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Vispute SY, Mandlik RM, Khadilkar VV, Gondhalekar KM, Khadilkar AV. Establishing a Unique, Single Cutoff Value for Body Frame Size for Screening for Risk of Hypertension in Indian Children and Adolescents-A Multicenter Study. Indian J Pediatr 2023; 90:327-333. [PMID: 35727529 DOI: 10.1007/s12098-022-04186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/27/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the strength of association of two measures of BFS: frame-size one (FS1; height ÷ wrist circumference) and frame-size two (FS2; elbow breadth), with body-fat indices, body composition, and hypertension in Indian children and adolescents, and to determine age and sex-specific cutoffs of BFS to predict hypertension. METHODS This was a cross-sectional, multicenter, school-based study in 9- to 18-y-old healthy children (n = 1423) randomly selected from 3 Indian states. Based on tertiles, FS1 and FS2 were categorized as small, medium, and large. RESULTS Greater BFS (both FS1 and FS2) was associated with higher body-fat indices, BP (r = -0.424 for FS1 and r = 0.282 for FS2, p < 0.01) and lower muscle mass (MM). A significantly greater percentage of children classified as having large BFS according to FS1 were found to be overweight/obese (46% vs. 25%), hypertensive (34% vs. 17%) than FS2 (p < 0.01). FS1 showed strong to very strong association (Cramer's V 0.15 to > 0.25) with body-fat indices, MM, and BP as opposed to FS2 (For BP X2 = 120.9 for FS1 vs. 9.06 for FS2). FS1 better identified obesity and hypertension, and a value of 10.6 was determined to be the optimum cutoff for predicting hypertension in both genders (sensitivity 71%, specificity 75%, AUC 0.795, and NPV 95%). CONCLUSIONS Height-to-wrist circumference is a novel, simple, and precise BFS measure for predicting hypertension and muscle mass (9-18 y) and a single cutoff value (< 10.6) may contribute to rapid screening and prompt identification of children at risk of hypertension.
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Affiliation(s)
- Smruti Y Vispute
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411001, India.,Interdisciplinary School of Health Science, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Rubina M Mandlik
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411001, India
| | - Vaman V Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411001, India.,Interdisciplinary School of Health Science, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Ketan M Gondhalekar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411001, India
| | - Anuradha V Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411001, India. .,Interdisciplinary School of Health Science, Savitribai Phule Pune University, Pune, Maharashtra, India.
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2
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Zhou Y, Zhao L, Meng X, Cai QJ, Zhao XL, Zhou XL, Hu AH. Seasonal variation of ambulatory blood pressure in Chinese hypertensive adolescents. Front Pediatr 2022; 10:1022865. [PMID: 36467472 PMCID: PMC9715761 DOI: 10.3389/fped.2022.1022865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/19/2022] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Blood pressure (BP) exhibits seasonal variation with lower levels at higher temperatures and vice versa. This phenomenon affects both sexes and all age groups. So far, only a few research studies have investigated this condition in adolescents and none of them were based on hypertensive population or ever applied ambulatory blood pressure monitor (ABPM). Therefore, we carried out the first study that used ABPM to record seasonal variation of blood pressure in hypertensive adolescents. METHODS From March 2018 to February 2019, 649 ABPMs from hypertensive adolescents between 13 and 17 years who were referred to wear an ABPM device in Beijing and Baoding were extracted. Seasonal change in ambulatory BP value, dipping status, and prevalence of different BP phenotypes were analyzed and compared. RESULTS Mean age of participants was 14.9 ± 1.5 years and 65.8% of them were boys. Of the participants, 75.3% met the criteria of overweight or obesity. From summer to winter, average 24-hour, day-time, and night-time BP showed significant rise, which was 9.8/2.8, 9.8/3.0, and 10.9/3.4 mmHg, respectively. This seasonal effect on BP was not dependent on the obesity degree. In addition, higher prevalence of nondippers and risers existed in winter while white coat hypertension was more frequent in warmer seasons. CONCLUSION Hypertensive adolescents showed evident seasonal change in their ABPM results, which was featured by elevated BP level and more frequent abnormal dipping patterns in winter. On the contrary, higher prevalence of white coat hypertension was found in warmer seasons. Physicians should take seasonal variation into consideration when managing adolescent hypertension.
