Habitual food consumption, eating behavior and meal-timing among Jordanian adults with elevated Blood pressure: a cross-sectional population-based study

BACKGROUND

The prevalence of elevated blood pressure (BP) has been raised worldwide. Food consumption, eating habits, and nutritional lifestyle related to meal timing, skipping meals, and meal contents have recently received more attention in studies on BP and metabolic syndrome. Purpose: This study evaluated the association between habitual food consumption, eating behavior, and meal timing with BP among Jordanian adults.

METHODS

A cross-sectional study included 771 Jordanian adults. A food frequency questionnaire was completed. Data about eating habits, meal timing, and emotional eating were collected. BP was measured.

RESULTS

The prevalence of less than recommended intake of vegetables, milk, protein, and fruits was higher in participants with elevated BP (69.2%, 90.2%, 58.9%, and 25.5%, respectively) as compared to the normal BP group (p < 0.001). Consuming vegetables and milk less than the recommended was reported to significantly increase the likelihood of elevated BP by OR= (1.60, and 2.75 (95%CI: 1.06-2.40; 1.62-4.66). Hence, consuming more than recommended fruit reduced the risk of elevated BP by OR = 0.56 (95%CI: 0.38-0.82). A 63.2% of elevated BP participants have three meals daily, a higher percentage of intake of one (23.5%) and two (45.7%) snacks. However, they had a higher percentage of morning eaters (50.7%), had lunch between 1:00-6:00 PM (92.7%), and had dinner between 6:00 and 9:00 PM (68.1%).

CONCLUSIONS

Although Jordanian adults with elevated BP appear to have healthy eating habits and meal timing and frequency, their habitual food consumption falls short of the daily recommendations for milk, fruits, vegetables, and protein.

The Impact of Stimulant Medications on Blood Pressure and Body Mass Index in Children with Attention Deficit Hyperactivity Disorder

OBJECTIVE

To describe changes in blood pressure (BP) and body mass index (BMI) associated with stimulant medication fills in children.

METHODS

Observational, retrospective matched cohort study of children 6-17.9 years initiating stimulant medication between 7/1/2010-6/30/2017 matched 1:3 by age, race, ethnicity, and sex to children with no stimulant use during this period. All BPs and BMIs recorded during ambulatory visits were identified. Generalized linear models were used to estimate differences in change in systolic BP (SBP), diastolic BP (DBP), and BMI over time.

RESULTS

The 686 children with stimulant prescription fills and 2048 matched controls did not differ by baseline SBP or BMI. The matched control group (30.5% female, mean age 11.2 ± 3.4 years 79.7% white) was more likely to be publicly insured (35% vs. 21%, P < .01). After adjusting for baseline values, over a mean follow-up of 144 days change in SBP or DBP did not differ significantly between patients with stimulant medication fills and matched controls. Stimulant use was associated with a 4.7 percentile decrease in BMI percentile compared to matched controls (95% CI: 3.69, 5.71; P < .01).

CONCLUSIONS

In a pediatric primary care cohort, stimulant prescription fills were associated with marked decreases in BMI but no significant changes in BP over time.

Association between anxiety and elevated blood pressure in adolescent patients: a single-center cross-sectional study

OBJECTIVE

Although anxiety is known to be associated with elevated blood pressure and hypertension in adults, this has not been studied in children. The aim of this study was to determine the association between anxiety and elevated blood pressures in adolescents.

METHODS

Adolescents, aged 12-18 years old, referred to the nephrology clinic were eligible to participate. Elevated blood pressure was defined as either SBP or DBP measurement above the 95th percentile for age, height, and sex. Participants were evaluated for anxiety using the validated Screen for Child Anxiety Related Disorders questionnaire filled independently by the child (SCARED-C) and parent (SCARED-P) evaluating the child.

RESULTS

Two hundred adolescents participated in this study. Thirty-one (53%) of SCARED-P-positive participants were found to have elevated blood pressure compared with 27 (19%) of SCARED-P negative, P 0.03. Twenty-five (43%) of SCARED-P positive had elevated DBP compared with 31 (28%) of SCARED-P negative ( P 0.003). In SCARED-P positive, mean DBP (78.4 ± 9.9) was higher compared with SCARED-P negative (74.9 ± 9.2) ( P 0.03). In a subgroup of adolescents (№ 130) not treated with blood pressure medications mean DBP was higher in both SCARED-P (79.0 ± 10.1) and SCARED-C (77.1 ± 10.4) positive groups compared with SCARED-P (73.6 ± 9.3) and SCARED-C (73 ± 8.9) negative, respectively.

CONCLUSION

Our study demonstrates an association between anxiety and elevated DBP in adolescent children. Screening adolescents for anxiety should be a part of the routine evaluation of adolescent children.

A retrospective study at a tertiary facility in Japan

AIM

In 2017, the American College of Cardiology (ACC) re-defined hypertension (HT) as follows: elevated blood pressure (EBP), systolic blood pressure (SBP) 120-129 mmHg and diastolic blood pressure (DBP) <80 mmHg; stage 1 HT, SBP 130-139 mmHg or DBP 80-89 mmHg; and stage 2 HT: SBP ≥140 mmHg or DBP ≥90 mmHg. It is well known that women with stage 2 HT are at higher risk of preeclampsia and have poorer pregnancy and delivery outcomes. While there are few reports on the risk in women with EBP and stage 1 HT, and none from Japan. This study aimed to determine whether women in Japan with EBP and stage 1 HT are at risk of preeclampsia.

METHODS

In this single-center retrospective study conducted in Japan, subjects were classified into stage 2 HT, stage 1 HT, EBP, and normal groups based on blood pressure measurements at the time of the first visit before 20 weeks of gestation. Women with a diagnosis of hypertension made before pregnancy were classified into the stage 2 HT group. We compared pregnancy and delivery outcomes, such as preeclampsia, between groups.

