including total 78,114 children and adolescents. Body weight, height, waist circumference (WC) and blood pressure (BP) were measured. Overweight and obesity were defined according to sex- and age- specific Chinese reference data. Results Both SBP and DBP were very significantly increased in overweight (OW) and obese (OB) groups. With age and sex controlled, BMI and WC were independently positively correlated with SBP and DBP. The prevalence of high SBP, DBP and hypertension were markedly higher among OW and OB children than normal weight (NW) group. Odds ratios (ORs) for high SBP, high DBP and high BP were significantly greater in OW and OB children than NW group, and showed a trend increase correlating with obesity stages (all P <0.0001). According to the increasing OR with different combination of obese status of BMI and WC, WC has a stronger influence on hypertension. The combination of BMI and WC obese shows substantially higher ORs compared with those for either BMI or WC obese alone. Conclusions In this study on a large school-based population in Shanghai, China, BMI and WC are positively correlated with SBP and DBP. Being overweight or obese greatly increased the risk of hypertension in Chinese children and adolescents, in which WC is considered as a more sensitive indicator than BMI.
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Affiliation(s)
- Xi Lu
- Shanghai Municipal Center for Disease Control and Prevention & Shanghai Institutes of Preventive Medicine, 1380 W, Zhongshan Road, Shanghai 200336, China.
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Cao ZQ, Zhu L, Zhang T, Wu L, Wang Y. Blood pressure and obesity among adolescents: a school-based population study in China. Am J Hypertens 2012; 25:576-82. [PMID: 22337208 DOI: 10.1038/ajh.2012.5] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is little information regarding the obesity epidemical situation and risk factors of childhood hypertension (HTN) in China. The present study aimed to determine the prevalence of HTN/prehypertension (PHTN), as well as the associated risk factors, among adolescents in Changsha city, China. METHODS A total of 88,974 adolescents from 49 middle schools in Changsha city between 12 and 17 years of age were examined during 2009. Body weight, height, and blood pressure (BP) were measured in all adolescents. HTN and PHTN were defined according to sex- and age-specific Chinese reference data. Overweight and obesity were also defined according to sex- and age-specific Chinese reference data. RESULTS It was determined that the prevalence of PHTN and HTN were 7.2 and 3.1%, respectively. Furthermore, 14.6% of male adolescents were overweight and 7.0% were obese, whereas 8.6% of female adolescents were overweight and 2.9% were obese. The risk ratio (RR) of HTN were significantly higher in overweight (RR: 2.8, 95% confidence interval (CI): 2.6-3.2) and obese (RR: 8.7, 95% CI: 8.1-9.5) adolescents adjusted for age, sex, and height. CONCLUSIONS Chinese reference data were used to evaluate BP and body mass index (BMI) of children and adolescents. Higher prevalence of HTN was associated with higher BMI percentiles. Being overweight or obese markedly increased the risk of both HTN and PHTN among adolescents between 12 and 17 years of age in Changsha city, China.
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Juhász M, Katona E, Settakis G, Paragh G, Molnár C, Fülesdi B, Páll D. Gender-related differences in adolescent hypertension and in target organ effects. J Womens Health (Larchmt) 2012; 19:759-65. [PMID: 20187749 DOI: 10.1089/jwh.2009.1407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess whether a gender difference exists in adolescent hypertension and its target organ damage and to compare potential confounding factors and target organ damage in hypertensive and normotensive adolescent girls. METHODS From the Debrecen Hypertension Study, the anthropometric, blood pressure, and laboratory data as well as intima-media thickness (IMT) and left ventricular mass index (LVMI) of 58 hypertensive boys, 56 hypertensive girls, and 30 normotensive girls were analyzed. RESULTS Both systolic and mean blood pressure values were higher in adolescent hypertensive boys than in girls. This difference was also present when comparing 24-hour average blood pressure values. Plasma concentrations of nitric oxide (NO) and endothelin-1 were not different in the two gender groups. IMT of the carotid arteries were similar in hypertensive boys and girls, but a significantly higher LVMI was detected in boys. A significant difference was detected in anthropometric data (height, weight, and body mass index [BMI]), plasma concentration of NO (lower levels in hypertensives), and IMT in hypertensive and normotensive girls (higher IMT in hypertensive girls). CONCLUSIONS There is a difference between the severity of hypertension between hypertensive adolescent girls and boys. Hypertensive girls differ from normotensive girls not only in blood pressure values but also in risk factors and subclinical target organ effects. Further studies are needed to explain the gender differences in adolescent hypertension. The potential role of sex hormones in hypertensive teenagers also needs to be clarified in future works.