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Affiliation(s)
- Yi Zhou
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Lin Zhao
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xu Meng
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Qiu-Jing Cai
- Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiao-Lei Zhao
- Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Ai-Hua Hu
- Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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3
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Vispute S, Mandlik R, Patwardhan V, Gondhalekar K, Khadilkar V, Khadilkar A. Prevalence and determinants of primary hypertension in urban and rural children from six Indian States– a multicentre study. Nutrition 2022; 103-104:111759. [DOI: 10.1016/j.nut.2022.111759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 02/19/2022] [Accepted: 05/29/2022] [Indexed: 11/26/2022]
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4
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Kankaria A, Narang R, Saxena A, Ramakrishnan S, Desai A, Thangjam RS, Krishnan A. Determinants of Waist-to-Height Ratio and Its Relation to Hypertension among School Children in India: A Multicenter Study. Indian J Pediatr 2022; 89:546-552. [PMID: 34406592 DOI: 10.1007/s12098-021-03879-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To study the factors associated with waist-to-height ratio (WHtR) among school children aged 5-15 y and its association with hypertension. METHODS In this cross-sectional study, data on background characteristics, socioeconomic status (SES), anthropometric parameters, and blood pressure were obtained from school children from three states of India. WHtR ≥ 0.5 was defined as obesity and hypertensives were defined based on Fourth Report criteria. Descriptive statistics were applied and multiple linear regression was done to identify factors associated with WHtR. A receiver operating characteristics (ROC) analysis was used to evaluate the predictive ability of WHtR to predict hypertension RESULTS: The mean WHtR among the 12,068 students was 0.40 (± 0.05) and it showed a U-shaped distribution with age with trough at 10 y of age for both genders. Mean WHtR was higher among residents of Manipur, among boys and hypertensives. WHtR was positively associated with weight > 30 kg, male gender, schools with high SES, Manipur and Goa region, and negatively associated with age > 10 y. The area under the ROC curve of WHtR for diagnosis of hypertension was low 0.544 (95% CI 0.532, 0.556). CONCLUSION There is a nonlinear relation between age, gender, and WHtR, which varies by geographical region and HT. This would need to be kept in mind while using it to identify obesity in children, though its discriminant value for hypertension is low.
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Affiliation(s)
- Ankita Kankaria
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Rajiv Narang
- Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | | | - Ankush Desai
- Endocrinology Unit, Department of Medicine, Goa Medical College, Bambolim, Goa, India
| | - Rajendra S Thangjam
- Department of Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India
| | - Anand Krishnan
- Department of Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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5
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Zhou Y, Zhao L, Meng X, Cai QJ, Zhao XL, Zhou XL, Hu AH. Seasonal variation of ambulatory blood pressure in Chinese hypertensive adolescents. Front Pediatr 2022. [PMID: 36467472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Blood pressure (BP) exhibits seasonal variation with lower levels at higher temperatures and vice versa. This phenomenon affects both sexes and all age groups. So far, only a few research studies have investigated this condition in adolescents and none of them were based on hypertensive population or ever applied ambulatory blood pressure monitor (ABPM). Therefore, we carried out the first study that used ABPM to record seasonal variation of blood pressure in hypertensive adolescents. METHODS From March 2018 to February 2019, 649 ABPMs from hypertensive adolescents between 13 and 17 years who were referred to wear an ABPM device in Beijing and Baoding were extracted. Seasonal change in ambulatory BP value, dipping status, and prevalence of different BP phenotypes were analyzed and compared. RESULTS Mean age of participants was 14.9 ± 1.5 years and 65.8% of them were boys. Of the participants, 75.3% met the criteria of overweight or obesity. From summer to winter, average 24-hour, day-time, and night-time BP showed significant rise, which was 9.8/2.8, 9.8/3.0, and 10.9/3.4 mmHg, respectively. This seasonal effect on BP was not dependent on the obesity degree. In addition, higher prevalence of nondippers and risers existed in winter while white coat hypertension was more frequent in warmer seasons. CONCLUSION Hypertensive adolescents showed evident seasonal change in their ABPM results, which was featured by elevated BP level and more frequent abnormal dipping patterns in winter. On the contrary, higher prevalence of white coat hypertension was found in warmer seasons. Physicians should take seasonal variation into consideration when managing adolescent hypertension.
