The prevalence of primary pediatric prehypertension and hypertension in a real-world managed care system

Exome sequencing implicates ancestry-related Mendelian variation at SYNE1 in childhood-onset essential hypertension

Childhood-onset essential hypertension (COEH) is an uncommon form of hypertension that manifests in childhood or adolescence and, in the United States, disproportionately affects children of African ancestry. The etiology of COEH is unknown, but its childhood onset, low prevalence, high heritability, and skewed ancestral demography suggest the potential to identify rare genetic variation segregating in a Mendelian manner among affected individuals and thereby implicate genes important to disease pathogenesis. However, no COEH genes have been reported to date. Here, we identify recessive segregation of rare and putatively damaging missense variation in the spectrin domain of spectrin repeat containing nuclear envelope protein 1 (SYNE1), a cardiovascular candidate gene, in 3 of 16 families with early-onset COEH without an antecedent family history. By leveraging exome sequence data from an additional 48 COEH families, 1,700 in-house trios, and publicly available data sets, we demonstrate that compound heterozygous SYNE1 variation in these COEH individuals occurred more often than expected by chance and that this class of biallelic rare variation was significantly enriched among individuals of African genetic ancestry. Using in vitro shRNA knockdown of SYNE1, we show that reduced SYNE1 expression resulted in a substantial decrease in the elasticity of smooth muscle vascular cells that could be rescued by pharmacological inhibition of the downstream RhoA/Rho-associated protein kinase pathway. These results provide insights into the molecular genetics and underlying pathophysiology of COEH and suggest a role for precision therapeutics in the future.

Adapting a clinical decision support system to improve identification of pediatric hypertension in a rural health system: Design of a pragmatic trial

BACKGROUND

Identifying hypertension (HTN) early is crucial in preventing and lowering the long-term risk of heart disease, yet HTN in children often goes undiagnosed. An electronic health record linked, web-based clinical decision support (CDS) called PedsBP can help address this care gap and has been previously shown to increase recognition of HTN by primary care clinicians.

OBJECTIVES

To adapt the PedsBP tool for use in a mostly rural health system and then to evaluate the effectiveness of PedsBP for repeat of hypertensive level blood pressure (BP) measurements and HTN recognition among youth 6-17 years of age in primary care settings, comparing low-intensity and high-intensity implementation approaches.

METHODS AND DESIGN

PedsBP was evaluated through a pragmatic, clinic-randomized trial. The tool was piloted in 2 primary care clinics and modified prior to the full trial. Forty community-based, primary care clinics (or clusters of clinics) were randomly allocated in a 1:1:1 ratio to usual care, low-intensity implementation (CDS only), or high-intensity implementation (CDS plus in-person training, monthly use reports, and ongoing communication between study staff and clinics). Accrual of eligible patients started on August 1, 2022 and will continue for 18 months. Primary outcomes include repeating hypertensive level BP measurements at office visits and clinical recognition of HTN. Secondary outcomes include lifestyle counseling, dietician referral, and BP at follow-up.

CONCLUSION

This report focuses on the design and feasibility of adapting and implementing PedsBP in a rural primary care setting. The trial and analysis are ongoing with main results expected in mid-2024.

Guideline-Adherent Hypertension in Children and Adolescents: A Multi-Institutional Database Analysis from Taiwan

BACKGROUND/AIMS

Childhood-onset hypertension is associated with cardiovascular morbidity and adult mortality. This study aimed to assess guideline-adherent hypertension among Taiwanese youth and the agreement on hypertension between the 2017 American Academy of Pediatrics guidelines and the 2004 Fourth Report.

METHODS

In this cross-sectional study, we collected outpatient blood pressure (OBP) measurements obtained during routine care visits from a large healthcare delivery system between 2009 and 2018 to evaluate the rate of guideline-adherent hypertension and assess patient-related factors of pediatric hypertension.

RESULTS

In total, 12,469 children and adolescents who underwent three separate ≥3 OBP measurements over 33,369 person-years with a total of 95,608 BP measurements in an outpatient setting were analyzed. According to the 2017 American Academy of Pediatrics (AAP) guidelines, the rate of pediatric hypertension in the study setting, which included participants aged 1 to 17 years, ranged from 0.78 to 5.95 per 1000 persons. Although there was perfect agreement between the thresholds of the two guidelines for defining hypertension in the age groups of 1-7, 8-12, and 13-17 years (all κ statistic ≥ 0.85), the use of the AAP threshold classified more adolescents as having hypertension. Children and adolescents with hypertension often had complex chronic diseases and required substantial healthcare services in outpatient, emergency, and inpatient settings.

CONCLUSIONS

The present study provides evidence of guideline-adherent pediatric hypertension and highlights the importance of regularly monitoring blood pressure to identify and manage hypertension in children and adolescents. Further research is required to determine the impact of new thresholds on the detection of target organ damage at a pediatric age.