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Affiliation(s)
- Mária Juhász
- 1st Department of Medicine, University of Debrecen , Health and Medical Science Center, Debrecen, Hungary
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Pall D, Kiss I, Katona E. Importance of ambulatory blood pressure monitoring in adolescent hypertension. Kidney Blood Press Res 2011; 35:129-34. [PMID: 22056843 DOI: 10.1159/000331057] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
There has been a steady increase in the prevalence of adolescent hypertension in recent years. In order to prevent target organ damages, it is important to determine the group of hypertensive adolescents. If repeatedly elevated blood pressure values are observed, with special emphasis on white coat hypertension, which is particularly frequent at this age, ambulatory blood pressure monitoring is highly recommended before pharmacological treatment is started. In addition, performing ambulatory blood pressure monitoring is recommended with target organ damage, resistance to therapy, and suspicion of secondary hypertension. The results of the widely available, simple-to-use device are easy to reproduce.
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Affiliation(s)
- Denes Pall
- First Department of Medicine, Medical and health Science Center, University of Debrecen, Debrecen, Hungary. pall.denes @ gmail.com
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Kollias A, Pantsiotou K, Karpettas N, Roussias L, Stergiou GS. Tracking of blood pressure from childhood to adolescence in a Greek cohort. Eur J Public Health 2011; 22:389-93. [PMID: 21705785 DOI: 10.1093/eurpub/ckr082] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Studies have reported tracking of blood pressure (BP) from childhood to adulthood but with inconsistent results mainly due to methodological and ethnic differences. We aimed to examine BP tracking during a 7-year period in a Greek cohort. METHODS This is a longitudinal school-based study conducted during 1990-96 in Athens, Greece. Children underwent BP and anthropometric measurements on two to three visits annually (averaged to annual values) for 7 years. RESULTS A total of 166 children with complete yearly follow-up data for the examined period were included (mean baseline age 9 ± 1.7 years, range: 5-12 years, 89 boys). At baseline, the prevalence of pre- and hypertension was 22.9 and 24.1% respectively and at the end of the follow-up 24.1% (P = NS vs. baseline) and 13.3% (P = 0.02 vs. baseline) respectively. Systolic/diastolic BP tracking correlation coefficients between 1990 and 1996 were 0.38 (P < 0.001)/0.20 (P = 0.06) for boys and 0.30 (P = 0.007)/0.22 (P = 0.06) for girls. Among children with baseline BP ≥90th centile (systolic and/or diastolic), 44% remained in the same BP range after 7 years. In stepwise multiple regression analysis, baseline systolic BP, male gender, baseline body mass index (BMI) and change in BMI from baseline to the end of the follow-up (ΔBMI) were significant predictors of systolic BP levels at the end of the follow-up. Baseline diastolic BP, baseline BMI and ΔBMI were significant predictors of diastolic BP at the end of the follow-up. CONCLUSIONS These data suggest that the risk of developing high BP during adolescence can be predicted by BP and BMI at childhood.