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Affiliation(s)
- Yi Zhou
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Lin Zhao
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xu Meng
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Qiu-Jing Cai
- Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiao-Lei Zhao
- Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Ai-Hua Hu
- Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Liu K, Li C, Gong H, Guo Y, Hou B, Chen L, Liu F, Liu Y, Wang J, Hou Q, Wang Z, Hui R, Jiang X, Zou Y, Zhang Y, Song L. Prevalence and Risk Factors for Hypertension in Adolescents Aged 12 to 17 Years: A School-Based Study in China. Hypertension 2021; 78:1577-1585. [PMID: 34538102 DOI: 10.1161/hypertensionaha.121.17300] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Kai Liu
- Department of Cardiology (K.L., C.L., R.H., X.J., Y. Zou, Y. Zhang, L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Chen Li
- Department of Cardiology (K.L., C.L., R.H., X.J., Y. Zou, Y. Zhang, L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haibin Gong
- Xuzhou Cardiovascular Disease Institute, Jiangsu, China (H.G.)
| | - Ye Guo
- The First Hospital of Fangshan District, Beijing, China (Y.G.)
| | - Bingjie Hou
- The Fourth Central Hospital of Baoding City, Hebei, China (B.H.)
| | - Liangyu Chen
- The First People's Hospital of Chuzhou, Anhui, China (L.C.)
| | - Fusong Liu
- The Third People's Hospital of Qingdao, Shandong, China (F.L.)
| | - Yajuan Liu
- Central Hospital of Yichun City, Heilongjiang, China (Y.L.)
| | - Jizheng Wang
- State Key Laboratory of Cardiovascular Disease (J. W., R.H., L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qing Hou
- BestNovo (Beijing) Diagnostics Laboratory, China (Q.H.)
| | - Zengwu Wang
- Division of Prevention and Community Health (Z.W.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Rutai Hui
- Department of Cardiology (K.L., C.L., R.H., X.J., Y. Zou, Y. Zhang, L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,State Key Laboratory of Cardiovascular Disease (J. W., R.H., L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiongjing Jiang
- Department of Cardiology (K.L., C.L., R.H., X.J., Y. Zou, Y. Zhang, L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yubao Zou
- Department of Cardiology (K.L., C.L., R.H., X.J., Y. Zou, Y. Zhang, L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuqing Zhang
- Department of Cardiology (K.L., C.L., R.H., X.J., Y. Zou, Y. Zhang, L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lei Song
- Department of Cardiology (K.L., C.L., R.H., X.J., Y. Zou, Y. Zhang, L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,State Key Laboratory of Cardiovascular Disease (J. W., R.H., L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,National Clinical Research Center of Cardiovascular Diseases (L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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7
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Seasonal variation of blood pressure in children. Pediatr Nephrol 2021; 36:2257-2263. [PMID: 33211170 PMCID: PMC8260525 DOI: 10.1007/s00467-020-04823-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/20/2020] [Accepted: 10/13/2020] [Indexed: 01/18/2023]
Abstract
Seasonal blood pressure (BP) variation is mostly found between the summer and winter months. Guidelines for diagnosis and treatment of hypertension in children have not considered this variation until recently. This review aims to present an overview of seasonal BP variation in childhood along with potential underlying pathophysiological mechanisms and long-term implications as well as conclusions for future studies. In pediatric cohorts, seven studies investigated seasonal changes in BP. These changes amount to 3.4-5.9 mmHg (or 0.5-1.5 mmHg per - 1 °C difference in environmental temperature) in systolic BP with a peak in fall or winter. Potential mechanisms and mediators of seasonal BP variation include sympathetic activation of the nervous system with an increase of urinary and plasma norepinephrine levels in the winter season. Additionally, the physical activity among children and adolescents was inversely correlated with BP levels. Temperature sensitivity of BP and pediatric BP levels predict future systolic BP and target-organ damage. Therefore, cardiovascular events may even be long-term complications of seasonal BP variation in pediatric hypertensive patients. Overall, these data strongly suggest an important effect of ambient temperature on BP in children. Additional studies in pediatric cohorts are needed to define how best to incorporate such variation into clinical practice.