RESULTS

A total of 5129 cases (normal, n = 4283; EBP, n = 427; stage 1 HT, n = 303; stage 2 HT, n = 116) were included. Preeclampsia incidence rates were 2.7%, 5.6%, 10.6%, and 21.6%, respectively. The adjusted OR (95% CI) for preeclampsia incidence were 2.90 (1.81-4.66), 5.90 (3.87-9.20), and 13.80 (7.97-24.0), respectively.

CONCLUSIONS

Women with EBP and stage 1 HT are at high risk of preeclampsia, similar to those with stage 2 HT.

The efficacy of glyceryl trinitrate for acute intracerebral hemorrhage: A systematic review and meta-analysis

Current research on the effects of glyceryl trinitrate (GTN) on the lowering of elevated blood pressure (BP) among patients with acute intracerebral hemorrhage (AIH) has not been highly emphasized. The aim of this meta-analysis is to examine the effects of GTN in patients with acute stroke. The lowering of BP was the primary outcome measure in patients treated with GTN compared to no-GTN treatment. A meta-analysis was performed to evaluate the efficacy of GTN in lowering BPs and analyze the outcomes of GTN treatment. Appropriate articles were searched using PubMed, Taylor & Francis Online, Cochrane, Scopus, ScienceDirect, Wiley Online Library, and Springer, with the use of appropriate keywords as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Out of 13 articles eligible for this study, 7 studies qualified for the meta-analysis by meeting the inclusion criteria. The PRISMA guidelines and the recommendations of Cochrane Collaboration were followed when conducting this meta-analysis. After subgroup analysis, differences between patients treated with GTN and without GTN were analyzed. The lowering of BP resulted in improved functional outcomes in patients treated with GTN. This meta-analysis showed differences between the 2 groups, with a risk ratio (RR) of 1.01 (95% confidence interval (95% CI): 0.92-10.07, p = 0.30, I2 = 18%). There was a significant improvement in outcome measures in patients treated with GTN by lowering elevated BP after acute stroke.

Oral Glucose Tolerance Test in Pregnancy and Subsequent Maternal Hypertension

OBJECTIVE

The aim of the study is to evaluate whether values and the shape of the glucose curve during the oral glucose tolerance test (OGTT) in pregnancy identify women at risk of developing hypertension (HTN) later in life.

STUDY DESIGN

This category includes the secondary analysis of a follow-up from a mild gestational diabetes mellitus (GDM) study that included a treatment trial for mild GDM (n = 458) and an observational cohort of participants with abnormal 1-hour glucose loading test only (normal OGTT, n = 430). Participants were assessed at a median of 7 (IQR 6-8) years after their index pregnancy, and trained staff measured their blood pressure (systolic blood pressure [SBP]; diastolic blood pressure [DBP]). The association between values and the shape of the glucose curve during OGTT in the index pregnancy and the primary outcome defined as elevated BP (SBP ≥120, DBP ≥80 mm Hg, or receiving anti-HTN medications), and secondary outcome defined as stage 1 or higher (SBP ≥130, DBP ≥80 mm Hg, or receiving anti-HTN medications) at follow-up were evaluated using multivariable regression, adjusting for maternal age, body mass index, and pregnancy-associated hypertension during the index pregnancy.

RESULTS

There was no association between fasting, 1-hour OGTT, and the outcomes. However, the 2-hour OGTT value was positively associated (adjusted odds ratio [aRR] per 10-unit increase 1.04, 95% CI 1.01-1.08), and the 3-hour was inversely associated (aRR per 10-unit increase 0.96, 95% CI 0.93-0.99) with the primary outcome. When the shape of the OGTT curve was evaluated, a monophasic OGTT response (peak at 1 hour followed by a decline in glucose) was associated with increased risk of elevated BP (41.3vs. 23.5%, aRR 1.66, 95% CI 1.17-2.35) and stage 1 HTN or higher (28.5 vs. 14.7%, aRR 1.83, 95% CI 1.15-2.92), compared with a biphasic OGTT response.

CONCLUSION

Among persons with mild GDM or lesser degrees of glucose intolerance, the shape of the OGTT curve during pregnancy may help identify women who are at risk of HTN later in life, with biphasic shape to be associated with lower risk.

KEY POINTS

· The shape of the Oral Glucose Tolerance Test curve may help identify patients who are at risk of having elevated BP or HTN 5 to 10 years following pregnancy.. · The 2-hour Oral Glucose Tolerance Test values is positively associated with elevated BP 5 to 10 years following pregnancy.. · This supports the concept of pregnancy as a window to future health and represents a potential novel biomarker for maternal cardiovascular health screening..

Management of Hypertension With Non-pharmacological Interventions: A Narrative Review

Hypertension (HTN) is a condition that affects nearly half of the adult population in the United States. HTN is the elevation of blood pressure (BP) 130/80 mm Hg or higher. Untreated high blood pressure may increase the risk of myocardial infarction, stroke, and other serious complications. BP over 180/120 mm Hg with end-organ damage is called a hypertensive emergency. Despite advancements in medicine and treatment options, the global burden of HTN has been increasing due to the advancing age of the population and an increasing prevalence of obesity. Non-pharmacological management of HTN has gained prominence worldwide due to its additional benefits and positive impact on the overall health of individuals, having almost no side effects and reducing the financial burden of medication expenses. This article has compiled studies like systematic reviews, meta-analyses, and randomized controlled trials and reviewed the role of non-pharmacological management of HTN, including lifestyle modifications like exercise, weight loss, dietary interventions like dietary approaches to stop hypertension (DASH) diet, low sodium diet, limiting alcohol consumption, smoking cessation and stress management to help control blood pressure. However, non-pharmacological interventions should be initiated in an early phase, and for proper management of HTN, we may need to include both pharmacological and non-pharmacological interventions. This article explored and integrated various studies to highlight the role of non-pharmacological interventions to manage HTN. We also examined the need for more research studies for strategies to alleviate morbidity and mortality associated with HTN.