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Affiliation(s)
- Anastasios Kollias
- Hypertension Centre, Third University Department of Medicine, Sotiria Hospital, Athens, Greece
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Lengyel S, Katona É, Zatik J, Molnár C, Paragh G, Fülesdi B, Páll D. The impact of serum homocysteine on intima-media thickness in normotensive, white-coat and sustained hypertensive adolescents. Blood Press 2011; 21:39-44. [DOI: 10.3109/08037051.2011.575577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Katona E, Zrínyi M, Komonyi E, Lengyel S, Paragh G, Zatik J, Fülesdi B, Páll D. Factors influencing adolescent blood pressure: the Debrecen Hypertension Study. Kidney Blood Press Res 2011; 34:188-95. [PMID: 21502767 DOI: 10.1159/000326115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 02/17/2011] [Indexed: 01/15/2023] Open
Abstract
AIM To obtain epidemiological data on the blood pressure (BP) status of high school students and factors influencing BP. METHODS Subjects filled out a questionnaire and three repeated BP measurements were taken. All high school attending students in Debrecen (final sample n = 10,194, mean age 16.6 ± 1.0 years) participated in the study. RESULTS Boys had significantly higher systolic BP (+11.3 mm Hg) and diastolic BP (+2.2 mm Hg) than girls (p < 0.001). There was a positive correlation between weight and BP (r(syst) = 0.42, r(diast) = 0.29), height and BP (r(syst) = 0.33, r(diast) = 0.15), body mass index (BMI) and BP (r(syst) = 0.31, r(diast) = 0.27). Multiple regression was used for statistical analysis. Gender (β = 0.36), BMI (β = 0.25), hypertension of parents (father β = 0.04 and mother β = 0.02), smoking, alcohol consumption and age determined systolic outcomes in descending order. For the diastolic model, BMI remained a strong determining factor (β = 0.25) and gender was also significant (β = -0.09). Entering independents together accounted for 28.2% of the total variance in systolic and for 18.1% in diastolic BP. CONCLUSION Body weight is central to determining BP. Because that is an alterable cardiovascular risk factor, we presume that lifestyle modification will not only result in reduced weight, but also in decreased BP.
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Affiliation(s)
- Eva Katona
- 1st Department of Medicine, Medical and Health Center, University of Debrecen, Nagyerdei krt. 98, Debrecen, Hungary
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Karpettas N, Kollias A, Vazeou A, Stergiou GS. Office, ambulatory and home blood pressure measurement in children and adolescents. Expert Rev Cardiovasc Ther 2011; 8:1567-78. [PMID: 21090932 DOI: 10.1586/erc.10.148] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There is an increasing interest in pediatric hypertension, the prevalence of which is rising in parallel with the obesity epidemic. Traditionally the assessment of hypertension in children has relied on office blood pressure (BP) measurements by the physician. However, as in adults, office BP might be misleading in children mainly due to the white coat and masked hypertension phenomena. Thus, out-of-office BP assessment, using ambulatory or home monitoring, has gained ground for the accurate diagnosis of hypertension and decision-making. Ambulatory monitoring is regarded as indispensable for the evaluation of pediatric hypertension. Preliminary data support the usefulness of home monitoring, yet more evidence is needed. Office, ambulatory and home BP normalcy tables providing thresholds for diagnosis have been published and should be used for the assessment of elevated BP in children.