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8
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Ramakrishnan S. Pediatric cardiology: Is India self-reliant? Ann Pediatr Cardiol 2021; 14:253-259. [PMID: 34667394 PMCID: PMC8457276 DOI: 10.4103/apc.apc_153_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/07/2022] Open
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9
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Rerksuppaphol L, Rerksuppaphol S. Prevalence and Risk Factors of Hypertension in Schoolchildren from Central Thailand: A Cross-Sectional Study. Int J Prev Med 2021; 12:28. [PMID: 34249277 PMCID: PMC8218803 DOI: 10.4103/ijpvm.ijpvm_110_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Hypertension (HTN) among children is a major health issue with mounting prevalence rates. The aim of this research is to assess the prevalence of HTN and its associated risk factors among apparently healthy schoolchildren. Methods: We conducted a cross-sectional study of schoolchildren in the academic year 2015 from 38 public primary schools in central Thailand for the prevalence and risk factors of HTN. Apparently healthy children aged 6-12 years were included. Informed consents were obtained before participation. Hypertension was diagnosed as per the new reference cutoff levels recommended by the American Academy of Pediatrics. Results: A total of 3,870 children with a median age of 9.5 years were included in the final analysis. The prevalence of obesity, overweight, and thinness among children was 15.7%, 13.6% and 5.2%, respectively. The overall prevalence of hypertension in the study population was 26.2%. HTN was significantly more prevalent in boys than girls (summary odds ratio (OR) 1.16 [95% confidence interval (CI) = 1.01-1.34]). Overweight and obesity were among the associated risk factors of HTN in the enrolled children with (OR 2.44 [95% CI 1.98-3.00]) and (OR 7.99 [95% CI 6.58-9.70]), respectively. Obese children who had central obesity were at greater risk of hypertension (OR 9.16 [95% CI 7.45-11.27]). Conclusions: The prevalence of HTN among Thai children is markedly high. Obesity, overweight, and male gender are considerable risk factors of HTN in children. Routine blood pressure measurement and further studies are recommended to investigate the potential risks and to lessen the associated complications.
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Affiliation(s)
- Lakkana Rerksuppaphol
- Departments of Preventive Medicine, Faculty of Medicine, Srinakharinwirot University, Thailand
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10
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Ashraf M, Irshad M, Parry NA. Pediatric hypertension: an updated review. Clin Hypertens 2020; 26:22. [PMID: 33292828 PMCID: PMC7706222 DOI: 10.1186/s40885-020-00156-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/15/2020] [Indexed: 12/05/2022] Open
Abstract
Globally hypertension in adults is among the leading preventable cause of premature death, where a graded association from the childhood hypertension is well recognised. With the concurrent rise in obesity and pediatric hypertension (HTN) during the past decade in developed countries, a parallel trend is emerging in developing countries that has a potential for exponential rise in cardiovascular, cerebrovascular and renal tragedies. A cumulative incidence of pediatric HTN in China and India is 50–70 and 23% respectively, is quite disturbing. New guidelines for the detection, evaluation and management of hypertension in children and adolescents published in 2017, where a jump in prevalence of pediatric HTN is observed, rings a call to address this under-attended burning problem; for which a review in pediatric hypertension and its management is warranted.