High blood pressure in children and adolescents: current perspectives and strategies to improve future kidney and cardiovascular health

Hypertension is one of the most common causes of preventable death worldwide. The prevalence of pediatric hypertension has increased significantly in recent decades. The cause of this is likely multifactorial, related to increasing childhood obesity, high dietary sodium intake, sedentary lifestyles, perinatal factors, familial aggregation, socioeconomic factors, and ethnic blood pressure (BP) differences. Pediatric hypertension represents a major public health threat. Uncontrolled pediatric hypertension is associated with subclinical cardiovascular disease and adult-onset hypertension. In children with chronic kidney disease (CKD), hypertension is also a strong risk factor for progression to kidney failure. Despite these risks, current rates of pediatric BP screening, hypertension detection, treatment, and control remain suboptimal. Contributing to these shortcomings are the challenges of accurately measuring pediatric BP, limited access to validated pediatric equipment and hypertension specialists, complex interpretation of pediatric BP measurements, problematic normative BP data, and conflicting society guidelines for pediatric hypertension. To date, limited pediatric hypertension research has been conducted to help address these challenges. However, there are several promising signs in the field of pediatric hypertension. There is greater attention being drawn on the cardiovascular risks of pediatric hypertension, more emphasis on the need for childhood BP screening and management, new public health initiatives being implemented, and increasing research interest and funding. This article summarizes what is currently known about pediatric hypertension, the existing knowledge-practice gaps, and ongoing research aimed at improving future kidney and cardiovascular health.

Hypertension in adolescents: The role of obesity and family history

We evaluated the combined effect of obesity and family history (FH) on the risk of hypertension in adolescents. We studied 1288 school‐aged adolescents aged 16.0 ± 0.5 years (49.0% males) attending the medical examination for enrollment in the city of Nanning, China. Their blood pressure, weight, and height were measured. A questionnaire was administered to both adolescents and their parents to obtain information on the participants’ medical history. Multiple logistic regression analysis, according to bodyweight categories and adjusted for age, gender, and body mass index (BMI), was done to determine the association of FH with hypertension. Hypertension was found in 14.1% of adolescents. The prevalence of hypertension was significantly higher in adolescents with obesity and positive FH than their normal weight and negative FH counterparts. For adolescents with normal weight and waist circumstance (WC), those with a positive FH in parents compared to those without had an significantly increased risk for hypertension (odds ratio [OR], 2.15; 95% confidence interval [CI] 1.28–3.61, and 1.96; 95% CI 1.16–3.32, respectively). These findings were adjusted for age, gender, and BMI. Our study showed that routine screening for pediatric hypertension should be performed in adolescents who are overweight and obese. Furthermore, parental FH of hypertension played an important role in predicting the hypertension phenotype among adolescents with normal weight.

Prevalence of Hypertension and Prehypertension in Iranian Children

Background: Hypertension (HTN) is a significant public health problem worldwide. Early diagnosis of HTN and its related risk factors has been considered as one of the main requirements of general healthcare in children. Objectives: This study aimed to examine the nomograms of normal systolic and diastolic blood pressure (BP) and the prevalence of asymptomatic HTN and pre-HTN in a population of school-aged children. Methods: Systolic and diastolic BP, height, and weight were measured in 5811 healthy school-aged children (2904 males and 2907 females) during healthcare visits. HTN was defined as systolic or diastolic BP ≥ 95th percentile for age, gender, and height of the screened population on ≥ 3 occasions. Pre-HTN was considered as systolic or diastolic BP between 90 - 95 percentile. Results: HTN and pre-HTN were detected in 8.4% and 7.8% of the children, respectively. The prevalence of HTN was 8.6% among the males and 8.2% among the females. Systolic HTN and pre-HTN were detected in 5.8 and 6.4% of the cases compared to diastolic HTN and pre-HTN observed in 5.9 and 6.1% of the participants, respectively. In addition, HTN was detected in 27.9% of children with obesity. Conclusions: According to the high incidence of asymptomatic HTN and pre-HTN in asymptomatic children, it is recommended to perform routine BP measurement during medical care visits of all healthy school children and to prevent and treat obesity in childhood.

Persistent Hypertension in Children and Adolescents: A 6-Year Cohort Study

OBJECTIVES

To determine the natural history of pediatric hypertension.

METHODS

We conducted a 72-month retrospective cohort study among 165 primary care sites. Blood pressure measurements from two consecutive 36 month periods were compared.

RESULTS

Among 398 079 primary care pediatric patients ages 3 to 18, 89 347 had ≥3 blood pressure levels recorded during a 36-month period, and 43 825 children had ≥3 blood pressure levels for 2 consecutive 36-month periods. Among these 43 825 children, 4.3% (1881) met criteria for hypertension (3.5% [1515] stage 1, 0.8% [366] stage 2) and 4.9% (2144) met criteria for elevated blood pressure in the first 36 months. During the second 36 months, 50% (933) of hypertensive patients had no abnormal blood pressure levels, 22% (406) had elevated blood pressure levels or <3 hypertensive blood pressure levels, and 29% (542) had ≥3 hypertensive blood pressure levels. Of 2144 patients with elevated blood pressure in the first 36 months, 70% (1492) had no abnormal blood pressure levels, 18% (378) had persistent elevated blood pressure levels, and 13% (274) developed hypertension in the second 36-months. Among the 7775 patients with abnormal blood pressure levels in the first 36-months, only 52% (4025) had ≥3 blood pressure levels recorded during the second 36-months.

CONCLUSIONS

In a primary care cohort, most children initially meeting criteria for hypertension or elevated blood pressure had subsequent normal blood pressure levels or did not receive recommended follow-up measurements. These results highlight the need for more nuanced initial blood pressure assessment and systems to promote follow-up of abnormal results.

School-Based Exercise Intervention Improves Blood Pressure and Parameters of Arterial Stiffness in Children: A Randomized Controlled Trial

PURPOSE

To evaluate the effectiveness of a school-based exercise intervention on endurance performance (EP), blood pressure (BP), and arterial stiffness in children.

