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Nagaraju SP, Shenoy SV, Rao IR, Bhojaraja MV, Rangaswamy D, Prabhu RA. Measurement of Blood Pressure in Chronic Kidney Disease: Time to Change Our Clinical Practice - A Comprehensive Review. Int J Nephrol Renovasc Dis 2022; 15:1-16. [PMID: 35177924 PMCID: PMC8843793 DOI: 10.2147/ijnrd.s343582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/31/2021] [Indexed: 11/24/2022] Open
Abstract
Chronic kidney disease (CKD) is extremely common all over the world and is strongly linked to cardiovascular disease (CVD). The great majority of CKD patients have hypertension, which raises the risk of cardiovascular disease (CVD), end-stage kidney disease, and mortality. Controlling hypertension in patients with CKD is critical in our clinical practice since it slows the course of the disease and lowers the risk of CVD. As a result, accurate blood pressure (BP) monitoring is crucial for CKD diagnosis and therapy. Three important guidelines on BP thresholds and targets for antihypertensive medication therapy have been published in the recent decade emphasizing the way we measure BP. For both office BP and out-of-office BP measuring techniques, their clinical importance in the management of hypertension has been well defined. Although BP measurement is widely disseminated and routinely performed in most clinical settings, it remains unstandardized, and practitioners frequently fail to follow the basic recommendations to avoid measurement errors. This may lead to misdiagnosis and wrong management of hypertension, especially in CKD patients. Here, we review presently available all BP measuring techniques and their use in clinical practice and the recommendations from various guidelines and research gaps emphasizing CKD patients.
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Affiliation(s)
- Shankar Prasad Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | - Srinivas Vinayak Shenoy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | - Indu Ramachandra Rao
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | - Mohan V Bhojaraja
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
- Correspondence: Mohan V Bhojaraja, Email
| | - Dharshan Rangaswamy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | - Ravindra Attur Prabhu
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
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Stergiou G, Stambolliu E, Bountzona I, Ntineri A, Kollias A, Vazeou A, Soldatou A. Home Blood Pressure Monitoring in Children and Adolescents: Systematic Review of Evidence on Clinical Utility. Curr Hypertens Rep 2019; 21:64. [PMID: 31240404 DOI: 10.1007/s11906-019-0967-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW For the accurate diagnosis and management of hypertension, out-of-office blood pressure evaluation using ambulatory (ABPM) or home monitoring (HBPM) is currently recommended. In children, there is considerable evidence on the clinical utility of ABPM, whereas the evidence on HBPM is limited. This systematic review presents (i) the benefits of HBPM in children; (ii) the evidence on normal range, diagnostic accuracy, and relationship with preclinical organ damage; and (iii) guidance for devices, monitoring schedule, and interpretation. RECENT FINDINGS HBPM is a useful adjunct to the conventional office measurements for the evaluation of children with suspected or treated hypertension. HBPM is feasible in children and has good reproducibility, diagnostic accuracy and acceptability by users, and relatively low cost. Thus, it has greater potential for widespread and long-term use than ABPM, which is more expensive and often not available or not tolerated. Automated monitors that have been clinically validated specifically in children should be used with appropriate cuff size. HBPM for 7 days (minimum 3) with duplicate morning and evening measurements (minimum 12 readings) should be performed in children with suspected or treated hypertension before each office visit. Until more data become available, in case of diagnostic disagreement between office blood pressure and HBPM, treatment decisions should be based on ABPM. HBPM is clinically useful in children with hypertension. More research is needed on its clinical application, and more automated devices need to be clinically validated in this population.
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Affiliation(s)
- George Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece.
| | - Emelina Stambolliu
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Ioanna Bountzona
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Andriani Vazeou
- First Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, P&A Kyriakou Children's Hospital, Athens, Greece
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Management of high blood pressure in children: similarities and differences between US and European guidelines. Pediatr Nephrol 2019; 34:405-412. [PMID: 29594504 PMCID: PMC6162184 DOI: 10.1007/s00467-018-3946-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
Over the last several decades, many seminal longitudinal cohort studies have clearly shown that the antecedents to adult disease have their origins in childhood. Hypertension (HTN), which has become increasingly prevalent in childhood, represents one of the most important risk factors for cardiovascular diseases (CVD) such as heart disease and stroke. With the risk of adult HTN much greater when HTN is manifest in childhood, the future burden of CVD worldwide is therefore concerning. In an effort to slow the current trajectory, professional societies have called for more rigorous, evidence-based guideline development to aid primary care providers and subspecialists in improving recognition, diagnosis, evaluation, and treatment of pediatric HTN. In 2016 the European Society of Hypertension and in 2017 the American Academy of Pediatrics published updated guidelines for prevention and management of high blood pressure (BP) in children. While there are many similarities between the two guidelines, important differences exist. These differences, along with the identified knowledge gaps in each, will hopefully spur clinical researchers to action. This review highlights some of these similarities and differences, focusing on several of the more important facets regarding prevalence, prevention, diagnosis, management, and treatment of childhood HTN.
