A survey of blood pressure in Lebanese children and adolescence

A comparison of paediatric hypertension clinical practice guidelines and their ability to predict adult hypertension in an African birth cohort

It remains unclear which paediatric hypertension clinical practice guideline (CPG) should be applied in an African population. We, therefore, aimed to compare commonly used CPG (2017 AAP, 2016 ESH, 2004 Fourth Report) developed in high-income countries for use in South African children at four paediatric ages (children: 5 years, 8 years; adolescents: 13 years, 17 years) to determine which best predicts elevated blood pressure (BP) in adulthood (22 years, 28 years). Moreover, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each specific paediatric CPG was calculated across the age points. The 2017 AAP definition identified more children and adolescents with hypertension when compared to the 2004 Fourth Report and 2016 ESH guidelines. In computed hazards ratios, ages 8 years to 17 years, all three paediatric CPG significantly predicted the risk of elevated BP in young adulthood (p ≤ 0.032). However, sensitivity to predict elevated BP at age 22 years for all CPG was generally low (17.0%-33.0%) with higher specificity (87.4%-93.1%). Sensitivity increased at age 28 years (51.4%-70.1%), while specificity decreased (52.8%-65.1%). Both PPV and NPV at both adult age points varied widely (17.9%-79.9% and 29.3%-92.5% respectively). The performance of these paediatric CPG in terms of AUC were not optimal at both adult age points, however, the 2017 AAP definition at age 17 years met an acceptable level of performance (AUC = 0.71). Our results, therefore, highlight the need for more research to examine if an African-specific CPG would better identify high-risk children to minimise their trajectory towards adult hypertension.

Systematic review and meta-analysis: Prevalence of hypertension among adolescents in the Arab countries

PROBLEM

Hypertension (HTN) is one of the non-communicable diseases which prevalence is rising in both developed and developing countries. There is a scarcity of data on the prevalence of HTN in Arab countries. This review outlines what is currently known about prevalence and risk factors of HTN in adolescence in Arab world.

ELIGIBILITY CRITERIA

A systematic review and meta-analysis were conducted using PubMed, Cochrane Library, Scopus, CINAHL, Science Direct, and Google Scholar databases from 2011 to 2021.

SAMPLE

Fourteen studies from 9 Arab countries met inclusion criteria. Studies included a total of 777 adolescents with HTN and 2147 adolescents with pre-HTN.

RESULTS

The overall prevalence of HTN among adolescents in the Arab World was estimated at 12.6% (95CI 0.083-0.176), while pre-HTN was 13.9% (95CI 0.084-0205). Overweight and obesity resemble the higher risk of developing hypertension. Family history, high consumption of salt, smoking and low physical activity also increase the risk of HTN. The development of adolescent HTN can be predicted through anthropometric measurements such as Body Mass Index (BMI), wrist circumferences, and high waist circumference.

CONCLUSION

The prevalence of HTN among adolescents in the Arab world was significant, ranging from 4 to 26%. The heterogeneity between studies was high.

IMPLICATION

Local governments and policymakers must consider strengthening regulations to address environmental risk factors and improve public awareness about risk factors to HTN. A combined use of nurse- and patient targeted educational interventions could also help in reducing the burden of HTN in this population.

Blood pressure standards for pre-school children in Saudi Arabia

The prevalence of hypertension (HTN) in children is increasing. Early detection of HTN in childhood may prevent the occurrence of complications in adult age. Blood pressure (BP) varies between populations according to ethnic and environmental factors. Based on these variations, reference norms developed for one particular population may not be applicable to others. Thus, this study aimed to provide age-, gender-, and height-related BP reference standards using oscillometric techniques for pre-school children in Saudi Arabia. A sub-sample of preschool children aged from 2 to 6 years was selected by multi-stage probability sampling of Saudi population. The samples represented Saudi children from the whole country. Data were collected through a house-to-house survey of all selected households in all 13 regions in the country. Oscillometric devices were used to measure the BP. Data were analyzed to study the distribution pattern of systolic (SBP) and diastolic BP (DBP) and to develop reference values based on age, gender, and height. The values for each age and height percentile were compared with the recent (2017) values of the North American children. A total of 2553 Saudi Arabian children (1299 boys and 1254 girls) aged 2-6 years with complete data on age, gender, height, SBP, and DBP were considered for analysis. Values for SBP and DBP were significantly higher in Saudi children than in the North American children. This study adds evidence to the BP variations between populations with influences such as genetic and environmental factors. The need of every population to define its normal BP standards is essential to avoid unnecessary investigations and anxiety in patients and their parents.

HbA1c AND BLOOD PRESSURE MEASUREMENTS: RELATION WITH GENDER, BODY MASS INDEX, STUDY FIELD, AND LIFESTYLE IN LEBANESE STUDENTS