METHODS

A total of 105 students (mean age = 8.2 [0.6] y; 51% girls; body mass index = 17.8 [3.0] kg/m2) were randomized to the intervention group (IG, n = 51) and control group (CG, n = 54). During a 37-week experimental period, the IG received an exercise intervention (2 × 45 min/wk) in addition to their regular school physical education class (3 × 45 min/wk). EP, peripheral and central BP, pulse pressure, augmentation pressure, augmentation index, and aortic pulse wave velocity were assessed.

RESULTS

Following the intervention, significant changes (P < .05) in EP, peripheral and central systolic BP, pulse pressure, augmentation pressure, augmentation index, and aortic pulse wave velocity were found in the IG. Children in the CG displayed significant changes in peripheral and central diastolic BP. An analysis of the baseline-to-post changes revealed significant between-group differences in EP (P < .001), pulse pressure (P = .028), augmentation pressure (P = .007), and aortic pulse wave velocity (P = .037) that favored the IG and in peripheral and central diastolic BP that favored the CG.

CONCLUSION

The school-based exercise intervention had beneficial effects not only on EP but also on different hemodynamic parameters.

Prevalence of Hypertension and Associated Factors among the Outpatient Department in Akaki Kality Subcity Health Centers, Addis Ababa, Ethiopia

Background

Fatalities from hypertension in East Africa are increasing, even though they decreased in western industrial regions. Older age, being female, illiterate, smoking, physical inactivity, and high waist circumferences are major risk factors for the development of hypertension. The prevalence of hypertension among Federal Ministry Civil servants in Addis Ababa, Ethiopia, has found to be high; which is an indication for institution-based hypertension-screening programs.

Objective

Prevalence of hypertension and associated factors among the outpatient department in Akaki Kality Subcity Health Centers, Addis Ababa, Ethiopia. Methodology. Facility-based cross-sectional study was carried out on systematically sampled 401 out-department patients whose age was greater than or equal to 18 years in four government health centers in Addis Ababa. Data collection took place from March 10, 2018, to April 06 2018. Binary logistic regression analysis was carried out to identify predictors of hypertension.

Results

Patients had a mean age of 41.17 years (95% CI: 39.77–42.57). The prevalence of hypertension was 14% (95% CI: 13.653–14.347), and 30 (53.57%) were males. Alcohol drinkers were 11.844 times more likely to be hypertensive as compared to non-alcohol drinkers (AOR = 11.844, 95% CI: 3.596–39.014). Cigarette smokers were 16.511 times more likely to be hypertensive as compared to non-cigarette smokers (AOR = 16.511, 95% CI: 4.775–57.084). Khat chewers were 6.964 times more likely to be hypertensive as compared to non-khat chewers (AOR = 6.964, 95% CI: 1.773–26.889).

Conclusion

The prevalence of patients with hypertension was 14%. Alcohol drinking, cigarette smoking, khat chewing, body mass index ≥25 kg/m², and age ≥44 years old are major determinants identified by this study. Hence, appropriate management of patients focusing on the relevant associated factors would be of great benefit in controlling hypertension.

Hemodynamics in young athletes following high-intensity interval or moderate-intensity continuous training

BACKGROUND

The present study aimed to investigate the effects of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) on blood pressure (BP) and parameters of arterial stiffness in young athletes.

METHODS

Seventeen rowers (aged 15±1.3 years) were randomized into an intervention group (IG, N.=10) and the control group (CG, N.=7). During an 8-week intervention period, the IG completed a HIIT on the rowing ergometer twice-weekly (2×4×2 min at ≈95% of maximum heart rate [HR<inf>max</inf>], 60 s rest) in addition to the regular rowing training (3×/week MICT 70-90 min, ≈70% HR<inf>max</inf>). The CG completed the regular normal rowing training and, instead of the HIIT units, two additional MICT units (70-90 min, ≈70% HR<inf>max</inf>). Before and after the intervention period, hemodynamic parameters were recorded non-invasively in both groups.

RESULTS

After the intervention period, there was a significant decrease in peripheral systolic (P=0.01) and diastolic (P=0.05) BP, as well as in central systolic (P=0.05) and diastolic BP (P=0.03) in the IG. Furthermore, pulse wave velocity (PWV) (P=0.05) was significantly reduced. Analysis of intervention effects revealed significant between-group differences in central diastolic BP (P=0.05), in augmentation pressure (P=0.02), and in augmentation index (P=0.006) favoring IG. The CG showed no significant changes in the respected parameters throughout the intervention.

CONCLUSIONS

Already in adolescent athletes, a HIIT intervention has beneficial effects on peripheral and central BP as well as on PWV, augmentation pressure, and augmentation index.

Diagnostic accuracy of triglyceride/glucose and triglyceride/HDL index as predictors for insulin resistance in children with and without obesity

OBJECTIVE

To investigate which of two indexes (TyG or TG/HDL) are the best predictors for insulin resistance (IR) and to evaluate the magnitude of each cardiometabolic risk factor in Mexican schoolchildren of 5-9 years with overweight-obesity and normal weight.

MATERIAL AND METHODS

We realized a comparative cross-sectional prospective study in accordance of STARD guidelines. Setting was Family Medicine Unit (FMU) No. 80 of Mexican Institute of Social Security(IMSS) of Morelia, Michoacán, Mexico. Children between 5 and 9 years, both genders, 104 with normal weight(NW), 97 with Overweight-Obesity(OO Group) were included. Once the informed consent was signed we obtained the BMI, waist circumference, blood pressure(BP) and 5 mL of blood collected for glucose, cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, uric acid and insulin. As main outcome measures TyG or TG/HDL, HOMA-IR, and Receiving Operating Curves(ROC), sensitivity, specificity by ROC were obtained.