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Lalji R, Tullus K. What's new in paediatric hypertension? Arch Dis Child 2018; 103:96-100. [PMID: 28818842 DOI: 10.1136/archdischild-2016-311662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/31/2017] [Accepted: 06/12/2017] [Indexed: 11/04/2022]
Abstract
Paediatric hypertension predisposes to hypertension and cardiovascular disease in adult life. Despite clear guidelines, there remains a lack of screening. Diagnosis remains challenging given the high rate of false-positive high blood pressure (BP) readings at a single visit; thus, multiple visits are required to confirm the diagnosis. Depending on the normative data sets used, hypertension in overweight and obese children can be underestimated by up to 20%. Specific BP targets are required for subgroups such as adolescents, children with chronic kidney disease (CKD) and type 1 diabetes. High dietary salt intake is a risk factor for cardiovascular disease. Given the rise in processed food consumption, children in developed nations are likely to benefit from salt restriction at a population-based level.
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Affiliation(s)
- Rowena Lalji
- Departmentof Paediatric Nephrology, Great Ormond Street Hospital for Children, London, UK.,Departmentof Paediatric Nephrology, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Kjell Tullus
- Departmentof Paediatric Nephrology, Great Ormond Street Hospital for Children, London, UK
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Mollerup PM, Lausten-Thomsen U, Fonvig CE, Baker JL, Holm JC. Reductions in blood pressure during a community-based overweight and obesity treatment in children and adolescents with prehypertension and hypertension. J Hum Hypertens 2017; 31:640-646. [DOI: 10.1038/jhh.2017.36] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/02/2017] [Accepted: 03/27/2017] [Indexed: 11/09/2022]
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Jardim TV, Gaziano TA, Nascente FM, Carneiro CDS, Morais P, Roriz V, Mendonça KL, Póvoa TIR, Barroso WKS, Sousa ALL, Jardim PCV. Office blood pressure measurements with oscillometric devices in adolescents: a comparison with home blood pressure. Blood Press 2017; 26:272-278. [PMID: 28376650 DOI: 10.1080/08037051.2017.1312279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Compare multiple in office BP measurements in adolescents using an oscillometric device with out-of-office blood pressure measurements (home blood pressure monitoring - HBPM). MATERIALS AND METHODS Office measurements were performed with validated semi-automatic devices twice (3 minutes interval) in two different moments (1 week apart), with a total of four readings. These BP readings were named R1, R2, R3 and R4 (following the sequence they were performed), FDM (mean of two readings on first day) and SDM (mean of two readings on second day) and SRM (R2-R4 means). The HBPM protocol included two day-time and two evening-time measurements over 6 days. RESULTS A total of 1024 students between 12 and 17 years were included (mean age 14.68 years; 52.4% females). The mean systolic blood pressure (SBP) values of R2, SDM and SRM were similar to HBPM values. Regarding diastolic blood pressure (DBP) HBPM value was different than R4. High SBP and DBP correlation coefficients with HBPM values were found for R2, SDM and SRM values. CONCLUSION The second office BP measurement performed with an oscilometric device in adolescents was comparable to HBPM values, suggesting that two office readings might be suitable to rule out hypertension in this age group.