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Affiliation(s)
- Nikos Karpettas
- Hypertension Center, Third University Department of Medicine, Sotiria Hospital, 152 Mesogion Avenue, Athens 11527, Greece
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Katona É, Zrínyi M, Lengyel S, Komonyi É, Paragh G, Zatik J, Nagy G, Fülesdi B, Páll D. The prevalence of adolescent hypertension in Hungary – The Debrecen Hypertension Study. Blood Press 2010; 20:134-9. [DOI: 10.3109/08037051.2010.538987] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Páll D, Juhász M, Lengyel S, Molnár C, Paragh G, Fülesdi B, Katona É. Assessment of target-organ damage in adolescent white-coat and sustained hypertensives. J Hypertens 2010; 28:2139-44. [DOI: 10.1097/hjh.0b013e32833cd2da] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Páll D, Lengyel S, Komonyi É, Molnár C, Paragh G, Fülesdi B, Katona É. Impaired cerebral vasoreactivity in white coat hypertensive adolescents. Eur J Neurol 2010; 18:584-9. [DOI: 10.1111/j.1468-1331.2010.03209.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baráth A, Boda K, Tichy M, Károly E, Túri S. International comparison of blood pressure and BMI values in schoolchildren aged 11-16 years. Acta Paediatr 2010; 99:251-5. [PMID: 19839956 DOI: 10.1111/j.1651-2227.2009.01541.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS This study comprised part of a larger cross-sectional survey performed in Hungary in the period 2005-2006, which was designed first to reveal the representative age-, gender- and height-specific percentile values for the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) in Hungarian children aged 11-16 years. The second aim was to determine the prevalence of overweight and obesity. METHODS Analyses were performed on 14,290 Hungarian children aged 11-16 years. All blood pressure (BP) measurements were made with a validated, automated, digital device. The criteria recommended by international guidelines were used. RESULTS The prevalence of overweight and obesity among the Hungarian children was found to be 23.4% (3347 adolescents; International Obesity Task Force criteria). Previous studies have reported that the strongest correlation is observed between the BP values and weight, and our results are in accordance with this. CONCLUSIONS Regional differences in morphometry (different prevalences of overweight and obesity) and the genetic background, disparate eating habits and other cultural factors may account for the differences in BP levels during childhood. As the prevalence of overweight and obesity is increasing worldwide, it is important that countries carefully monitor the weight and BP status of their children and adolescents.
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Affiliation(s)
- A Baráth
- Department of Paediatrics, Albert Szent-Györgyi Medical and Pharmaceutical Centre, University of Szeged, Szeged, Hungary.
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Páll D, Juhász M, Katona E, Lengyel S, Komonyi E, Fülesdi B, Paragh G. [Importance of ambulatory blood pressure monitoring in adolescent hypertension]. Orv Hetil 2009; 150:2211-7. [PMID: 19939781 DOI: 10.1556/oh.2009.28732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The prevalence of adolescent hypertension is increasing. The national epidemiological study found 2.5% prevalence, while it is 4.5% according to the newest international survey. Repeated casual blood pressure measurements, but not ambulatory blood pressure monitoring is needed for the diagnosis of adolescent hypertension on the basis of the presently available European guideline. At the last decade growing evidence came into light for ambulatory blood pressure monitoring in adolescence. These data show better correlation with end-organ damages than casual measurements. In patients with hypertension diagnosed based on repeated casual blood pressure measurements, 24-hour monitoring showed normal blood pressure in 21-47%, so this is the rate of white coat hypertension. Masked hypertension can also be diagnosed with the help of this method, which has a prevalence of 7-11%. We can also get useful data for secondary forms of hypertension. Until the appearance of the new European guidelines, more frequent use of ambulatory blood pressure monitoring is affordable. The confirmation of the diagnosis based on elevated casual blood pressure data is important. Ambulatory blood pressure monitoring is suggested in cases suspicious for white coat or masked hypertension, in cases of target organ damages or therapy resistant hypertension. Before administration of pharmaceutical therapy in adolescence hypertension - according to author's opinion - ambulatory blood pressure monitoring is absolutely necessary.
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Affiliation(s)
- Dénes Páll
- Debreceni Egyetem, Altalános Orvostudományi Kar, Orvos- és Egészségtudományi Centrum, I. Belgyógyászati Klinika, Debrecen.