Comorbidities of Rural Children and Adolescents with Migraine and without Migraine

(1) Background: Migraine is associated with comorbidities that are common in the general rural pediatric population. The purpose of this study is to evaluate the differences in the occurrence of comorbidities between rural children and adolescents with and without migraine. (2) Methods: A cross-sectional, secondary data analysis using electronic medical records of 1296 patients (53.8% females, aged 12.4 ± 3.2) was completed. Mann-Whitney U test was used to detect the difference in the number of comorbidities between the two groups. Chi-square test was used to identify the differences in the number of comorbidities, which were classified as low (0-1 comorbidities), medium (2-3 comorbidities), and high (4 or plus comorbidities) degree of comorbidities. (3) Results: Significant differences were found between those children and adolescents with migraine vs. those without for depression (p < 0.0001), anxiety (p < 0.0001), and Ehlers-Danlos Syndrome (EDS; p = 0.0309). A marginally significant difference was found between those children and adolescents with migraine (47.2%; n = 306) vs. those without (42.1%; n = 273) for unhealthy weight (p = 0.0652). Approximately 40% of the migraineurs had 2-3 comorbidities, whereas 32% of the non-migraineurs had 2-3 comorbidities (p = 0.0003). (4) Conclusions: Findings demonstrate the importance of identifying comorbidities associated with rural pediatric migraine in order to develop effective treatment strategies that optimize patient outcomes.

Impact of the 2017 AAP clinical guideline on the prevalence of high blood pressure among adolescents in Lagos, Nigeria

Introduction

Adolescent high blood pressure (HBP) can lead to several end-organ complications if it continues into adulthood. The 2017 AAP Guideline has lower blood pressure cut-off points and consequently leads to the identification of more people with high blood pressure. This study evaluated the impact of the 2017 American Academy of Pediatrics (AAP) Clinical Guideline on the prevalence of high blood pressure among adolescents when compared to the 2004 Fourth Report.

Methodology

A descriptive cross-sectional study was conducted from August 2020 to December 2020. The selection of 1,490 students, 10-19 years old, was by a two-stage sampling technique. Socio-demographic information and relevant clinical data were obtained using a structured questionnaire. Blood pressure was measured according to standard protocol. Categorical and numerical variables were summarized using frequency, percentages, mean, and standard deviation. The McNemar-Bowker test of symmetry was used to compare the blood pressure values in the 2004 Fourth Report and the 2017 AAP Clinical Guideline. The Kappa statistic was used to test for the degree of agreement between the 2004 Fourth Report and the 2017 AAP Clinical Guideline.

Results

The prevalence rates of high blood pressure, elevated blood pressure, and hypertension among adolescents were 26.7%, 13.8%, and 12.9%, respectively, using the 2017 AAP Clinical Guideline, and 14.5%, 6.1%, and 8.4%, respectively, using the 2004 Fourth Report. The degree of agreement between the 2004 and 2017 guidelines with respect to the classification of blood pressure was 84.8%. The Kappa statistic was 0.71 (CI: 0.67-0.75). The impact of this was a 12.2%, 7.7%, and 4.5% increase in the prevalence of high blood pressure, elevated blood pressure, and hypertension, respectively, using the 2017 AAP Clinical Guideline.

Conclusion

The 2017 AAP Clinical Guideline detects a greater proportion of high blood pressure among adolescents. The adoption of this new guideline in clinical practice and its use in the routine screening of high blood pressure among adolescents is recommended.

Change in blood pressure status defined by 2017 ACC/AHA hypertension guideline and risk of cardiovascular disease: results of over a decade of follow-up of the Iranian population

Background

Hypertension (HTN) is known to be the leading cause of cardiovascular disease (CVD) and mortality. We aimed to assess the impact of changes in 3 years in different blood pressure (BP) categories on incident CVD.

Methods

In this study, 3,685 Tehranians aged ≥30 years (42.2% men) free of prevalent CVD with BP level <140/90 mmHg and not on BP-lowering medications were enrolled. Participants were grouped according to baseline BP category using the 2017 ACC/AHA hypertension guideline definition: normal BP (<120/80 mmHg), elevated BP (120-129/<80), and stage 1 HTN (130-139 and/or 80-89). The hazard ratio of incident CVD by changes in the BP category was estimated after adjustment for traditional risk factors using Cox's proportional hazard model, with stable normotension as a reference.

Results

During a median follow-up of 11.7 years, 346 CVD events (men = 208) occurred. Compared to the reference group, among participants with normal BP at baseline, only those with BP rising to stage 1 HTN [1.47 (0.99-2.16)], and among those with stage 1 HTN at baseline, regression to elevated BP [1.80 (1.11-2.91)], remaining at stage 1 [1.80 (1.29-2.52)], and progression to stage 2 HTN [1.81 (1.25-2.61)] had a higher risk for CVD; however, regression to normal BP attenuated this risk [1.36 (0.88-2.12)]. Conversion from elevated BP to any other categories had no significant association with CVD risk.

Conclusions

Generally, prevalent stage 1 HTN (regardless of changing category) and incident stage 1 HTN were significantly associated with a higher risk of CVD; even regression to elevated BP did not attenuate the risk. Accordingly, these populations are potential candidates for antihypertensive management.

High blood pressure pattern amongst adolescents in Lagos, South West Nigeria

Introduction

high blood pressure (HBP), once considered rare in adolescents is now a growing health problem. Usually asymptomatic in adolescents, if uncontrolled, can track into adulthood leading to various end-organ complications. In 2017, the American Academy of Pediatrics (AAP) published a new Clinical Practice Guideline (CPG) for screening and management of high blood pressure in children and adolescents to update the 2004 Fourth report. The objective of this study was to determine the prevalence of high blood pressure among adolescents in Mushin Local Government Area (LGA) using the 2017 AAP guidelines.

Methods

a descriptive cross-sectional study, conducted from August 2020 to December 2020. A two-stage sampling technique was used to select 1490 students aged 10 to 19 years, from 14 secondary schools. Socio-demographic information and relevant clinical data were obtained using a structured questionnaire. The anthropometry and blood pressure measurements were taken according to standard protocol (elevated blood pressure is systolic and/or diastolic blood pressure ≥ 90^th percentile but ≤ 95^th percentile for age, gender and height). Socio-demographic and anthropometric characteristics were described with descriptive statistics. Categorical variables were summarized using frequency and percentages, while numerical variables were summarized using mean and standard deviation. The predictors of hypertension were determined using logistic regression analysis.