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Affiliation(s)
- Thiago Veiga Jardim
- a Hypertension League - Federal University of Goias , Goiânia , GO , Brazil.,b Brigham & Women's Hospital - Division of Cardiovascular Medicine , Boston , MA , USA.,c Harvard TH Chan School of Public Health - Department of Health Policy and Management , Center for Health Decision Science , Boston , MA , USA
| | - Thomas A Gaziano
- b Brigham & Women's Hospital - Division of Cardiovascular Medicine , Boston , MA , USA.,c Harvard TH Chan School of Public Health - Department of Health Policy and Management , Center for Health Decision Science , Boston , MA , USA
| | | | | | - Polyana Morais
- a Hypertension League - Federal University of Goias , Goiânia , GO , Brazil
| | - Vanessa Roriz
- a Hypertension League - Federal University of Goias , Goiânia , GO , Brazil
| | | | - Thaís Inácio Rolim Póvoa
- a Hypertension League - Federal University of Goias , Goiânia , GO , Brazil.,d School of Physical Education and Therapy (ESEFFEGO) , State University of Goiás (UEG) , Goiânia , GO , Brazil
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Kang KT, Chiu SN, Weng WC, Lee PL, Hsu WC. Comparisons of Office and 24-Hour Ambulatory Blood Pressure Monitoring in Children with Obstructive Sleep Apnea. J Pediatr 2017; 182:177-183.e2. [PMID: 27939257 DOI: 10.1016/j.jpeds.2016.11.032] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 10/05/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare office blood pressure (BP) and 24-hour ambulatory BP (ABP) monitoring to facilitate the diagnosis and management of hypertension in children with obstructive sleep apnea (OSA). STUDY DESIGN Children aged 4-16 years with OSA-related symptoms were recruited from a tertiary referral medical center. All children underwent overnight polysomnography, office BP, and 24-hour ABP studies. Multiple linear regression analyses were applied to elucidate the association between the apnea-hypopnea index and BP. Correlation and consistency between office BP and 24-hour ABP were measured by Pearson correlation, intraclass correlation, and Bland-Altman analyses. RESULTS In the 163 children enrolled (mean age, 8.2 ± 3.3 years; 67% male). The prevalence of systolic hypertension at night was significantly higher in children with moderate-to-severe OSA than in those with primary snoring (44.9% vs 16.1%, P = .006). Pearson correlation and intraclass correlation analyses revealed associations between office BP and 24-hour BP, and Bland-Altman analysis indicated an agreement between office and 24-hour BP measurements. However, multiple linear regression analyses demonstrated that 24-hour BP (nighttime systolic BP and mean arterial pressure), unlike office BP, was independently associated with the apnea-hypopnea index, after adjustment for adiposity variables. CONCLUSIONS Twenty-four-hour ABP is more strongly correlated with OSA in children, compared with office BP.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.
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Hypertension in Young People: Epidemiology, Diagnostic Assessment and Therapeutic Approach. High Blood Press Cardiovasc Prev 2015; 22:381-8. [PMID: 26153401 DOI: 10.1007/s40292-015-0114-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022] Open
Abstract
High blood pressure (BP) still remains one of the most relevant cardiovascular risk factors, also due to its persistently high prevalence and growing incidence in the general adult and elderly population. Since almost all hypertension-related cardiovascular complications, mostly including coronary artery disease, myocardial infarction, ischemic stroke, and congestive heart failure, occurred in adult and elderly individuals, evidence on both prevalence and clinical management of hypertension in young individuals are lacking. Therefore, the clinical impact of high BP levels in young populations remains to be explored. In the recent years, the attitude of the scientific community has changed and more attention was devoted to young individuals with hypertension, also in view of the fact that early identification of these subjects may prevent developing of established hypertension in adulthood. In addition, unhealthy lifestyle habits have progressively involved children and adolescents worldwide, thus contributing to further increase the risk of developing hypertension in young individuals. On the basis of these considerations, the present review is aimed at providing a brief reappraisal of the major aspects of hypertension in the young age, as well as at promoting interest and discussion on this important issue.