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Affiliation(s)
- Mohd Ashraf
- Department of Pediatrics, Govt Medical College, Srinagar, Jammu and Kashmir, 190010, India.
| | - Mohd Irshad
- Department of Paediatrics, Govt Medical College Baramulla, Baramulla, Jammu and Kashmir, India
| | - Nazir Ahmed Parry
- Department of Paediatrics, SKIMS Medical College Bemina, Srinagar, Jammu and Kashmir, India
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11
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Safdar O, AlJehani R, Aljuhani M, AlGhamdi H, Asiri A, AlGhofaily O, Hisan F, Altabsh G. Hypertension in pediatric patients admitted to inpatient ward at King Abdulaziz Universty Hospital in Saudi Arabia: Prevalence, causes, and outcomes. J Family Med Prim Care 2020; 9:4031-4038. [PMID: 33110806 PMCID: PMC7586632 DOI: 10.4103/jfmpc.jfmpc_214_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/13/2020] [Accepted: 03/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The secondary hypertension (HTN) is the predominant form of HTN in pediatrics. Renal diseases and renovascular anomalies are the most commonly reported causes. In this study, we aimed to identify the prevalence, causes, and outcomes of secondary HTN in Saudi Arabia. Methods: A retrospective study was conducted among 3,640 pediatric patients aged between 0 and 18 years, admitted to the pediatric nephrology ward at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The study has been approved by the ethics review committee of King Abdulaziz University. Results: Prevalence of secondary HTN due to renal disease was (77.0%). Most of the cases were diagnosed with stage 5 renal disease (78.3%). Small kidney size was frequently diagnosed (n = 29, 11.9%), followed by large kidney size (n = 26, 10.7%). One third of the cases (n = 79, 32.4%) were under control, 49 (20.1%) lost follow-up, and 24 (10.1%) deceased. A total of 61 (33.1%) patients progressed to end-stage renal disease and patientswere managed by different types of treatments. Conclusion: The prevalence of secondary HTN due to renal disease is considered to be high in pediatric patients admitted to King Abdulaziz University. Several renal diseases in the renal system are associated with secondary HTN mostly attriubuted to renal malformation. In addition, renal affection, cerebral infarction, bleeding, left ventricular hypertrophy, and valvular lesion are the highest reported complications in our population. Follow-up with ECHO and brain CT is highly recommended in pediatric HTN. Future studies on a larger sample and vigorous follow-up are recommended.
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Affiliation(s)
- Osama Safdar
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Reham AlJehani
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Aljuhani
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hajar AlGhamdi
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Arub Asiri
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Oyoon AlGhofaily
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fatimah Hisan
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghidah Altabsh
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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12
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Piepoli MF. Editor's Presentation: 'The forbidden fruits: Fake or reality?'. Eur J Prev Cardiol 2019; 27:3-6. [PMID: 31850821 DOI: 10.1177/2047487319895946] [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: 11/17/2022]
Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
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13
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Piepoli MF. Editor’s presentation: ‘Accreditation and certification. A step towards optimising quality’. Eur J Prev Cardiol 2019; 26:1687-1689. [DOI: 10.1177/2047487319881613] [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: 11/16/2022]
Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, Piacenza, Italy
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
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14
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Castelletti S, Adami PE. From the last EuroPrevent towards the first ESC Preventive Cardiology Congress. Eur J Prev Cardiol 2019; 26:1408-1411. [DOI: 10.1177/2047487319853330] [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: 11/16/2022]
Affiliation(s)
- Silvia Castelletti
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - Paolo E Adami
- Università degli studi di Roma ‘Foro Italico’, Italy