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Koshy SM, Garcia-Garcia G, Pamplona JS, Renoirte-Lopez K, Perez-Cortes G, Gutierrez MLS, Hemmelgarn B, Lloyd A, Tonelli M. Screening for kidney disease in children on World Kidney Day in Jalisco, Mexico. Pediatr Nephrol 2009; 24:1219-25. [PMID: 19271247 DOI: 10.1007/s00467-009-1136-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 12/12/2008] [Accepted: 01/12/2009] [Indexed: 12/25/2022]
Abstract
World Kidney Day (WKD) is intended to raise awareness and increase detection of chronic kidney disease (CKD), but most emphasis is placed on adults rather than children. We examined yield of screening for CKD and hypertension among poor children in Mexico. On WKD (2006, 2007), children (age < 18 years) without known CKD were invited to participate at two screening stations. We measured body mass index (BMI), blood pressure, and serum creatinine, and performed dipstick urinalysis. The Schwartz equation was used to estimate glomerular filtration rate (GFR; reduced GFR defined as < 60 ml/min per 1.73 m(2)). Proteinuria and hematuria were defined by a reading of >or= 1+ protein or blood on dipstick. Hypertension was defined by gender, age, and height-specific norms. In total, 240 children were screened (mean age 8.9 +/- 4.1 years; 44.2% male). Proteinuria and hematuria were detected in 38 (16.1%) and 41 (17.5%), respectively; 15% had BMI > 95th percentile for age. Reduced GFR was detected in four (1.7%) individuals. Systolic hypertension was more prevalent in younger children (age 0-8 years, 19.6%; age 9-13 years, 7.1%; age 14-17 years, 5.3%) suggesting a possible white-coat effect. Hematuria, proteinuria, hypertension and obesity were frequently detected among children in a community based screening program in Mexico. This form of screening might be useful in identifying children with CKD and hypertension in developing nations.
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Túri S, Baráth Á, Boda K, Tichy M, Károly É. Blood Pressure Reference Tables for Hungarian Adolescents Aged 11–16 Years. Kidney Blood Press Res 2008; 31:63-9. [DOI: 10.1159/000115519] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 12/21/2007] [Indexed: 11/19/2022] Open
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Stabouli S, Kotsis V, Zakopoulos N. Ambulatory blood pressure monitoring and target organ damage in pediatrics. J Hypertens 2008; 25:1979-86. [PMID: 17885534 DOI: 10.1097/hjh.0b013e3282775992] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The prevalence of hypertension in children and adolescents is rising in association with the increasing rate of childhood obesity, and it is associated with early target organ damage. Published guidelines on high blood pressure in children and adolescents, focused on the early and accurate diagnosis of hypertension, resulted in improved ability to identify children with hypertension. Although auscultation using a mercury sphygmomanometer remains the method of choice for evaluation of hypertension in children, accumulating evidence suggests that ambulatory blood pressure monitoring is a more accurate method for diagnosis, and it is more closely associated with target organ damage. In addition, ambulatory blood pressure monitoring is a valuable tool in the assessment of white-coat hypertension, and masked hypertension in children and adolescents. Masked hypertension in children and adolescents is associated with a similar risk of target organ damage as in established hypertension.
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Affiliation(s)
- Stella Stabouli
- Second Department of Pediatrics, 'P. and A. Kyriakou' Children's Hospital, Greece.
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Falkner B. Management of Hypertension in Children and Adolescents. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50046-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Falkner B. Hypertension in Children and Adolescents. Hypertension 2007. [DOI: 10.1016/b978-1-4160-3053-9.50043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Settakis G, Páll D, Molnár C, Katona E, Bereczki D, Fülesdi B. Hyperventilation-induced cerebrovascular reactivity among hypertensive and healthy adolescents. Kidney Blood Press Res 2006; 29:306-11. [PMID: 17106208 DOI: 10.1159/000097018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Accepted: 09/14/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is known that cerebral vasoreactivity is altered in adult arterial hypertension but no information is available about cerebral arteriolar function in hypertensive adolescents. Therefore, the aim of the present work was to assess cerebral vasoreactivity responses in adolescent hypertension. METHODS 113 hypertensive and 58 normotensive adolescents were assessed with transcranial Doppler sonography by using voluntary hyperventilation (HV) as vasoconstrictory stimulus. Absolute blood flow velocities (systolic, mean and diastolic) and pulsatility indices (PIs) at rest and after HV, as well as percentage change of the blood flow velocities after HV were compared among the groups. RESULTS Blood flow velocities at rest were significantly higher in hypertensive individuals, while PIs were similar in the two groups. After HV, all blood flow velocity parameters were higher among hypertensive teenagers than in healthy controls, while PIs did not differ between the two groups. Taking the relative changes after HV into account, it was found that HV induced a more pronounced change of the systolic and mean blood flow velocities of the control subjects than in hypertensive adolescents. CONCLUSIONS Cerebrovascular reactivity to hypocapnia is decreased in hypertensive adolescents as compared to healthy teenagers. Further studies are needed to clarify the clinical significance of altered cerebral microvascular function in adolescent hypertension.