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Tekın N, Ersoy B, Coskun S, Tekın G, Polat M. Ambulatory blood pressure parameters in office normotensive obese and non-obese children: relationship with insulin resistance and atherosclerotic markers. Med Princ Pract 2014; 23:154-9. [PMID: 24247272 PMCID: PMC5586850 DOI: 10.1159/000356120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 10/03/2013] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To determine differences in ambulatory blood pressure (ABP) parameters between office normotensive obese and non-obese children and to evaluate correlations of ABP parameters with insulin resistance and the lipid profile. SUBJECTS AND METHODS Thirty-eight obese [body mass index (BMI) above the 95th percentile] and 38 non-obese children aged 9-17 years were recruited. All subjects who were normotensive during office visits and who underwent 24-hour ABP monitoring were evaluated. Insulin resistance and the lipid profile were also evaluated. RESULTS The mean daytime, night-time and 24-hour systolic blood pressure (SBP) and the daytime and 24-hour diastolic blood pressure (DBP) in normotensive obese children were significantly higher compared to the values in non-obese children (p < 0.05). There was no difference in the frequency of nocturnal non-dippers and nocturnal hypertension (night-time SBP at or above the 95th percentile) between the two groups (p > 0.05). Children with night-time SBP at or above the 95th percentile and non-dippers had higher atherosclerotic markers than children with night-time SBP below the 95th percentile and dippers (p < 0.05). In logistic regression analysis, the low-density lipoprotein cholesterol (LDL-C):high-density lipoprotein cholesterol (HDL-C) ratio and night-time SBP had significantly positive associations with being obese in adolescents (OR 6.54, 95% CI 1.15-37.07, p = 0.03, and OR 1.1, 95% CI 1.01-1.19, p = 0.02, respectively). CONCLUSION Normotensive obese children had higher ABP parameters. A high LDL-C:HDL-C ratio and night-time SBP were associated with an increased risk of being obese. High LDL-C:HDL-C ratios and total cholesterol:HDL-C levels in children and adolescents may be risk factors for night-time hypertension.
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Affiliation(s)
- Nese Tekın
- Department of Pediatrics and Divisions, Celal Bayar University, Manisa, Turkey
| | - Betul Ersoy
- Pediatric Endocrinology and Metabolism, Celal Bayar University, Manisa, Turkey
- *Betül Ersoy, MD, 52/100 Sokak, No. 7/9, TR-35350 Esendere-İzmir (Turkey), E-Mail
| | - Senol Coskun
- Pediatric Cardiology, School of Medicine, Celal Bayar University, Manisa, Turkey
| | - Gokhan Tekın
- Department of Pediatrics and Divisions, Celal Bayar University, Manisa, Turkey
| | - Muzaffer Polat
- Department of Pediatrics and Divisions, Celal Bayar University, Manisa, Turkey
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Eakin MN, Brady T, Kandasamy V, Fivush B, Riekert KA. Disparities in antihypertensive medication adherence in adolescents. Pediatr Nephrol 2013; 28:1267-73. [PMID: 23512259 PMCID: PMC3702665 DOI: 10.1007/s00467-013-2455-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 02/20/2013] [Accepted: 02/21/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hypertension affects up to 5 % of all children, but little is known about the role of medication adherence on blood pressure (BP) control. In this study we examined the association between adolescents' antihypertensive medication adherence and BP control, investigating for racial disparities. METHODS A total of 21 adolescents with essential hypertension [mean age 14.7 ± 2.0 years, 57 % male, 52 % African American] were recruited from a pediatric nephrology clinic. Objective medication adherence measures were obtained with Medication Event Monitoring System (MEMS) caps and pharmacy refill records to determine medication possession ratios (MPRs). RESULTS The African Americans adolescents had lower medication adherence than non-African Americans adolescents based on the MPR over the past 12 months (mean 0.54 ± 0.21 vs. 0.85 ± 0.16, respectively; p < 0.001) and a trend for less adherence measured by MEMS caps over the last 28 days (mean 0.75 ± 0.26 vs. 0.91 ± 0.04, respectively; p < 0.07). Seven of the eight participants with low adherence (MPR <0.65) had uncontrolled BP (systolic and/or diastolic BPs ≥ 95th percentile), and no participants with high adherence according to the MPR had uncontrolled BP (p < 0.001). There was no difference in BP control by race. CONCLUSIONS Antihypertensive medication adherence measured by pharmacy refills was associated with BP control. AAs were more likely to have lower medication adherence. Targeting medication adherence through the use of electronic medical records may be a potential mechanism to reduce health disparities.