Results

study participants were 1490, 49.9% (744) were male and 50.1% (746) females (male: female ratio was 1: 1). Subjects mean age was 14.39 ± 2.79 years. There were 8.9% overweight and 1.7% obese participants. Prevalence of high blood pressure, elevated blood pressure and hypertension were 26.7% (n = 398), 13.8% (n = 205), and 12.9% (n = 193). Middle and late adolescence, when compared to early adolescence, significantly predicted the likelihood of high blood pressure; aOR 1.78, 95%CI: 1.20 - 2.63, p=0.004 and 3.90 (2.69 - 5.67, p=0.001 respectively). Similarly, male sex had increased odds for raised blood pressure when compared to female sex aOR 1.49,95% CI: 1.1 - 2.0, p= 0.009.

Conclusion

the prevalence of high blood pressure, elevated blood pressure and hypertension amongst adolescents was high. Early detection and treatment will forestall development of complications.

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.

Associations of parental reproductive age and elevated blood pressure in offspring: An observational study

Background

Increased parental reproductive age has been a social trend around the world, and elevated blood pressure in children leads to an approximately two-fold increased risk of hypertension in adulthood. Aim of this study is to assess the associations of parental reproductive age with the risk of elevated blood pressure in offspring, and to explore the influence of offspring lifestyle on the associations.

Methods

Data was obtained from a national school program conducted in 7 Chinese provinces, and the final sample was 39,190 students aged 7-18 years. Anthropometric measurements and questionnaires were designed to collect data of children blood pressure and information respectively.

Results

In this study, 26.7% of children were defined as elevated blood pressure. A U-shaped pattern was observed in the relationship between maternal age and risk of elevated blood pressure, while risk of elevated blood pressure decreased continuously with paternal age increased. After adjustment, offspring of paternal age ≤27 & maternal age ≤26 years and those of paternal age >30 & maternal age >32 years were related to great risk of elevated blood pressure (OR = 1.18, 95% CI: 1.08-1.29, P < 0.001; OR = 1.18, 95% CI: 1.01-1.38, P < 0.05). When stratified by lifestyle status, significant associations between maternal/paternal age and risk of elevated blood pressure were only observed in those with worse lifestyle behaviors, but not in offspring with healthier lifestyle.

Conclusion

Our findings demonstrate that risk of elevated blood pressure in children is independently related to parental reproductive age, and children maintaining a healthy lifestyle may mitigate the adverse effect.

Prioritizing Workplace Health Promotion Policy to Address High Blood Pressure and Obesity in a Public University in the Northern Region of Ghana

The International Labour Organization (ILO) recommends the engagement of the world of work in providing comprehensive and effective prevention strategy for noncommunicable diseases (NCDs). Workers are at risk of developing 1 or more cases of NCDs due to their exposure to risk factors at work. The ILO suggests that the work-related risk factors can be prevented by improving working conditions and integration of workplace health promotion programs. Workplace health promotion policies promote workers general health, improve working environment, work practices, and reduces the risks of common NCDs including hypertension (high blood pressure) and obesity among employees. A number of studies have described the increasing trends of hypertension and obesity among civil servants but are limited in assessing the availability and effectiveness of workplace health promotion policies to address them. We assessed the availability and effectiveness of workplace health promotion policy to address the prevalence of high blood pressure in a public university in the Northern Region of Ghana. Using a mixed method study design, 191 administrative staff were recruited and in-depth qualitative interviews conducted among 5 key informants. The study found significant number of participants with elevated and high blood pressure and overweight and obesity with no functional workplace health promotion at the time of the study. We therefore recommend the prioritization and development of a workplace health policy to reduce the prevalence of high blood pressure and obesity among staff of the university using the integrative workplace health promotion model.

Ambulatory blood pressure monitoring in children: A retrospective single-center study

OBJECTIVES

(1) Compare 24-hour ambulatory blood pressure monitoring (ABPM) diagnoses in a pediatric population with the new 2022 guidelines to the original diagnoses with the 2014 guidelines. (2) Determine whether findings of hypertension from ABPM could be predicted from prior patient data. (3) Determine whether ABPM readings could predict left ventricular mass index (LVMI) in patients who obtained an echocardiogram (ECHO).

STUDY DESIGN

Single-center retrospective study on patients referred to Pediatric Nephrology Clinic for evaluation of elevated blood pressure who underwent ABPM from 2015 to 2018. Predictions of hypertension were obtained using a logistic regression model, and predictions of LVMI were performed using regression models including (a) the wake systolic and diastolic BP indices, or (b) additionally including the standard deviation (SD) of wake SBP and DBP.

RESULTS

With the change in 2022 to new ABPM guidelines from the AHA, comparing the old and new guidelines led to 70% of previous pre-hypertensive diagnoses now meeting criteria for diagnosis of hypertension, and a rise from 21% of the ABPMs meeting criteria for hypertension to 51% now meeting criteria. In a logistic regression model, prior patient data were not predictive of a diagnosis of hypertension from ABPM (Nagelkerke's R ² = 0.04). Among the individual variables studied, none were statistically significant. For prediction of LVMI, the SD of wake SBP and DBP were significantly associated with increased LVMI, but the wake SBP and DBP indices were not.

CONCLUSIONS

In our patient population, the new ABPM guidelines led to a significant increase in diagnoses of hypertension. Prior patient data was not sufficient to predict a diagnosis of hypertension by ABPM, supporting the need for evaluation by ABPM as the gold standard. Our analysis of the relationship between ABPM readings and LVMI supports the hypothesis that BP variability contributes to increased LVMI. These data are consistent with growing evidence in the adult literature that BP variability detected by ABPM is associated with left-ventricular hypertrophy.

Increased prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes and hypertension: The SWEET international database

AIMS

To investigate the prevalence of modifiable cardiovascular risk factors (CVRFs), including dyslipidaemia, obesity and high glycated haemoglobin (HbA1c) concentration, in patients with type 1 diabetes (T1D), and to evaluate their association with blood pressure (BP) categories.