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Affiliation(s)
- Georgios Settakis
- Department of Neurology, University of Debrecen, Health and Medical Science Center, Debrecen, Hungary
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Katona E, Settakis G, Varga Z, Juhász M, Paragh G, Bereczki D, Fulesdi B, Páll D. Both Nitric Oxide and Endothelin-1 Influence Cerebral Blood Flow Velocity at Rest and after Hyper- and Hypocapnic Stimuli in Hypertensive and Healthy Adolescents. Kidney Blood Press Res 2006; 29:152-8. [PMID: 16931893 DOI: 10.1159/000095348] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2005] [Accepted: 07/04/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Nitric oxide (NO)/endothelin imbalance may play a role in the regulation of cerebral blood flow. The aim of the present study was to assess whether these endothelial factors influence middle cerebral artery blood flow velocities (MCAV) and cerebrovascular reactivity (CVR) in healthy and hypertensive adolescents. SUBJECTS AND METHODS 106 adolescents (61 hypertensive and 45 normotensive) underwent transcranial Doppler measurements of the middle cerebral artery at rest and after 30 s of breath-holding (BH) and 60 s of hyperventilation (HV). Additionally, NO and endothelin-1 (ET-1) concentrations of the serum were assessed. The correlation between NO and ET-1 levels as well as MCAV and CVR values was analyzed. RESULTS Resting MCAVs were higher among hypertensive teenagers (76.5 +/- 24 vs. 62.8 +/- 15.6 cm/s, respectively, p < 0.001). CVR values did not differ between hypertensive and healthy adolescents after the BH and HV procedure. A significant negative correlation was found between absolute MCAV values and NO concentrations. ET-1 was positively related to MCAV. CONCLUSIONS Cerebral blood flow velocities, but not CVR values, are associated with serum NO and ET-1 concentrations in adolescents.
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Affiliation(s)
- Eva Katona
- First Department of Medicine, Health and Medical Centre, University of Debrecen, Debrecen, Hungary
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Chen LJ, Fox KR, Haase A, Wang JM. Obesity, fitness and health in Taiwanese children and adolescents. Eur J Clin Nutr 2006; 60:1367-75. [PMID: 16775581 DOI: 10.1038/sj.ejcn.1602466] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the prevalence of childhood and adolescent obesity in Taiwan and investigate the association between excess weight and physical fitness and blood pressure. DESIGN Cross-sectional study. SUBJECTS A total of 13 935 children and adolescents aged 6-18 years (boys: 7031, girls: 6904) were involved in the 1999 survey and 24 586 (boys: 12 367, girls: 12 219) were available in the 2001 survey. MEASUREMENTS Weight, height, systolic and diastolic blood pressures, and health-related fitness tests (bent-leg curl-ups, sit-and-reach test and step test) were measured. RESULTS The overall prevalence of obesity (including overweight) in boys was 19.8% in 1999 and 26.8% in 2001. It was lower in girls with 15.2% in 1999 and 16.5% in 2001. The normal weight group performed better (P<0.05) than the overweight/obese group in all fitness tests except in the 2001 sit-and-reach test where there were no differences between the two groups. The risk of hypertension increased nearly two times for the overweight/obese-fit group and nearly three times for the overweight/obese-unfit group compared to the normal weight-fit group (adjusted odds ratio (AOR)=1.93, 95%CI=1.514-2.451 and AOR=2.93, 95%CI=2.493-3.454, respectively). CONCLUSION Overall, the findings demonstrated that there is an increasing trend in overweight/obesity prevalence for Taiwanese youth even in a 2-year period. The overweight/obese youngsters tend to have poorer muscular strength and cardiovascular endurance than the normal weight group. The overweight/obese and unfit group had a greater risk of hypertension than other groups. However, this risk was significantly lower if obese/overweight children had a higher than average level of cardiovascular fitness.