RESULTS

Cutoff point TyG: 8.5 by ROC had an area under curve (AUC):0.802 IC95% 0.77to0.893, P = 0.0001; diagnostic accuracy of 73%.

TG/HDL

2.22; AUC:0.729 IC95% 0.622to0.837, P = 0.014; diagnostic accuracy of 52%. TyG can identify cardiometabolic alterations more than HOMA and TG/HDL. Cardiometabolic alterations in the OO group were hypertriglyceridemia:49.5%, low HDL:63.9%, IR:39.2% and in NW group were hypertriglyceridemia:30.8%, low HDL:60.6%, IR:9.6%.

CONCLUSIONS

We reported high frequency of hypertriglyceridemia and low HDL in Mexican children. TyG and TG/HDL are good predictors for IR. TyG has a better diagnostic accuracy. We need implementing TyG for identifying alterations and intervening in a timely manner to delay the onset of chronic diseases in children.

The triglycerides and glucose index is associated with elevated blood pressure in apparently healthy children and adolescents

Prevalence of elevated blood pressure in pediatric population has been increasing worldwide. Thus, the aim of this study was to examine whether the triglycerides and glucose (TyG) index is associated with the presence of prehypertension or hypertension in children and adolescents. Apparently healthy children aged 6 to 15 years were enrolled in a population-based cross-sectional study. Participants were allocated into groups with normal blood pressure (NBP), prehypertension, and hypertension. Smoking, alcohol intake, pregnancy, previous diagnosis of diabetes, kidney, hepatic, or endocrine diseases were exclusion criteria. NBP was defined by systolic and/or diastolic blood pressure < 90th percentile, prehypertension by systolic and/or diastolic blood pressure ≥ 90th < 95th percentile, and hypertension by systolic and/or diastolic blood pressure ≥ 95th percentile, according to age, sex, and height percentiles. A total of 3589 children were enrolled, 1748 (49%) girls and 1841 (51%) boys, and allocated into groups with NBP (n = 2874), prehypertension (n = 271), and hypertension (n = 444). The multiple logistic regression analysis stratified by age and adjusted by the Z-score/SDS of body mass index and waist circumference showed that elevated TyG index was significantly associated with prehypertension (OR = 1.48; 95% CI: 1.08-2.05) and hypertension (OR = 1.63; 95% CI: 1.26-2.11).Conclusion: The results of the present study shows that the elevated TyG index is significantly associated with the presence of prehypertension and hypertension in children and adolescents. What is Known: • Prevalence of elevated blood pressure in children and adolescents has been increasing worldwide. • Insulin resistance plays a key role in the pathogenesis of hypertension. What is New: • The elevated TyG index is significantly associated with the presence of prehypertension in children aged 6-9 years and adolescents aged 10-15 years. • The elevated TyG index is significantly associated with the presence of hypertension in children aged 6-9 years and adolescents aged 10-15 years.

Prevalence of prehypertension and hypertension and its risk factors in Iranian school children: a population-based study

OBJECTIVE

Because of the incidence of a childhood obesity epidemic and the widespread changes in people's lifestyle, the prevalence of high blood pressure in children is increasing. This study was conducted to determine the prevalence of prehypertension and hypertension and its risk factors in Iranian children.

METHODS

Using random cluster sampling in urban areas and census in rural areas, a total of 5620 schoolchildren aged 6-12 years living in Shahroud, Northeast of Iran, were studied. The prevalence of hypertension was determined on the basis of the fourth report of the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents by age, sex, and place of residence. The factors influencing blood pressure were studied using multivariate regression.

RESULTS

The prevalence of prehypertension was 7.44% and the prevalence of hypertension was 6.82%. The relative risk ratio (RRR) of prehypertension was 1.17 for BMI, 1.43 for female sex, and 3.71 for residence in rural areas; in addition, the RRR of hypertension was 1.22 for BMI, 6.64 for residence in rural areas, 1.69 for moderate economic status, and 1.89 for low economic status.

CONCLUSION

The prevalence of prehypertension and hypertension is significant in children and alarming in rural areas and requires urgent intervention. As factors such as high BMI, female sex, residence in rural areas, and moderate and low economic status are associated with increased risk of prehypertension and hypertension, it is recommended to conduct routine care programs at regular intervals in schools to prevent hypertension and its related complications.

Impact of updated pediatric hypertension guidelines on progression from elevated blood pressure to hypertension in a community-based primary care population

In 2017, definitions for pediatric hypertension were updated. A threshold of 130/80 mm Hg was introduced for stage 1 hypertension in adolescents, and children with obesity were removed from the reference population, lowering the 95th percentile, compared to the 2004 Fourth Report. The impact of these changes on care for youth with elevated blood pressure has not been well described. The objective of this study was to compare the 2017 and 2004 criteria for hypertension, evaluating how they impact estimates of risks for elevated blood pressure to progress to hypertension. Data came from youth 10-17 years of age with ≥2 elevated blood pressure measurements (≥90th percentile or ≥120/80 mm Hg) between 04/15/2014 and 04/14/2016 and three additional measurements over two subsequent years. Blood pressures were recorded in primary care practices within a large health system, as part of routine care. Rates of incident hypertension following persistent elevated blood pressure based on the 2017 guidelines vs the 2004 Fourth Report were compared. We found, among 2025 youth with persistent elevated blood pressure, 46% were female and mean age was 14.6 years. Over 2 years of follow-up, progression to hypertension occurred in 5.9% using the 2017 guidelines vs 1.1% using 2004 Fourth Report definitions. Using the 2017 criteria, progression was most common in older youth and those with obesity. In conclusion, for most youth, elevated blood pressure does not progress to hypertension within 2 years. However, progression from elevated blood pressure to hypertension was more than 5-fold greater when applying the 2017 guidelines compared to the older 2004 Fourth Report criteria.

