1
|
Di Bonito P, Valerio G, Pacifico L, Chiesa C, Invitti C, Morandi A, Maffeis C, Licenziati MR, Manco M, Miraglia Del Giudice E, Baroni MG, Loche S, Tornese G, Tomat M, de Simone G. A new index to simplify the screening of hypertension in overweight or obese youth. Nutr Metab Cardiovasc Dis 2017; 27:830-835. [PMID: 28755804 DOI: 10.1016/j.numecd.2017.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Hypertension (HTH) is a frequent complication in pediatric obesity. To simplify the screening of HTH in overweight/obese (Ow/Ob) youth, we compared the performance of a new index (High Blood Pressure index, HBPi) with respect to the standard criteria of the IV Report [systolic BP (SBP) and/or diastolic BP (DBP) ≥95th percentile for age, gender and height]. We also compared the performance of HBPi with other simplified indices such as the BP/height ratio and the absolute height-specific BP thresholds. Ten pediatrics' outpatient centers participating in the "CARdiometabolic risk factors in ITALY study" provided medical records of 4225 Ow/Ob children and adolescents (age 6-16 years). METHODS AND RESULTS Centers were divided into two groups: training set (TS) (n = 2204 participants) and validation set (VS) (n = 2021 participants). The simplified HBPi (mmHg) was: (SBP/2 + DBP/10) - age + (1 × female gender). In the TS, a HBPi value ≥57 mmHg in both children and adolescents had high sensitivity (0.89), specificity (0.97), positive (0.89) and negative (0.97) predictive values in classifying youth at high risk of HTN compared with the IV Report. In the VS, the HBPi showed a better performance than high levels of BP/height ratio and height-specific BP thresholds in classifying individuals at risk of HTN: area under curves 0.95 (0.93-0.96), 0.80 (0.78-0.82), 0.76 (0.74-0.79), respectively; specificities 0.95 (0.94-0.96), 0.69 (0.67-0.72), 0.60 (0.57-0.62), respectively. CONCLUSIONS HBPi, combining SBP and DBP, gender and age, may help pediatricians to implement HTN screening in Ow/Ob youth.
Collapse
Affiliation(s)
- P Di Bonito
- Department of Internal Medicine, "S. Maria delle Grazie", Pozzuoli Hospital, Naples, Italy
| | - G Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy.
| | - L Pacifico
- Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - C Chiesa
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - C Invitti
- IRCCS Istituto Auxologico Italiano, Department of Medical Sciences & Rehabilitation, Milan, Italy
| | - A Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona, Italy
| | - C Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - M R Licenziati
- Department of Pediatrics, AORN Santobono-Pausilipon, Naples, Italy
| | - M Manco
- IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - E Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M G Baroni
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy; Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Loche
- Pediatric Endocrine Unit, Pediatric Hospital for Microcitemia, AO Brotzu, Cagliari, Italy
| | - G Tornese
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - M Tomat
- Pediatric Unit, AOU Udine, Udine, Italy
| | - G de Simone
- Hypertension Research Center, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| |
Collapse
|
2
|
Kelly RK, Magnussen CG. Epidemiology of elevated blood pressure in youth and its utility for predicting adulthood outcomes: A review. World J Hypertens 2014; 4:29-36. [DOI: 10.5494/wjh.v4.i4.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/29/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
Elevated blood pressure has been demonstrated to track from youth to adulthood and some have demonstrated an association between early-life blood pressure and subsequent atherosclerosis and cardiovascular disease. In addition, reports regarding the strength of tracking are inconsistent and the modifiable risk factors that affect the trajectory of blood pressure from youth to adulthood remain unclear. This paper comprehensively evaluated the existing classifications of youth hypertension and the current trends of youth hypertension. Further, evidence for the consequences of hypertension in youth has been comprehensively evaluated. Importantly, a review of the studies examining tracking from youth to adulthood has been performed and a number of studies investigating the factors affecting tracking has also been investigated. The overall consideration of this body of literature highlights the vital importance of identifying hypertension in youth to prevent complications in adulthood. Adiposity is regarded to be a factor affecting the progression of hypertension from youth to adulthood yet there is little evidence available for other modifiable factors. It is apparent that further research is necessary within this field in order to create effective preventative strategies to target youth hypertension.