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Affiliation(s)
- L J Chen
- Department of Exercise and Health Sciences, Centre for Sport, Exercise and Health, University of Bristol, Tyndall Avenue, Bristol BS8 1TP, UK
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Katona E, Settakis G, Varga Z, Paragh G, Bereczki D, Fülesdi B, Páll D. Target-organ damage in adolescent hypertension. Analysis of potential influencing factors, especially nitric oxide and endothelin-1. J Neurol Sci 2006; 247:138-43. [PMID: 16737713 DOI: 10.1016/j.jns.2006.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Revised: 04/06/2006] [Accepted: 04/10/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE To assess the role of the nitric oxide-endothelin imbalance in the development of target-organ damages (carotid intima-media thickness and left ventricular mass index) in adolescent hypertension. METHODS 125 adolescents--67 hypertensive and 58 normotensive--underwent routine anthropology (height, weight) and blood pressure measurements, and laboratory (glucose, cholesterol and triglyceride levels) testing as well as sampling blood for determination of the plasma concentrations of nitric oxide (NOx) and endothelin-1 (ET-1), followed by measurement of the carotid intima-media thickness (IMT) and left ventricular mass index (LVMI). RESULTS Plasma concentration of NOx was significantly lower (27.7+/-13.7 vs. 35.8+/-7.0 micromol/l, respectively, p<0.001) and ET-1 was higher (3.11+/-3.9 vs. 1.09+/-1.07 fmol/ml, respectively, p<0.001) in hypertensive adolescents than that of controls. NOx negatively, endothelin positively correlated with blood pressure values, especially with systolic BP. An inverse relationship has been found between NOx and ET-1 concentrations (r=-0.29, p<0.003). In this adolescent population body weight, systolic blood pressure and plasma ET-1 were the most important factors influencing IMT, whereas LVMI correlated with height and weight and systolic BP of the teenagers. CONCLUSIONS NO/endothelin imbalance seems to play a role in the development of hypertension and target-organ damages in adolescence. Further studies are encouraged in order to clarify the pathophysiological role of NO/endothelin imbalance in adolescent hypertension.
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Affiliation(s)
- Eva Katona
- First Department of Medicine, University of Debrecen, Medical and Health Science Centre, Hungary
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Pileggi C, Carbone V, Nobile CGA, Pavia M. Blood pressure and related cardiovascular disease risk factors in 6-18 year-old students in Italy. J Paediatr Child Health 2005; 41:347-52. [PMID: 16014139 DOI: 10.1111/j.1440-1754.2005.00629.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aims of this study were to provide data on blood pressure (BP) levels, to measure prevalence of high-normal or high BP and to identify a set of conditions that may predict high BP (HBP) in a population of children and adolescents in Italy. METHODS A random sample of students 6-18 years old attending randomly selected schools in Catanzaro, Italy, was recruited. All students completed a questionnaire on their health and on health behaviours, such as physical activity, diet, drinking and smoking. Blood pressure, heart rate, height, weight and body mass index (BMI) were recorded. RESULTS Of the 603 subjects examined, 12.8% had high-normal BP, 3.5% hypertension (HTN) and 11.1% were obese. High-normal or high diastolic BP (DBP) was significantly more likely in older subjects with a higher BMI, in those with a smoker mother and in preterm children, whereas high-normal or high systolic BP (SBP) was significantly more likely to be found in older subjects with a higher BMI and in those who had at least one parent with HTN. High-normal or high DBP or SBP were significantly predicted by BMI and age. CONCLUSIONS Interventions should focus at reducing obesity and encouraging proper dietary habits, sufficient exercise and cessation of smoking habit in parents too, especially in children with a family history of HTN.
