The Prevalence of Elevated Blood Pressure and Its Association With Obesity in Children Aged 6-13 Years in Rural India: A Cross-Sectional Study

Introduction Globally, hypertension is one of the major risk factors for cardiovascular disease. Childhood hypertension is one of the emerging conditions due to the increase in the prevalence of obesity in children in developing countries. An increase in blood pressure (BP) can be classified as secondary hypertension if it is caused by an underlying disease process or as primary hypertension if there is no identifiable cause. Primary hypertension during childhood often tracks into adulthood. The prevalence of primary hypertension, mostly in older school-aged children and adolescents, has increased in parallel with an obesity epidemic. Materials and methods This cross-sectional descriptive study was taken in different schools in the rural areas of Trichy District, Tamil Nadu, for a period of six months from July 2022 to December 2022; the study was done in children between six and 13 years. Anthropometry was taken, and blood pressure was measured using an appropriate-size BP cuff and standardized sphygmomanometer. Three values were taken at an interval for a minimum of five minutes, and the mean of the three values was calculated. Blood pressure percentiles were adopted from the American Academy of Pediatrics (AAP) 2017 guidelines for childhood hypertension. Results Out of 878 students, 49 (5.58%) students had abnormal BP, of which 28 (3.19%) students were categorized into elevated BP and 21 (2.39%) students had hypertension both in stages 1 and 2. Abnormal blood pressure was equally distributed in both males and females. More students were from the age group between 12 and 13 years (chi-square value: 58.469, P=0.001), which shows that as age increases, the prevalence of hypertension increases. The mean weight was around 31.97 kg, and the mean height was 135.34 cm. In this study, we found that 223 (25%) students were overweight and 53 (6.03%) students were obese. The prevalence of hypertension was 15.09% in the obese category and 1.35% in the overweight category (chi-square value: 83.712, P=0.000). Conclusion Due to limited data available on childhood hypertension based on the American Academy of Pediatrics (AAP) 2017 guidelines, this study highlights the AAP 2017 guidelines for early diagnosis of elevated BP and various stages of hypertension in children, and also, the need for early detection of obesity is essential for the implementation of a healthy lifestyle. This study helps create awareness among parents regarding the rise of obesity and hypertension in children in rural populations of India.

Role Of Glp-1 Analogs In The Management Of Diabetes And Its Secondary Complication

The cardiovascular complications of type 2 diabetes mellitus (T2DM) include myocardial infarction, heart failure, peripheral vascular disease and, stroke and retinopathy, nephropathy and neuropathy are microvascular complications. While the newer therapies like glitazones or even dipeptidyl-peptidase-IV (DPP-IV) inhibitors increase the risk of therapy, the Glucagon Like Peptide-1 Receptor Agonists (GLP-1RAs), were reported as suitable alternates. The GLP-1RAs reduce the major adverse cardiovascular events (MACE), have anti-atherogenic potential, possess pleiotropic activity. The GLP-1RAs were found to improve neuroprotection, enhance neuronal growth, reduce the incidence of stroke, and found to improve central insulin resistance. The GLP-1RAs are beneficial in improving the glycemic profile, prevents macroalbuminuria and reduces the decline in eGFR and beneficial in improving renal protection. The renal benefits of add on therapy of GLP-1RAs with SGLT-2 inhibitors have composite renal outcomes such as suppression of inflammatory pathways, improvement in natriuresis, diuresis, and also found to be nephroprotective. Improvement in glycemic control with reduction in body weight and intraglomerular pressure and prevention of tubular injury makes the GLP-1RAs as suitable add-on therapies in improving cardiorenal outcomes. Obesity important contributor of insulin resistance and a reduction in weight is an important therapeutic option in addressing diabetic-obesity. It also reduces the damage to blood-retinal-barrier, thus beneficial in halting the development of diabetic retinopathy. In diabetic complications, glycemic control, addressing insulin resistance through weight loss, controlling atherosclerosis through anti-inflammatory effects and cardio-renal-neuro protection, makes GLP-1RAs a suitable therapeutic strategy on long-term treatment of T2DM. This review discusses the role of GLP-1RAs in diabetes, the dosage, mono or combination therapy with other antidiabetics in long-term treatment and its effect in uncontrolled diabetes.