Objective: The purpose of this study is to determine the prevalence of prediabetes/diabetes in Lebanese university students and to examine the relationship between both hemoglobin A1c (HbA1c) and blood pressure (BP) and gender, body mass index (BMI), study field, and lifestyle factors. Methods: This cross-sectional study was carried out at the Saint-Joseph University of Beirut. A total of 603 students aged 18 to 25 years were recruited from both the medical science campus (MSC) and the social science campus (SSC) between January, 2016, and May, 2018. Waist circumference (WC), BMI, and BP were determined for each student and HbA1c was measured using the Siemens vintage DCA device. Participants completed a self-administered questionnaire about their eating habits and level of physical activity. Results: The mean age of the population was 20.31 ± 1.76 years. The percentage of participants recruited from the MSC was 59.2%. The prevalence of prediabetes was 2.5%. Lower BMI, WC, and HbA1c values, and higher diastolic BP (DBP) were found in MSC students compared to SSC ones. HbA1c, systolic BP (SBP), and DBP were correlated with BMI (P = .02, P<.0001, and P = .017, respectively). HbA1c was not associated with eating habits or physical activity. DBP was inversely associated with physical activity (P = .002), while SBP was positively associated with fast food consumption (P = .003). Conclusion: The present study shows a low prevalence of prediabetes in Lebanese students. BMI and the study field are the main factors predicting HbA1c and BP. Further studies are needed to extrapolate our results to the overall young Lebanese population. Abbreviations: ADA = American Diabetes Association; BMI = body mass index; BP = blood pressure; DBP = diastolic blood pressure; HbA1c = hemoglobin A1c; HTN = hypertension; MSC = medical science campus; SBP = systolic blood pressure; SSC = social science campus; T2D = type 2 diabetes; US = United States; USJ = Saint-Joseph University; WC = waist circumference.

Strengths and limitations of current pediatric blood pressure nomograms: a global overview with a special emphasis on regional differences in neonates and infants

The availability of robust nomograms is essential for the correct evaluation of blood pressure (BP) values in children. A literature search was conducted by accessing the National Library of Medicine by using the keywords BP, pediatric and reference values/nomograms. A total of 43 studies that evaluated pediatric BP nomograms were included in this review. Despite the accuracy of the latest studies, many numerical and methodological limitations still remain. The numerical limitations include the paucity of data for neonates/infants and for some geographic areas (Africa/South America/East Europe/Asia) and ethnicities. Furthermore, the data on ambulatory BP and response to exercise are extremely limited, and the criteria for stress-test interruption are lacking. There was heterogeneity in the methodologies employed to perform the measurements, in the inclusion/exclusion criteria (often not reported), in the data normalization and the data expression (Z-scores/percentiles/mean values). Although most studies adjusted the measurements for age and/or height, the classification by specific age/height subgroups varied. Gender differences were generally considered, whereas other confounders (that is, ethnicity/geographic area/environment) were seldom evaluated. As a result, nomograms were heterogeneous, and when comparable, at times showed widely different confidence intervals. These differences are most likely because of both methodological limitations and differences among the populations studied. Some robust nomograms exist (particularly those from the USA); however, it has been demonstrated that if adopted in other countries/continents, they may generate an unpredictable bias in the evaluation of BP values in children. Actual pediatric BP nomograms present consistent limitations that affect the evaluation of BP in children. Comprehensive nomograms, which are based on a large population of healthy children (including neonates/infants) and use standardized methodology, are warranted for every country/region.

Prevalence of overweight and obesity in portuguese adolescents: comparison of different anthropometric methods

Background:

The recommended anthropometric methods to assess the weight status include body mass index (BMI), skinfold thickness, and waist circumference. However, these methods have advantages and disadvantages regarding the classification of overweight and obesity in adolescents.

Aims:

The study was to analyze the correlation between the measurements of BMI, skinfold thickness and waist circumference to assess overweight and obesity in Portuguese adolescents.

Materials and Methods:

A sample of 966 students of Portugal was used. Of them, 437 (45.2%) were males and 529 (54.8%) were females aged between 10 and 16 years. The evaluations included BMI calculation, skinfold thickness, and waist circumference measurements.

Results:

This study revealed a high prevalence of overweight and obesity with values ranging from 31.6%, 61.4%, and 41.1% according to the measurement of BMI, skinfold thickness, and waist circumference, respectively. The results found a high level of correlation between BMI and skinfold thickness (P < 0.001, r = 0.712), between BMI and waist circumference (P < 0.001, r = 0.884), and waist circumference and skinfold thickness (P < 0.001, r = 0.701).

Conclusions:

This study revealed a high prevalence of overweight and obesity in Portuguese adolescents using three different anthropometric methods, where the BMI showed the lowest values of prevalence of overweight and obesity and the skinfold thickness showed the highest values. The three anthropometric methods were highly correlated.

Fractional systolic and diastolic pressures act as predictors of coronary artery disease

AIMS

This study was designed to determine if fractional systolic/diastolic pressures act as predictors of the extent of coronary artery disease.

PATIENTS AND METHODS

A total of 545 consecutive patients (305 men, 240 women, with mean age 54.2 years) were involved in the study. The patients were diagnosed with coronary and non-coronary artery disease confirmed by angiography.

RESULTS

353 patients were confirmed to have coronary artery disease, with 134 cases involving one vessel, 101 two vessels and 118 three vessels. There were significant differences between brachial and ascending aortic systolic blood pressures, fractional systolic blood pressures and fractional diastolic blood pressures in the patients with coronary artery disease compared with patients with non-coronary artery disease. Blood pressure measured in the brachial artery was higher than the pressure measured in the ascending artery. Ascending aortic fractional systolic/diastolic pressures were associated with coronary Gensini score, and were significantly related to the number of diseased vessels.

CONCLUSIONS

Fractional systolic and diastolic pressures in the ascending aorta were strong predictive factors for the extent of coronary artery disease. Central pressures measured invasively in the ascending aorta were more predictive than peripheral pressures for the evaluation of coronary artery disease.