METHODS

We analysed 21 634 children and adolescents with T1D from the SWEET international database with office BP values assessed at a three or more visits within a year from 2010 to 2021. Participants were classified into a normotensive group, a group with elevated BP (90 to 94th percentile) or a hypertensive group (≥95th percentile), based on the median BP for the visits within the last treatment year. The prevalences of dyslipidaemia [cholesterol ≥ 5.18 mmol/L (200 mg/dL)  and/or HDL cholesterol ≤ 1.036 mmol/L (40 mg/dL)  and/or LDL cholesterol ≥ 2.59 mmol/L (100 mg/dL)], obesity (body mass index ≥2 standard deviation score) and elevated HbA1c [≥ 75 mmol/mol (9%)] were evaluated in patients within each BP group.

RESULTS

Patients with hypertension/elevated BP had less favourable lipid profiles, and a higher prevalence of obesity and HbA1c ≥ 75 mmol/mol than normotensive patients. A total of 38.4% of hypertensive patients and 36.0% of those with elevated BP had one CVRF, 15.1% and 10.1%, respectively, had two CVRFs, and 2.3% and 0.8%, respectively, had three CVRFs. Patients with hypertension/elevated BP had a higher prevalence of one or more CVRFs versus normotensive patients (P < 0.001). Obesity was the CVRF most strongly related to hypertension. Girls had a higher prevalence of one or more CVRFs than boys. Similar results were found in patients aged ≥13 years with hypertension compared to those aged <13 years.

CONCLUSIONS

The prevalence of modifiable CVRFs is higher in children and adolescents with T1D who have elevated BP/hypertension than in those with normotension, suggesting that they are more vulnerable to future morbidity and mortality requiring early detection and intervention.

Clinical Decision Support Tool for Elevated Pediatric Blood Pressures

Under-diagnosis of pediatric hypertension remains pervasive due to difficulty recognizing elevated systolic blood pressures (SBPs). We performed a retrospective review comparing recognition of and response to elevated SBPs ≥95th percentile before and after development of a clinical decision support tool (CDST) in an academic pediatric system. Of 44,351 encounters, 477 had elevated SBPs with documented recognition of an elevated SBP in 17.9% of encounters pre-CDST that increased to 33.7% post-CDST (P = .001). Post-CDST, 75.5% of elevated SBPs had repeat measurement, with 90.8% of initially elevated SBPs normalizing to <95th percentile. If repeat measurement was obtained and SBP remained elevated, documented recognition increased from 14.0 to 83.3% (P < .0001). These data support using the CDST is associated with increased identification of elevated SBPs in children with greatest improvements associated with repeat SBP measurement. This suggests targeted training and support systems at medical intake would be high yield for increasing recognition of elevated SBP.

The prevalence of hypertension and elevated blood pressure and its correlation with overweight/obesity among students aged 6-17 years in Suzhou

OBJECTIVES

Lifestyle changes have led to an increase in the prevalence of hypertension in Chinese children and adolescents. The aim of this study was to analyze the prevalence of hypertension and its association with overweight and obesity among students aged 6-17 years in Suzhou. This retrospective analysis included physical examination data of primary and junior high school students in Suzhou Industrial Park from 2016 to 2019.

METHODS

Elevated blood pressure and hypertension were defined using blood pressure criteria appropriate for age, sex, and height percentile. Overweight and obesity were defined using the 2007 diagnostic criteria proposed by the World Health Organization for school-age children. Logistic regression analysis was used to evaluate the association between hypertension and overweight and obesity.

RESULTS

A total of 128,113 students were included. The prevalence of elevated BP and hypertension was 9.92% and 13.56%, respectively. The incidence of high blood pressure was higher in boys than in girls and increased with an increase in body mass index (BMI). The prevalence of hypertension in obese boys and girls (27.07% and 27.49%, respectively) was 2.3-fold and 2.8-fold higher than that in normal-weight boys and girls (11.58% and 9.83%, respectively).

CONCLUSIONS

Blood pressure was positively correlated with BMI, and the risk of high blood pressure due to overweight/obesity was 10.44%. Overweight and obesity significantly increased the risk of hypertension in students aged 6-17 years in Suzhou. Targeted weight-loss programs during childhood and adolescence may reduce the risk of hypertension in adulthood.

Pre-bout hypertension in the combat sports athlete: clearance recommendations

Hypertension is one of the most prevalent medical disorders in the world and is associated with significant cerebrovascular and cardiovascular morbidity. Pre-bout blood pressure (BP) elevation is extremely common, and ringside physicians must accurately assess the accompanying risk of adverse cerebrovascular and cardiovascular events in the decision to allow participation in combat sports. It is strongly recommended that a ringside physician consider disqualifying a combat sports athlete with severe pre-bout hypertension (systolic BP ≥160 mm Hg and/or diastolic BP ≥100 mm Hg, or stage 2 hypertension in children when indexed by gender, age, and height) from that bout, if it persists despite rest and repeated measurement with accurate equipment. This recommendation is congruent with that of the American College of Sports Medicine, the American College of Cardiology, and the American Heart Association, which recommend non-clearance for sports or exercise testing when BP exceeds those thresholds. Severely elevated BP, as defined above, confers markedly increased risk of morbidity and mortality. Exercise further raises BP markedly. The combination of severely elevated blood pressure and cranial trauma during combat sports is a risk factor for intracranial hemorrhage with a direct impact on the morbidity and mortality associated with ringside combat sports events. Combat sports athletes with SBP ≥130 or DBP ≥90 - and their coaches and families, if available and the athlete consents - should be educated on the causes of hypertension, its acute and chronic risks, and the possible future implications for bout clearance, and the athletes should be referred for evaluation and management.