Collapse
|
3
|
Sterling R, Checkley W, Gilman RH, Cabrera L, Sterling CR, Bern C, Miranda JJ. Beyond birth-weight: early growth and adolescent blood pressure in a Peruvian population. PeerJ 2014; 2:e381. [PMID: 25024902 PMCID: PMC4081287 DOI: 10.7717/peerj.381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/24/2014] [Indexed: 11/21/2022] Open
Abstract
Background. Longitudinal investigations into the origins of adult essential hypertension have found elevated blood pressure in children to accurately track into adulthood, however the direct causes of essential hypertension in adolescence and adulthood remains unclear. Methods. We revisited 152 Peruvian adolescents from a birth cohort tracked from 0 to 30 months of age, and evaluated growth via monthly anthropometric measurements between 1995 and 1998, and obtained anthropometric and blood pressure measurements 11–14 years later. We used multivariable regression models to study the effects of infantile and childhood growth trends on blood pressure and central obesity in early adolescence. Results. In regression models adjusted for interim changes in weight and height, each 0.1 SD increase in weight for length from 0 to 5 months of age, and 1 SD increase from 6 to 30 months of age, was associated with decreased adolescent systolic blood pressure by 1.3 mm Hg (95% CI −2.4 to −0.1) and 2.5 mm Hg (95% CI −4.9 to 0.0), and decreased waist circumference by 0.6 (95% CI −1.1 to 0.0) and 1.2 cm (95% CI −2.3 to −0.1), respectively. Growth in infancy and early childhood was not significantly associated with adolescent waist-to-hip ratio. Conclusions. Rapid compensatory growth in early life has been posited to increase the risk of long-term cardiovascular morbidities such that nutritional interventions may do more harm than good. However, we found increased weight growth during infancy and early childhood to be associated with decreased systolic blood pressure and central adiposity in adolescence.
Collapse
Affiliation(s)
- Robie Sterling
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Lima , Peru ; Asociación Benéfica PRISMA (A.B. PRISMA) , Lima , Peru
| | - William Checkley
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Lima , Peru ; Asociación Benéfica PRISMA (A.B. PRISMA) , Lima , Peru ; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University , Baltimore, MD , USA ; Division of Pulmonary and Critical Care, School of Medicine, The Johns Hopkins University , Baltimore, MD , USA
| | - Robert H Gilman
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Lima , Peru ; Asociación Benéfica PRISMA (A.B. PRISMA) , Lima , Peru ; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University , Baltimore, MD , USA
| | - Lilia Cabrera
- Asociación Benéfica PRISMA (A.B. PRISMA) , Lima , Peru
| | - Charles R Sterling
- Department of Veterinary Science and Microbiology, University of Arizona , Tucson, AZ , USA
| | - Caryn Bern
- Global Health Sciences, and Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco , San Francisco, CA , USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Lima , Peru ; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia , Lima , Peru
| |
Collapse
|
4
|
Lee CG, Moon JS, Choi JM, Nam CM, Lee SY, Oh K, Kim YT. Normative blood pressure references for Korean children and adolescents. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.1.33] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Chong Guk Lee
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
- The Committee for School Health and Public Health Statistics, The Korean Pediatric Society, Korea
| | - Jin Soo Moon
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
- The Committee for School Health and Public Health Statistics, The Korean Pediatric Society, Korea
| | - Joong-Myung Choi
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
- The Committee for School Health and Public Health Statistics, The Korean Pediatric Society, Korea
| | - Chung Mo Nam
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
| | - Soon Young Lee
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
| | - Kyungwon Oh
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
- Division of Chronic Disease Surveillance, Korea Centers for Disease Control and Prevention, Korea
| | - Young Taek Kim
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
- Division of Chronic Disease Surveillance, Korea Centers for Disease Control and Prevention, Korea
| |
Collapse
|