Prevalence and Risk Factors for Arterial Hypertension Development in Childhood Acute Lymphoblastic Leukemia Survivors

BACKGROUND

Childhood acute lymphoblastic leukemia (ALL) survivors are at an increased risk of cardiovascular disease including arterial hypertension (AH). The objectives of this study were to assess the prevalence of AH using 24-hour ambulatory blood pressure monitoring, explore characteristics of AH, and define risk factors for the development of AH in childhood ALL survivors.

PATIENTS AND METHODS

The study comprised 81 childhood ALL survivors (5 to 25 y of age) after a median follow-up time of 5 years. The control group consisted of 52 healthy children (5 to 17 y of age) without any known severe or chronic medical condition. Ambulatory blood pressure monitoring was performed in all patients and controls. Serum lipids were measured in all patients and controls.

RESULTS

ALL survivors were more likely to have AH than controls (odds ratio, 2.47; 95% confidence interval, 1.08-5.63; P=0.0315). The mean time from ALL diagnosis until diagnosis of AH was 5.1±2.97 years. Day-time diastolic SDS and day-time mean arterial pressure SDS were significantly higher in ALL cohort compared with the controls (-0.3±1.43 vs. -0.76±0.95; P=0.04 and 1.44±1.64 vs. 0.92±1.03; P=0.047). Childhood ALL survivors with AH were more likely to be systolic extreme dippers and reverse systolic/diastolic dippers compared with those with normal blood pressure (P<0.05). There was no association of AH with leukemia subtype, leukemia risk group, sex, central nervous system irradiation, and obesity.

CONCLUSIONS

The prevalence of AH in childhood ALL survivors may be as high as 37%. We recommend regular monitoring of blood pressure in childhood ALL survivors early in the follow-up.

Prevalence and risk factors for hypertension among school children in Ilorin, Northcentral Nigeria

BACKGROUND

The global prevalence of childhood hypertension has increased from 1% to 2% to 4%-5%, with a value as high as 9.8% reported in Nigeria. However, the various risk factors associated with childhood hypertension in Nigeria are less explored. The aim of this study was to determine the prevalence of hypertension and related risk factors (sociodemographic, family history of hypertension, history of snoring, birth order, and anthropometric indices) in primary school children in Nigeria.

MATERIALS AND METHODS

A total of 1745 school children aged 6-12 years were selected using systematic random sampling method. Blood pressure (BP) was measured using the fourth report guideline. Those with BP higher than 90^th percentile had repeated BP measurements on two more occasions (2 and 4 weeks after initial measurement). Relevant history was obtained, and anthropometric measurements were taken by the standard methods. Data were analyzed using SPSS version 20.

RESULTS

Prevalence of systolic and or diastolic hypertension at the third visit was 3.0%. Prevalence of systolic hypertension (3^rd visit) was more in females (3.3%) than males (1.3%), P = 0.004. Prevalence of diastolic hypertension (3^rd visit) was higher in females (1.4%) than males (0.3%), P = 0.019. Hypertension showed no significant relationship with socioeconomic class, family history of hypertension, birth order, and history of snoring. Of the anthropometric indices (weight, height, body mass index (BMI), hip circumference, waist circumference, waist-to-hip ratio, and waist-to-height ratio, and only obesity (BMI ≥ 95^th centile) was related with hypertension (odd ratio 8.3, 95% confidence interval 1.7, 40.3).

CONCLUSIONS

Prevalence of hypertension is low (3.0%), and only obesity (BMI ≥ 95^th centile) is associated with hypertension.

Epidemiology of Childhood Onset Essential Hypertension

The knowledge of epidemiology of a disease is paramount in identifying preventive measures. Currently there is a paucity of literature on the epidemiologic determinants of childhood onset essential hypertension (EH). We evaluated children with EH, ascertained in a rigorous manner, in a large multiethnic population in a tertiary pediatric hypertension clinic. We enrolled children with and without EH and obtained data by in-person interview of their parents and by direct anthropometric measurements including blood pressures. A total of 148 children (76 hypertension probands, 72 control probands, and males 53%, mean age 12.2 ± 4.3 years) were enrolled. Of these 148 children, 51 pairs were matched 1:1 on ethnicity, gender and age (± 2.5 years). In this study we evaluated the demographics, genetic predisposition and a variety of exposures including, socioeconomic, perinatal, lifestyle and environmental, between cases and controls. All measures were similar between cases and controls other than a significantly higher BMI (p = 0.01) and rates of obesity (p = 0.03), and a difference of near-significance in any family history of EH (p = 0.05) higher in cases compared to controls. The odds of obesity was 3.5 times higher among cases than controls. In this study we evaluated a variety of prenatal and postnatal exposures that could potentially contributed to the EH phenotype in childhood. The findings of the study elucidate the epidemiology of EH in children and two important associated risk factors, any family history of hypertension and a higher body weight.

The evaluation of arterial stiffness of essential hypertension and white coat hypertension in children: a case-control study

BACKGROUND

The aim of this study was to determine and compare cardiovascular risks by assessing arterial stiffness in children with essential hypertension and white coat hypertension.

METHODS

Paediatric patients followed up with essential hypertension and white coat hypertension diagnoses and with no established end organ damage were involved in the study. Arterial stiffness in children included in the study was evaluated and compared by using the oscillometric device (Mobil-O-Graph) method.