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Affiliation(s)
- Michelle N. Eakin
- Johns Hopkins Adherence Research Center, Department of Medicine Johns Hopkins School of Medicine
| | - Tammy Brady
- Division of Nephrology, Department of Pediatrics, Johns Hopkins School of Medicine
| | - Veni Kandasamy
- Johns Hopkins Adherence Research Center, Department of Medicine Johns Hopkins School of Medicine
| | - Barbara Fivush
- Division of Nephrology, Department of Pediatrics, Johns Hopkins School of Medicine
| | - Kristin A. Riekert
- Johns Hopkins Adherence Research Center, Department of Medicine Johns Hopkins School of Medicine
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Kollias A, Psilopatis I, Karagiaouri E, Glaraki M, Grammatikos E, Grammatikos EE, Garoufi A, Stergiou GS. Adiposity, blood pressure, and carotid intima-media thickness in greek adolescents. Obesity (Silver Spring) 2013; 21:1013-7. [PMID: 23784905 DOI: 10.1002/oby.20194] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 11/09/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In children and adolescents with cardiovascular risk factors, the assessment of subclinical target-organ damage is of paramount importance. This study investigated factors associated with carotid intima-media thickness (cIMT) in adolescents. DESIGN AND METHODS A cross-sectional study was performed in 448 apparently healthy adolescents recruited from schools (mean age 14 ± 2.2 years, 211 boys), which involved cIMT measurements (common carotid artery) and assessment of lipid profile, glucose, and blood pressure (BP). RESULTS The prevalence of overweight/obesity was 28.1%/12.7% and of BP ≥95th percentile 19.6%. Left cIMT was correlated with age (r = 0.10), waist circumference (WC) (0.15), and BP (0.21/0.13, systolic/diastolic) (all P < 0.05). Right cIMT was correlated with waist to hip ratio (WHR) (0.10), whereas the mean of left and right cIMT was correlated with WC (0.12), WHR (0.12), and systolic BP (0.14) (all P < 0.05). After the age of 13 years, boys tended to have higher cIMT than girls, which was significant in the 13-15 years subgroup (P < 0.05). In stepwise multivariate analysis (independent variables: age, gender, WC, WHR, body mass index z-score, lipid parameters, glucose, BP), left cIMT was independently associated with systolic BP; right cIMT with WHR; mean left and right cIMT with WC. Adolescents with BP ≥90th percentile had higher left cIMT than those <90th percentile (0.63 ± 0.09 vs. 0.61 ± 0.09 mm respectively, P < 0.05). CONCLUSION Central adiposity and systolic BP appear to be independently associated with increased cIMT values in apparently healthy adolescents. Left side cIMT appears to be superior to right side measurements in terms of association with cardiovascular risk factors.
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Affiliation(s)
- Anastasios Kollias
- Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
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Abstract
Pediatric hypertension (HTN) has become the focus of interest recently due to its increasing prevalence. This is mainly related to the increase in childhood obesity, although the current evidence suggests that other lifestyle factors, apart from obesity, contribute to high blood pressure (BP) in childhood. Traditionally, office BP measurements by the physician have been the cornerstone for the assessment of HTN in children. However, since the white coat and masked HTN phenomena are not rare in childhood, out-of-office BP measurements have significantly improved the accurate diagnosis of HTN and decision making. Ambulatory BP monitoring is regarded as indispensable for the evaluation of pediatric HTN, providing details not only for the staging for HTN, but also for the study of other ambulatory BP patterns. It should be pointed out that HTN in children and adolescents is associated with target-organ damage which is significant in terms of cardiovascular risk. The current knowledge, outlined in the present review, is expected to help in early and accurate diagnosis as well as in the management of HTN in children and adolescents.
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Kollias A, Skliros E, Stergiou GS, Leotsakos N, Saridi M, Garifallos D. Obesity and associated cardiovascular risk factors among schoolchildren in Greece: a cross-sectional study and review of the literature. J Pediatr Endocrinol Metab 2011; 24:929-38. [PMID: 22308844 DOI: 10.1515/jpem.2011.309] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine the prevalence and determinants of obesity and associated cardiovascular risk factors in a sample of Greek children. METHODS This is a cross-sectional, school-based study of 780 students (9.2 +/- 1.8 years old, 415 boys) conducted in Eastern Attica, the greater area of the city of Athens. The study protocol included anthropometric, blood pressure (BP), and biochemical measurements, as well as dietary and lifestyle habits assessment. A review of Greek studies on childhood obesity was also performed. RESULTS Approximately 22% of the participants were overweight and 8% were obese, which is in accordance with the results of 24 previous Greek studies showing the childhood overweight/obesity prevalence in the range of 30%. Overweight/obese children compared with normal-weight children had higher BP, lower high-density lipoprotein cholesterol (HDL-C), and higher triglycerides (p < 0.05 for all). Parental weight, consumption of sweets and fast-food, and decreased physical activity were independent determinants of being overweight/obese. Furthermore, overweight/obesity predicted the presence of high BP, low HDL-C, and high triglycerides. CONCLUSION A close association was revealed between obesity and metabolic abnormalities, underlining the need for early screening and intervention in overweight children in order to address the emerging childhood obesity epidemic in Greece.
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Affiliation(s)
- Anastasios Kollias
- Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
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