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Affiliation(s)
- Claudia Pileggi
- Medical School, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Lijnen PJ, Petrov VV, Diaz-Araya G, Fagard RH. Reversal of Angiotensin II-Stimulated Collagen Gel Contraction in Cardiac Fibroblasts by Aminopeptidase Inhibition. J Cardiovasc Pharmacol 2005; 45:68-73. [PMID: 15613982 DOI: 10.1097/00005344-200501000-00012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The purpose of this investigation was to determine whether aminopeptidase inhibition could affect the angiotensin II-stimulated collagen gel contraction in basal (control) and TGF-beta1-treated cardiac fibroblasts (or myofibroblasts). The tested aminopeptidase inhibitors were the broad range aminopeptidase inhibitor bestatin, the specific inhibitor of alanine aminopeptidase leuhistin, and the specific inhibitor of arginine aminopeptidase arphamenine A. Cardiac fibroblasts (from normal male adult rats) from passage 2 were cultured to confluency and incubated with(out) 400 pmol/L TGF-beta1 in Dulbecco Modified Eagle Medium (DMEM) with 10% fetal bovine serum (FBS). These fibroblasts were then further incubated in a floating collagen gel lattice with the tested products (angiotensin II, bestatin, leuhistin, or arphamenine A) for 3 days in DMEM without FBS. The contraction of the collagen gel lattice by cardiac fibroblasts was determined by measuring the gel volume with tritiated water. Aminopeptidase activity was estimated by spectrophotometric determination of the liberation of p-nitroaniline from alanine- or arginine-p-nitroanilide. Angiotensin II (100 nmol/L) reduced the gel volume in control and TGF-beta1-treated cardiac fibroblasts. The angiotensin II-stimulated collagen gel contraction in control and TGF-beta1-treated fibroblasts was almost completely reversed by leuhistin and arphamenine A (100 micromol/L). Bestatin (100 micromol/L) only partially inhibited the angiotensin II-stimulated collagen gel contraction in control fibroblasts, although it did not affect the angiotensin II-induced contraction in TGF-beta1-treated fibroblasts. In control and TGF-beta1-treated cardiac fibroblasts, 100 micromol/L leuhistin or arphamenine A only partially inhibited alanine aminopeptidase activity, whereas bestatin (100 micromol/L) completely inhibited the alanine aminopeptidase activity. Arginine aminopeptidase activity was only partially inhibited by leuhistin and arphamenine A at 100 micromol/L in control and TGF-beta1-treated fibroblasts. Bestatin, however, completely blocked the arginine aminopeptidase activity in control fibroblasts and only partially in TGF-beta1-treated fibroblasts at 100 micromol/L. Our data suggest that both alanine and arginine aminopeptidases are involved in the reversal of the angiotensin II-stimulated collagen gel contraction in control and TGF-beta1-treated cardiac fibroblasts or myofibroblasts.
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Affiliation(s)
- Paul J Lijnen
- Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, Katholieke Universiteit Leuven, Leuven, Belgium.
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Falkner B. Hypertension in Children. Hypertension 2005. [DOI: 10.1016/b978-0-7216-0258-5.50148-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Utilidad de la fórmula de Somu en el diagnóstico de hipertensión arterial en niños y adolescentes españoles. Med Clin (Barc) 2003. [DOI: 10.1016/s0025-7753(03)74095-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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