RESULTS

A total of 62 essential hypertension (34 male, 28 female), 38 white coat hypertension (21 male, 17 female), and 60 healthy controls (33 male, 27 female) were assessed in the present study. Pulse wave velocity of the essential hypertension, white coat hypertension, and control group was, respectively, as follows: 5.3±0.6 (m/s), 5.1±0.4 (m/s), 4.3±0.4 (m/s) (p<0.001); augmentation index outcomes were, respectively, determined as follows: 21.3±6.5, 19.3±6.4, 16.0±0.3 (p<0.001). Pulse wave velocity and augmentation index values of children with essential hypertension and white coat hypertension were found to be higher compared with the control group. This level was identified as correlated with the duration of hypertension in both patient groups (p<0.01).

CONCLUSION

Arterial stiffness in children with essential hypertension and white coat hypertension was impaired compared with healthy children. This finding has made us think that white coat hypertension is not an innocent clinical situation. This information should be taken into consideration in the follow-up and treatment approaches of the patients.

Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study

BACKGROUND AND OBJECTIVES

Pediatric hypertension predisposes children to adult hypertension and early markers of cardiovascular disease. No large-scale studies have examined diagnosis and initial medication management of pediatric hypertension and prehypertension. The objective of this study was to evaluate diagnosis and initial medication management of pediatric hypertension and prehypertension in primary care.

METHODS

Retrospective cohort study aggregating electronic health record data on >1.2 million pediatric patients from 196 ambulatory clinics across 27 states. Demographic, diagnosis, blood pressure (BP), height, weight, and medication prescription data extracted. Main outcome measures include proportion of pediatric patients with ≥3 visits with abnormal BPs, documented hypertension and prehypertension diagnoses, and prescribed antihypertensive medications. Marginal standardization via logistic regression produced adjusted diagnosis rates.

RESULTS

Three hundred ninety-eight thousand seventy-nine patients, ages 3 to 18, had ≥3 visits with BP measurements (48.9% girls, 58.6% <10 years old). Of these, 3.3% met criteria for hypertension and 10.1% for prehypertension. Among practices with ≥50 eligible patients, 2813 of 12 138 patients with hypertension (23.2%; 95% confidence interval, 18.2%-28.2%) and 3990 of 38 874 prehypertensive patients (10.2%; 95% confidence interval, 8.2%-12.2%) were diagnosed. Age, weight, height, sex, and number and magnitude of abnormal BPs were associated with diagnosis rates. Of 2813 diagnosed, persistently hypertensive patients, 158 (5.6%) were prescribed antihypertensive medication within 12 months of diagnosis (angiotensin-converting enzyme inhibitors/angiotensin receptive blockers [35%], diuretics [22%], calcium channel blockers [17%], and β-blockers [10%]).

CONCLUSIONS

Hypertension and prehypertension were infrequently diagnosed among pediatric patients. Guidelines for diagnosis and initial medication management of abnormal BP in pediatric patients are not routinely followed.

Childhood-Onset Essential Hypertension and the Family Structure

The prevalence and effect of single-parent families in childhood-onset essential hypertension (EH) is unknown. Children with EH and age-, sex-, and ethnicity-matched controls were enrolled. Family structure data were obtained by in-person interview. A total of 148 families (76 hypertension probands, 72 control probands; median 14 years) were prospective-ly enrolled in the study. Single-parent status was seen in 42% of the families--with and without EH (38% vs 46%, P=.41; odds ratio, 0.7; 95% confidence interval, 0.4-1.4). After multivariable analysis, a statistically significant sociofamilial contributor to the development of childhood-onset EH was not identified. A significant number of single-parent families (42%), the majority with single mothers, were found in our pedigree study. Sociofamilial factors are known to contribute to the expression of adult-onset EH, but findings in our study suggest that they appear to contribute less in the expression of childhood-onset EH.

Correlation of Insulin Resistance with Anthropometric Measures and Blood Pressure in Adolescents

BACKGROUND

Blood pressure is directly related to body mass index, and individuals with increased waist circumference have higher risk of developing hypertension, insulin resistance, and other metabolic changes, since adolescence.

OBJECTIVE

to evaluate the correlation of blood pressure with insulin resistance, waist circumference and body mass index in adolescents.

METHODS

Cross-section study on a representative sample of adolescent students. One group of adolescents with altered blood pressure detected by casual blood pressure and/or home blood pressure monitoring (blood pressure > 90th percentile) and one group of normotensive adolescents were studied. Body mass index, waist circumference were measured, and fasting glucose and plasma insulin levels were determined, using the HOMA-IR index to identify insulin resistance.

RESULTS

A total of 162 adolescents (35 with normal blood pressure and 127 with altered blood pressure) were studied; 61% (n = 99) of them were boys and the mean age was 14.9 ± 1.62 years. Thirty-eight (23.5%) adolescents had altered HOMA-IR. The group with altered blood pressure had higher values of waist circumference, body mass index and HOMA-IR (p<0.05). Waist circumference was higher among boys in both groups (p<0.05) and girls with altered blood pressure had higher HOMA-IR than boys (p<0.05). There was a significant moderate correlation between body mass index and HOMA-IR in the group with altered blood pressure (ρ = 0.394; p < 0.001), and such correlation was stronger than in the normotensive group. There was also a significant moderate correlation between waist circumference and HOMA-IR in both groups (ρ = 0.345; p < 0.05). Logistic regression showed that HOMA-IR was as predictor of altered blood pressure (odds ratio - OR = 2.0; p = 0.001).