Association Between Eating Speed and Metabolic Syndrome: A Systematic Review and Meta-Analysis

Objective: This review aimed to systematically summarize and meta-analyze the association between eating speed and metabolic syndrome (MetS). Methods: Following the Preferred Reporting Items for Systematic Reviews, and Meta Analyses (PRISMA) guidelines, four electronic databases (PubMed, Web of Science, MEDLINE, and EMBASE) were searched until March 2021 to identify eligible articles based on a series of inclusion and exclusion criteria. Heterogeneity was examined using I ² statistics. Using random-effects models, the pooled odds ratios (ORs), and 95% CIs were calculated to evaluate the association between eating speed with MetS and its components, including central obesity, blood pressure (BP), high-density lipoprotein cholesterol (HDL), triglyceride (TG), and fasting plasma glucose (FPG). Results: Of the 8,500 original hits generated by the systematic search, 29 eligible studies with moderate-to-high quality were included, involving 465,155 subjects. The meta-analysis revealed that eating faster was significantly associated with higher risks of MetS (OR = 1.54, 95% CI: 1.27-1.86), central obesity (OR = 1.54, 95% CI: 1.37-1.73), elevated BP (OR = 1.26, 95% CI: 1.13-1.40), low HDL (OR = 1.23, 95% CI: 1.15-1.31), elevated TG (OR = 1.29, 95% CI: 1.18-1.42), and elevated FPG (OR = 1.16, 95% CI: 1.06-1.27) compared to eating slowly. Conclusions: The results of the review indicated that eating speed was significantly associated with MetS and its components. Interventions related to decreasing eating speed may be beneficial for the management of MetS. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021242213, identifier: CRD42021242213.

Association between Body Fat and Elevated Blood Pressure among Children and Adolescents Aged 7-17 Years: Using Dual-Energy X-ray Absorptiometry (DEXA) and Bioelectrical Impedance Analysis (BIA) from a Cross-Sectional Study in China

To investigate the associations between body fat percentage (BF%) with childhood blood pressure (BP) levels and elevated BP (EBP) risks, and further examine the validity of bioelectrical impedance analysis (BIA), we conducted a cross-sectional study of 1426 children and adolescents aged 7–17 years in Beijing, 2020. EBP, including elevated systolic BP (ESBP) and elevated diastolic BP (EDBP), was defined based on the age- and sex-specific 90th BP reference values of children and adolescents in China. BF% was measured by dual-energy X-ray absorptiometry (DEXA) and BIA devices, and was divided into four quartiles. Log-binomial models were applied to calculate odds ratios (ORs) and 95% confidence intervals (95%CI). Girls tended to have higher BF% levels than boys (p < 0.05). There was 41.0% of girls who developed EBP. High BF% was associated with increased BP levels with ORs of 0.364 (95%CI = 0.283–0.444) for SBP, 0.112 (95%CI = 0.059–0.165) for DBP, and 1.043 (95%CI = 1.027–1.059) for EBP, while the effects were more pronounced in girls and older-aged children. BIA devices agreed well with BF% assessment obtained by DEXA. High BF% might have negative effects on childhood BP. Convenient measurements of body fat might help to assess childhood obesity and potential risks of hypertension.

Evaluating association between idiopathic thrombocytopenic purpura and hypertension

PURPOSE

The role of platelets in the pathogenesis of hypertension is not well known. The aim of this study was to ascertain if patients with immune thrombocytopenia (ITP) had different rates of hypertension.

MATERIALS AND METHODS

Using the Nationwide Inpatient Sample (NIS) database, we analyzed the correlation between hypertension and ITP from the years 2002-2011.

RESULTS

We found no significant differences in the rate of hypertension between ITP and Non-ITP patients. For instance, in 2002, 25.90% of patients with ITP had a concurrent diagnosis of hypertension, compared with 26.53% of Non-ITP patients. Then in 2011, 31.95% of patients with ITP had a concurrent diagnosis of hypertension, compared with 32.31% of Non-ITP patients.

CONCLUSION

Based on our large database, the presence of ITP does not appear to be associated with an increased or decreased risk of hypertension.

Perinatal outcomes in women with elevated blood pressure and stage 1 hypertension

BACKGROUND

Hypertension was redefined in 2017 with lower diagnostic thresholds; elevated blood pressure is defined as systolic blood pressure of 120 to 129 mm Hg with diastolic blood pressure of <80 mm Hg and stage 1 hypertension as systolic blood pressure of 130 to 139 mm Hg or diastolic blood pressure of 80 to 89 mm Hg. These guidelines did not include pregnant women. There is limited information on stage 1 hypertension and pregnancy outcomes.

OBJECTIVE

This study aimed to determine whether elevated blood pressure and stage 1 hypertension as newly defined by the 2017 American College of Cardiology and the American Heart Association guidelines are associated with an increased risk of hypertensive disorders of pregnancy and other adverse maternal and neonatal outcomes.

STUDY DESIGN

In this retrospective cohort study, 18,801 women with singletons from 2013 to 2019 were categorized as normotensive, prehypertensive (elevated blood pressure), stage 1 hypertensive, or chronic hypertensive. Women with ≥2 systolic blood pressures of 120 to 129 mm Hg before 20 weeks' gestation were classified into the elevated blood pressure group. Women with ≥2 systolic blood pressures of 130 to 139 mm Hg or ≥2 diastolic blood pressures of 80 to 89 mm Hg before 20 weeks' gestation were assigned to the stage 1 hypertension group. Women were classified as chronic hypertensives if they had any of the following: ≥2 systolic blood pressure of ≥140 mm Hg or ≥2 diastolic blood pressure of ≥90 mm Hg before 20 weeks' gestation, a history of chronic hypertension, or antihypertensive medication use before 20 weeks' gestation. Women with pregestational diabetes, lupus, or <2 blood pressures before 20 weeks' gestation were excluded. The association of stage 1 hypertension with the risk of developing hypertensive disorders of pregnancy was estimated using multivariate logistic regression controlling for maternal sociodemographic characteristics, gestational weight gain by prepregnancy body mass index, parity, and aspirin use. Secondary outcomes included subgroups of hypertensive disorders (gestational hypertension, preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count syndrome), gestational diabetes, placental abruption, intrauterine growth restriction, preterm birth, neonatal intensive care unit admission, stillbirth and neonatal death, and maternal intensive care unit admission. All outcomes were adjusted for potential confounders.