- Health and Science Department, International Association of Athletics Federation – IAAF, Monaco, France
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15
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Bonito PD, Licenziati MR, Baroni MG, Maffeis C, Morandi A, Manco M, Miraglia Del Giudice E, Sessa AD, Campana G, Moio N, Gilardini L, Chiesa C, Pacifico L, Simone GD, Valerio G. The American Academy of Pediatrics hypertension guidelines identify obese youth at high cardiovascular risk among individuals non-hypertensive by the European Society of Hypertension guidelines. Eur J Prev Cardiol 2019; 27:8-15. [PMID: 31387383 DOI: 10.1177/2047487319868326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Two different systems for the screening and diagnosis of hypertension (HTN) in children currently coexist, namely, the guidelines of the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH). The two systems differ in the lowered cut-offs proposed by the AAP versus ESH. OBJECTIVES We evaluated whether the reclassification of hypertension by the AAP guidelines in young people who were defined non-hypertensive by the ESH criteria would classify differently overweight/obese youth in relation to their cardiovascular risk profile. METHODS A sample of 2929 overweight/obese young people (6-16 years) defined non-hypertensive by ESH (ESH-) was analysed. Echocardiographic data were available in 438 youth. RESULTS Using the AAP criteria, 327/2929 (11%) young people were categorized as hypertensive (ESH-/AAP+). These youth were older, exhibited higher body mass index, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), triglycerides, total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, blood pressure, left ventricular mass index and lower HDL-C (p <0.025-0.0001) compared with ESH-/AAP-. The ESH-/AAP+ group showed a higher proportion of insulin resistance (i.e. HOMA-IR ≥3.9 in boys and 4.2 in girls) 35% vs. 25% (p <0.0001), high TC/HDL-C ratio (≥3.8 mg/dl) 35% vs. 26% (p = 0.001) and left ventricular hypertrophy (left ventricular mass index ≥45 g/h2.16) 67% vs. 45% (p = 0.008) as compared with ESH-/AAP-. CONCLUSIONS The reclassification of hypertension by the AAP guidelines in young people overweight/obese defined non-hypertensive by the ESH criteria identified a significant number of individuals with high blood pressure and abnormal cardiovascular risk. Our data support the need of a revision of the ESH criteria.
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Affiliation(s)
- Procolo Di Bonito
- Department of Internal Medicine, 'S. Maria delle Grazie', Pozzuoli Hospital, Naples, Italy
| | | | - Marco G Baroni
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Claudio Maffeis
- Paediatric Diabetes and Metabolic Disorders Unit, University of Verona, Italy
| | - Anita Morandi
- Paediatric Diabetes and Metabolic Disorders Unit, University of Verona, Italy
| | | | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Nicola Moio
- Department of Cardiology, 'S. Maria delle Grazie', Pozzuoli, Naples, Italy
| | - Luisa Gilardini
- IRCCS Istituto Auxologico Italiano, Department of Medical Sciences and Rehabilitation, Milan, Italy
| | - Claudio Chiesa
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - Lucia Pacifico
- Policlinico Umberto I Hospital, Sapienza University of Rome, Italy
| | - Giovanni de Simone
- Hypertension Research Centre and Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Giuliana Valerio
- Department of Movement and Wellbeing Sciences, University of Naples Parthenope, Naples, Italy
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16
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Saxena A, Narang R. Reply to letter ‘Prevalence and determinants of hypertension in apparently healthy schoolchildren in India: A multi-center study’. Eur J Prev Cardiol 2019; 26:1345-1346. [DOI: 10.1177/2047487318818905] [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: 11/16/2022]
Affiliation(s)
- Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, India
| | - Rajiv Narang
- Department of Cardiology, All India Institute of Medical Sciences, India
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17
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Singh TD. Letter to the Editor. Eur J Prev Cardiol 2018; 26:221. [PMID: 30428265 DOI: 10.1177/2047487318814297] [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: 11/15/2022]
Affiliation(s)
- Tripat Deep Singh
- International Sleep Specialist (World Sleep Federation Program), Clinical Manager Sleep Philips, Singapore
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