CONCLUSION

There was a significant association of insulin resistance with blood pressure and the impact of insulin resistance on blood pressure since childhood. The correlation and association between markers of cardiovascular diseases was more pronounced in adolescents with altered blood pressure, suggesting that primary prevention strategies for cardiovascular risk factors should be early implemented in childhood and adolescence.

Prevalence of hypertension in a sample of schoolchildren in the Belgrade district

OBJECTIVE

The aim of this study was to estimate the prevalence of hypertension in a sample of schoolchildren in the district of Vozdovac (Belgrade).

METHODS

This study included 780 pupils from I, III, V and VII classes of a primary school and I and III classes of a high school in the district of Vozdovac (Belgrade). The anthropometric data were obtained from medical records of a regular health survey in 2014-2015. Blood pressure (BP) was measured three times using a mercury sphygmomanometer with a cuff of appropriate size at a 5 min interval. BP values at or above the 95th percentile for age, sex, and height were considered indicative of hypertension. Statistical analysis included descriptive statistics, χ-test, t-test, and correlation analysis.

RESULTS

Of the participating students, 15.0% were overweight and 6.7% were obese. A significant negative correlation was observed between BMI categories and age (ρ=-0.126; P<0.01). The average systolic blood pressure values in boys and girls were 105.0±14.1 (range 80.0-150.0) and 102.5±12.3 (range 80-155) mmHg, respectively. The average diastolic blood pressure values in boys and girls were 67.6±8.8 (range 50-100) and 66.2±7.7 (range 50-95) mmHg, respectively. The prevalence of hypertension was 10.5%. A significant positive association was found between the presence of hypertension and age (ρ=0.150, P<0.01) and higher BMI level (ρ=0.115, P<0.01).

CONCLUSION

In our sample of schoolchildren, a high prevalence of hypertension was found. Moreover, elevated BP values correlated strongly with age and BMI.

Left Ventricular Diastolic Dysfunction Assessed by Conventional Echocardiography and Spectral Tissue Doppler Imaging in Adolescents With Arterial Hypertension

Compared to conventional echocardiography, spectral tissue Doppler imaging (s-TDI) allows more precise evaluation of diastolic cardiac function. The purpose of this study was to conduct s-TDI to analyze the slow movement of the left ventricular (LV) myocardium in adolescents with systemic arterial hypertension (HT) and to determine whether patients with HT suffer from LV diastolic dysfunction. The study group comprised 69 consecutive patients (48 boys and 21 girls aged 14-17 years [mean, 15.5 ± 1.1 years]) with primary HT, and the control group comprised 48 healthy participants (24 boys and 24 girls aged 14-17 years [mean, 15.8 ± 1.3 years]). Physical examinations, 24-hour arterial blood pressure monitoring, conventional 2-dimensional and Doppler echocardiography, and s-TDIs were performed. Analysis revealed that study group participants were significantly heavier and had greater LV mass indices than controls (P < 0.001). There were no differences between the velocities of E waves (peak early filling of mitral inflow), but the deceleration times of the mitral E waves were significantly shorter whereas the A waves survived longer in the study group than in the control group. The velocities of A waves (peak late filling of mitral inflow) were elevated (P = 0.041), and the E/A wave pattern (E/A = 1.8 ± 0.4) was normal. These results suggest pseudonormalization, a type of LV diastolic dysfunction in adolescents with HT.In the study group, when the sample volume was positioned at the septal or lateral insertion site of the mitral leaflet, the e' wave velocity was significantly depressed whereas the a' wave velocity was elevated, compared to those of the control group (P < 0.001).The e'/a' ratios from the septal and lateral insertion sites were lower, whereas the E/e' ratio from the septal insertion site was significantly higher in the study group, similar to that seen in atrial reversal velocity (P < 0.001).These findings indicate that using sTDI to find and measure diastolic LV failure is valuable when the probe is placed at the septal and lateral mitral valve annuli during examination.Changes in the myocardium appear similar to those seen in adults.

The Prevalence of Elevated Blood Pressure in Adolescents in Nassau, The Bahamas

OBJECTIVE

To determine the prevalence of elevated blood pressure (EBP) in Bahamian adolescents.

METHODS

A cross-sectional survey employing a self-administered questionnaire, and concurrently obtaining anthropometric measurements, was conducted involving selected grades 9, 10 and 11 students of all targeted public high schools in The Bahamas.

RESULTS

The mean age of the 785 participants was 14.6 (± 1.153) years, and 87.6% were Bahamian. The prevalence of elevated systolic blood pressure (SBP) was 4.7% and 6.6% for elevated diastolic blood pressure (DBP). Elevated blood pressure prevalence was 8.9%. Elevated blood pressure was more common among grade 9 students (12-14-year olds) who had the largest proportion of EBP (55.7%). Both SBP and DBP increased with age in the males. Overall, students' prevalence of overweight/obesity was 32.2% (14.4% overweight, 17.8% obese). Body mass index (BMI), number of days per week eating fast food and perception of body weight were predictive of EBP. Body mass index, age and perception of body weight were found to be predictive of SBP (βBMI = 0.25, p < 0.001; βAge = 0.14, p < 0.001; βWeight = 0.08, p < 0.037) and DBP (βDBP = 0.192, p < 0.001). Overweight/obese students were 2.7 times more likely to have EBP. Elevated blood pressure was markedly associated with BMI, family history of hypertension and parents' overweight/obese status.