RESULTS

Of the 18,801 women, 13,478 (71.7%) were normotensive, 2659 (14.1%) had elevated blood pressure, 1384 (7.4%) were stage 1 hypertensive, and 1280 (6.8%) were chronic hypertensive. A dose-response relationship was observed: the risk of hypertensive disorders of pregnancy increased from 4.2% in normotensive women to 6.7% (adjusted odds ratio, 1.50; 95% confidence interval, 1.26-1.79) in women with elevated blood pressure, to 10.9% (adjusted odds ratio, 2.54; 95% confidence interval, 2.09-3.08) in women with stage 1 hypertension, and 28.4% (adjusted odds ratio, 7.14; 95% confidence interval, 6.06-8.40) in women with chronic hypertension. Compared with normotensive women, women with stage 1 hypertension had an increased risk of neonatal intensive care unit admissions (15.8% vs 13.0%; adjusted odds ratio, 1.21; 95% confidence interval, 1.03-1.42), preterm birth at <37 weeks' gestation (7.2% vs 5.2%; adjusted odds ratio, 1.45; 95% confidence interval, 1.16-1.81), and gestational diabetes (14.8% vs 6.8%; adjusted odds ratio, 2.68; 95% confidence interval, 2.27-3.17).

CONCLUSION

Our study demonstrates that elevated blood pressure and stage 1 hypertension, using the 2017 American College of Cardiology and the American Heart Association guideline definition, are associated with increased maternal and neonatal risk. This group of women warrants further investigation to determine whether pregnancy management can be altered to reduce maternal and neonatal morbidity.

Measuring Hypertension Progression With Transition Probabilities: Estimates From the WHO SAGE Longitudinal Study

This paper assessed the transition probabilities between the stages of hypertension severity and the length of time an individual might spend at a particular disease state using the new American College of Cardiology/American Heart Association hypertension blood pressure guidelines. Data for this study were drawn from the Ghana WHO SAGE longitudinal study, with an analytical sample of 1884 across two waves. Using a multistate Markov model, we estimated a seven-year transition probability between normal/elevated blood pressure (systolic ≤ 129 mm Hg & diastolic <80 mm Hg), stage 1 (systolic 130-139 mm Hg & diastolic 80-89 mm Hg), and stage 2 (systolic ≥140mm Hg & diastolic≥90 mm Hg) hypertension and adjusted for the individual effects of anthropometric, lifestyle, and socio-demographic factors. At baseline, 22.5% had stage 1 hypertension and 52.2% had stage 2 hypertension. The estimated seven-year transition probability for the general population was 19.0% (95% CI: 16.4, 21.8) from normal/elevated blood pressure to stage 1 hypertension, 31.6% (95% CI: 27.6, 35.4%) from stage 1 hypertension to stage 2 hypertension, and 48.5% (45.6, 52.1%) for remaining at stage 2. Other factors such as being overweight, obese, female, aged 60+ years, urban residence, low education and high income were associated with an increased probability of remaining at stage 2 hypertension. However, consumption of recommended servings of fruits and vegetables per day was associated with a delay in the onset of stage 1 hypertension and a recovery to normal/elevated blood pressure. This is the first study to show estimated transition probabilities between the stages of hypertension severity across the lifespan in sub-Saharan Africa. The results are important for understanding progression through hypertension severity and can be used in simulating cost-effective models to evaluate policies and the burden of future healthcare.

A Meta-Analysis of Blood Pressure Disparities Among Sexual Minority Men

Purpose: The aim was to review and summarize reports on three measures of elevated blood pressure (BP) among sexual minority men (encompassing men who have sex with men [MSM] and both men and women [MSMW]), using men who have sex with women (MSW) as the reference population. Methods: Crude prevalence rates were calculated, and a meta-analysis was conducted to summarize the likelihood of elevated BP history, antihypertensive medication use, and elevated BP above a cutoff value, as well as the mean differences (MDs) in systolic BP (SBP) and diastolic BP (DBP) measurements. We used random effects to generate estimates with their respective 95% confidence intervals (CIs); alpha was set at 0.05. Results: Studies (n = 20) were published between 2007 and 2018, mostly in the United States. The likelihood of elevated BP history was not statistically significantly higher among sexual minority men, except when the measurement of sexual orientation was multidimensional (odds ratio [OR] 1.41, 95% CI 1.12-1.78). The likelihood of antihypertensive medication use was only statistically significantly higher for men who self-identified as MSMW (OR 1.44, 95% CI 1.11-1.85). When elevated BP was determined through a set cutoff, MSM were less likely (OR 0.34, 95% CI 0.16-0.70), whereas MSMW were more likely (OR 2.25, 95% CI 1.54-3.28) to have elevated BP. Although there were no statistically significant findings in the MD for SBP, the MD for DBP among sexual minority men was significantly higher (MD 1.46, 95% CI 1.38-1.55 mmHg) than among the MSW comparison group. Conclusions: Sexual minority men classified using a multidimensional approach to sexual orientation had a significantly higher likelihood of elevated BP history. Using BP cutoffs yielded opposite effects in MSM and MSMW. Although SBP was not different compared to MSW, DBP-a marker of hypertension at earlier ages-was elevated among sexual minority men.

Pediatric Hypertension: Parent Perspectives

Clinical practice guidelines for diagnosis and management of pediatric hypertension have been available for decades. Yet, most cases of hypertension in children are undiagnosed. Provider and system-based factors, such as the complexity of diagnostic standards, and a failure among physicians to recognize the importance of hypertension in children, play a role in underdiagnosis. It is unclear, however, how patient and family behaviors impact the diagnosis and treatment of pediatric hypertension. We aimed to explore the perspectives of parents whose children have had multiple high blood pressure readings or have been diagnosed with hypertension to inform clinicians with areas for practice improvement. In a 2 site qualitative study, we interviewed parents of 15 children diagnosed with hypertension. Results from semi-structured interviews with parents revealed barriers to the diagnosis of pediatric hypertension, including uncertainty about the diagnosis and concerns around the accuracy of blood pressure measurements. Delay in diagnosis and lack of child engagement emerged as obstacles to the treatment of pediatric hypertension.

