Ambulatory blood pressure monitoring and blood pressure load in obese children

Does the Body Mass Index Category Influence Ambulatory Blood Pressure Parameters in Office Normotensive Obese Children?

The aim of our study was to investigate the influence of the degree of obesity on ambulatory blood pressure parameters in selected group of office normotensive obese children and adolescents. Our study involved 119 obese patients (55 males, 46.2%) aged 7-18 years divided into 3 groups based on their body mass index Z-score, who underwent ambulatory blood pressure monitoring. Our results show that obese patients, even when office normotensive, have alterations in blood pressure values obtained by ambulatory blood pressure monitoring. We found a positive correlation between systolic and diastolic blood pressure and body mass index in our patients (p [Formula: see text] 0.001). Daytime blood pressure load correlated with rising body mass index and was higher in groups II and III compared to group I (p < 0.001). Body mass index category did not influence the dipping pattern in our subjects although most of our subjects (66.4%) showed non-dipping pattern for systolic blood pressure. The difference in blood pressure variability was confirmed only for daytime systolic and diastolic values between groups I and II (p = 0.019 and p = 0.002, respectively). In conclusion, our study showed that in office normotensive obese children and adolescents, systolic and diastolic blood pressure values obtained by ambulatory blood pressure monitoring are higher in subjects with higher body mass index. Patients with increased body mass index also have higher percentage of blood pressure readings above 95^th percentile and increased daytime blood pressure variability. Obese patients show non-dipping pattern, independently of the rising body mass index category.

Comparison of ambulatory blood pressure monitoring and office blood pressure measurements in obese children and adolescents

BACKGROUND

Obesity in adults has been related to hypertension and abnormal nocturnal dipping of blood pressure, which are associated with poor cardiovascular and renal outcomes. Here, we aimed to resolve the relationship between the degree of obesity, the severity of hypertension and dipping status on ambulatory blood pressure in obese children.

METHODS

A total 72 patients with primary obesity aged 7 to 18 years (mean: 13.48 ± 3.25) were selected. Patients were divided into three groups based on body mass index (BMİ) Z-score. Diagnosis and staging of ambulatory hypertension based on 24-h blood pressure measurements, obtained from ambulatory blood pressure monitoring.

RESULTS

Based on our ambulatory blood pressure data, 35 patients (48.6%) had hypertension, 7 (20%) had ambulatory prehypertension, 21 (60%) had hypertension, and 7 patients (20%) had severe ambulatory hypertension. There was a significant relationship between severity of hypertension and the degree of obesity (p < 0.05). Thirty-one patients (88.6%) had isolated nighttime hypertension, and 53 patients (73.6%) were non-dippers. All systolic blood pressure results and loads were similar between groups. Diastolic and mean arterial blood pressure levels during the night, diastolic blood pressure loads, and heart rate during the day were significantly higher in Group 3 (p < 0.05). Nocturnal non-dipping was not associated with severity of obesity.

CONCLUSION

Obesity was associated with severity of hypertension, higher diastolic blood pressure at night, mean arterial pressure at night, diastolic blood pressure loads and heart rate at day. Increase in BMI Z-score does not a significant impact on daytime blood pressure and nocturnal dipping status.

Effect of plasma NOx values on cardiac function in obese hypertensive and normotensive pediatric patients

BACKGROUND

Hypertension (HT) is a major comorbidity of obesity that is associated with an increased risk of cardiovascular disease and higher mortality. The aim of our study was to evaluate cardiac function in obese hypertensive (OHT) and obese normotensive (ONT) pediatric patients and determine the effects of plasma nitric oxide (NOx) values on cardiac function, while demonstrating the role of plasma NOx in HT in obese pediatric patients.

METHODS

The study population consisted of 62 patients (27 boys, 35 girls), aged 13-18 years and 21 age-matched healthy controls. All subjects enrolled in the study underwent echocardiography (Echo) evaluation and ambulatory blood pressure monitoring for HT. Plasma NOx and biochemical values were studied in both patient groups separately.

RESULTS

Plasma NOx levels were found to be lower in the OHT group than in the ONT and control groups (p < 0.001) and to be negatively correlated with left ventricular mass index values (p < 0.05). Both the OHT and ONT groups had concentric hypertrophy of the heart.

CONCLUSIONS

Plasma NOx plays an essential role in obesity-induced HT. Concentric hypertrophy of the left ventricle was found in both the OHT and ONT groups, indicating structural deformation of the heart.

Association between obesity and the severity of ambulatory hypertension in children and adolescents

The goal of our study was to analyze the association between obesity and the severity of ambulatory hypertension in obese children. A total of 109 patients with primary obesity ages 7 to 18 years (mean ± SD age 14.1 ± 3.1) were enrolled. Patients were divided into three groups according to body mass index (BMI) Z-scores: group 1 (n = 27): BMI >1.65 and < 3.28 standard deviation scores (SDS); group 2 (n = 55): BMI >3.29 and <4.91 SDS; group 3 (n = 27): BMI >4.92 SDS. Definition and staging of ambulatory hypertension was based on blood pressure (BP) levels and BP load, obtained from ambulatory BP monitoring (ABPM). Only 24% had ambulatory normotension, 25% had ambulatory prehypertension, 3% had hypertension, and 48% had severe ambulatory hypertension. The severity of hypertension increased significantly with the degree of obesity (P = .0027). Daytime systolic, diastolic, and mean arterial BPs increased significantly with increased BMI, whereas the nighttime pressure remained elevated regardless of the degree of obesity. Isolated nighttime hypertension was observed in 25% of patients and 38% were classified as nondippers. Almost 50% of children with obesity and hypertension detected on ABPM suffer from severe ambulatory hypertension. BMI is associated with the severity of ambulatory hypertension and the increase of daytime BP.

The prevalence of hypertension in children with spina bifida

AIM

To determine whether children with spina bifida (SB) have a higher prevalence of hypertension (HTN) than population-based controls.

METHODS

Charts of all patients (n=123) seen in the Spina Bifida Clinic at Shriners Hospital in Houston, Texas, were reviewed for age, gender, ethnicity, type and level of neural tube defect, height, weight and blood pressure (BP). HTN was defined as a systolic blood pressure or diastolic blood pressure≥95th percentile for age, gender and height on ≥3 occasions. Data from the National Health and Nutrition Examination Survey and from a Houston-based study were used for comparison.

RESULTS

Fifty-one (41.5%) patients were hypertensive. This was significantly higher than the 3% prevalence in the national controls, p<0.001 and the 4.5% prevalence in the Houston controls, p<0.001. Maximum body mass index increased the risk for HTN [odds ratio, 1.018; 95% confidence interval (1.005, 1.031); and p=0.005].

CONCLUSION

Children with SB have a significantly higher prevalence of HTN than children in the general population. Age-, gender-, and height-based norms are important for the early identification and treatment of HTN in children.