CONCLUSION

The estimated prevalence of EBP in adolescent school children in New Providence, Bahamas, was comparable with neighbouring nations.

Gender-specific prevalence and associated risk factors of high normal blood pressure and hypertension among multi-ethnic Chinese adolescents aged 8-18 years old

AIM

To date, accurate reports about the prevalence of high normal blood pressure (BP) and hypertension among Chinese adolescents have been rare. We examine the sex-specific and age-specific prevalence of high normal BP and hypertension, and the associated risk factors among multi-ethnic Chinese adolescents from a large and representative sample.

METHODS

29,997 adolescents aged 8-18 years old received blood pressure measurement on one clinical visit.

RESULTS

The overall prevalence was 4.15% for hypertension (4.73% for boys and 3.62% for girls) and 29.85% for high normal BP (33.40% for boys and 26.65% for girls). The odds ratios (ORs) increased with age, but the absolute changes of ORs were significantly different between boys and girls. Compared with that of the Han counterparts, the risk of high normal BP was 1.960-fold, 1.283-fold and 1.618-fold for Yi boys, Mongolian boys and Yi girls, respectively, whereas the OR was 0.440 for Tibetan boys, 0.492 for Tibetan girls and 0.794 for Korean girls. Compared with those of normal weight, overweight and obese adolescents had significantly increased risk of high normal BP (OR = 3.377 for obese boys and OR = 2.009 for overweight boys; OR = 2.865 for obese girls and OR = 1.738 for overweight girls). Rural adolescents had a higher risk of hypertension than those living in urban areas.

CONCLUSION

The prevalence of high normal BP and hypertension was high in Chinese adolescents. Age, ethnicity, obesity, overweight, abnormal waist circumference, family history of cardiovascular diseases and dwelling at rural districts were significantly associated with pediatric high normal BP or hypertension.

Epidemiology of elevated blood pressure in youth and its utility for predicting adulthood outcomes: A review

Elevated blood pressure has been demonstrated to track from youth to adulthood and some have demonstrated an association between early-life blood pressure and subsequent atherosclerosis and cardiovascular disease. In addition, reports regarding the strength of tracking are inconsistent and the modifiable risk factors that affect the trajectory of blood pressure from youth to adulthood remain unclear. This paper comprehensively evaluated the existing classifications of youth hypertension and the current trends of youth hypertension. Further, evidence for the consequences of hypertension in youth has been comprehensively evaluated. Importantly, a review of the studies examining tracking from youth to adulthood has been performed and a number of studies investigating the factors affecting tracking has also been investigated. The overall consideration of this body of literature highlights the vital importance of identifying hypertension in youth to prevent complications in adulthood. Adiposity is regarded to be a factor affecting the progression of hypertension from youth to adulthood yet there is little evidence available for other modifiable factors. It is apparent that further research is necessary within this field in order to create effective preventative strategies to target youth hypertension.

Pediatric hypertension: An update on a burning problem

A large number of adults worldwide suffer from essential hypertension, and because blood pressures (BPs) tend to remain within the same percentiles throughout life, it has been postulated that hypertensive pressures can be tracked from childhood to adulthood. Thus, children with higher BPs are more likely to become hypertensive adults. These “pre-hypertensive” subjects can be identified by measuring arterial BP at a young age, and compared with age, gender and height-specific references. The majority of studies report that 1 to 5% of children and adolescents are hypertensive, defined as a BP > 95^th percentile, with higher prevalence rates reported for some isolated geographic areas. However, the actual prevalence of hypertension in children and adolescents remains to be fully elucidated. In addition to these young “pre-hypertensive” subjects, there are also children and adolescents with a normal-high BP (90^th-95^th percentile). Early intervention may help prevent the development of essential hypertension as they age. An initial attempt should be made to lower their BP by non-pharmacologic measures, such as weight reduction, aerobic physical exercise, and lowered sodium intake. A pharmacological treatment is usually needed should these measures fail to lower BP. The majority of antihypertensive drugs are not formulated for pediatric patients, and have thus not been investigated in great detail. The purpose of this review is to provide an update concerning juvenile hypertension, and highlight recent developments in epidemiology, diagnostic methods, and relevant therapies.

Prevalence of Prehypertension and Hypertension in a Nationally Representative Sample of Iranian Children and Adolescents: The CASPIAN-IV Study

BACKGROUND

The global health burden has faced toward non-communicable diseases (NCDs). It is suggested that adulthood blood pressure (BP) is tracked from childhood. This study aims to evaluate the mean BP and the prevalence of prehypertension and hypertension in the Iranian pediatric population.

METHODS

In a national survey as the 4(th) phase of Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable diseases study and through random multistage cluster sampling, a national sample of Iranian school students, aged 6-18 years, were recruited. Data gathered by means of modified World Health Organization Global school-based student health survey questionnaire, a weight disorders determinants questionnaire and anthropometric and BP measurements. Prehypertension (HTN) was defined as BP equal or greater than 90(th) age and sex specific percentile or ≥120/80 mmHg and HTN was defined as BP ≥95(th) percentile.

RESULTS

A total of 13486 students entered the study (49.2% girls, 75.6% urban). Mean age of participants was 11.47 ± 3.36 years. A total rate of 4.17% (3.84-4.52 95% CI) for high systolic BP (SBP), 4.33% (3.99-4.68) for high diastolic BP (DBP) and 6.88% (6.45-7.32) for high SBP and/or DBP was depicted.

CONCLUSIONS

The prevalence rate of high BP (pre-HTN together with HTN) is substantially high in this population. It is needed to study the causative situations and implement relevant interventions.