Prevalence and factors that are associated with elevated blood pressure among primary school children in Mwanza Region, Tanzania

Introduction

hypertension (HTN) among children is reported to be increasing due to sedentary lifestyles. In developed countries the prevalence of paediatric HTN is recorded to be up to 21% while the magnitude of the same is up to 11% in Tanzania. This study aimed to determine the blood pressure profile and factors associated with elevated blood pressure (BP) among children of Mwanza region.

Methods

a cross sectional study involving 742 children aged 6 to 16 years in selected primary schools in Mwanza region was conducted from June to August 2019. Data were collected using self-administered structured questionnaires where parents helped children to fill in. Blood pressure, body weight and height were measured using digital portable sphygmomanometer, self-calibrating digital weighing scale and Shorr measuring board respectively. Data were analyzed using EpiInfo.

Results

this study found mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 109.2 ± 8.1 mmHg and 62.3 ± 7.2 mmHg respectively. Prevalence of elevated BP was 18.1%. Pre-hypertension 9.6%, and hypertension 8.5%. The age specific elevated BP prevalence was significantly higher (OR = 1.9, 95% CI: 1.2 - 2.9, p = 0.008) among children aged ≥10 years (21.4%) than younger ones (15.1%). Prevalence was also higher (OR = 1.5, 95% CI: 1.1 - 2.3, p = 0.048) among girls (20.1%) than boys (16.0%). Elevated BP was found to be associated with obesity (OR = 3.5, 95% CI: 1.6 - 7.7, p = <0.001), overweight (OR = 1.9, 95% CI: 1.1 - 3.3, p = 0.037), eating fried food (OR = 2.2, 95% CI: 1.1 - 4.4, p = 0.023), drinking sugar soft drinks (OR = 2.0, 95% CI: 1.2 - 3.5, p = 0.002) and not eating fruits (OR = 13.4, 1.6, 95% CI: 2.1 - 65.8, p-value 0.006).

Conclusion

findings indicate high prevalence of elevated BP among children of Mwanza region. There was an association between elevated BP and increased age, gender, sedentary lifestyle and obesity. Importance of measuring paediatric blood pressure and health information regarding effects of sedentary life is recommended to Tanzanians. Parents should encourage their children to have active physical activities. Moreover, health workers should implement programmes to modify sedentary lifestyle and prevent children from elevated blood pressure.

Body Mass Index and Blood Pressure-to-Height Ratio in Predicting Incidence of Hypertension in Serbian Children

BACKGROUND

A new method using blood pressure-to-height ratio for diagnosing elevated blood pressure/hypertension in children has been introduced recently. We aimed to compare blood pressure-to-height ratio (BPHR) and Body Mass Index (BMI) in predicting incidence of hypertension (HTN).

METHODS

The sample consisted of 1133 boys and 1154 girls aged 7-15. We used the following equations for BPHR: systolic BPHR (SBPHR) = SBP (mm Hg)/height (cm) and diastolic BPHR (DBPHR) = DBP (mm Hg)/height (cm). In order to determine the accuracy of SBPHR, DBPHR and BMI as diagnostic tests for elevated blood pressure (elevated BP), we used the receiveroperating characteristic curve analyses.

RESULTS

The area under the curve (AUC) values for BMI ranged from 0.625 to 0.723 with quite low sensitivity rates from 62% to 72.5% and specificities from 58.2% to 67.3% showing a modest ability to identify children with elevated BP and HTN. On the contrary, BPHR showed a great predictive ability to identify elevated BP and HTN with AUC values of 0.836 to 0.949 for SBP and from 0.777 to 0.904 for DBP. Furthermore, the sensitivity ranged from 78.5% to 95.7%, and the specificity from 73.9% to 87.6%.

CONCLUSION

the current study showed that BPHR is an accurate index for detecting elevated BP and HTN in children aged 7 to 15 years and can be used for early screening.

Renal artery dissection as an overuse Injury

The diagnosis of renal infarction is often convoluted due to its non-specific presentation. It can mimic disease processes as disparate as pyelonephritis, diverticulitis, or nephrolithiasis. This case is further complicated by the presence of a pelvic kidney with triplicate arterial input. It is difficult to estimate the incidence of pelvic kidneys as the numerous sources vary wildly in their estimations; however, the paucity information, in and of itself, speaks to the rarity of the condition. In this case, a 58-year-old male presents to the emergency department after experiencing sharp, sudden, and severe groin pain while swinging a golf club. The patient was noted to have an abnormally high systolic blood pressure in the 170s and hematuria, but all other initial labs and assessments were unremarkable. An initial computed tomography scan with intravenous contrast of the abdomen and pelvis showed partial necrosis of a pelvic kidney. Follow-up computed tomography angiography revealed that a dissection in one of the arteries supplying the kidney created an infarction and resultant necrosis. Vessel size, location and time between injury and diagnosis made endovascular intervention impractical. The patient was started on aspirin and Plavix, observed for 3 days and sent home.

Pharmacological treatment of high-normal blood pressure (prehypertension) in high-risk patients for primary prevention of cardiovascular events

Currently, the best treatment strategy for patients with a high-normal blood pressure (prehypertension) is not known. The authors aimed to determine whether pharmacological reduction of systolic blood pressure (SBP) to a normal level (<120 mm Hg) would prevent cardiac morbidity and mortality in prehypertensive patients. In this secondary analysis, the authors obtained the data from SPRINT from the National Heart, Lung, and Blood Institute data repository center. Among 9361 patients enrolled in SPRINT, 289 high-risk (ASCVD risk = 24.8% ± 13.0 [10-65]) prehypertensive patients without previous cardiovascular disease and not receiving any antihypertensive medications were enrolled. One hundred and forty-eight of them were assigned to standard treatment which consisted of clinical follow-up till SBP goes above 140 mm Hg and then staring medications to keep SBP <140 mm Hg. One hundred and forty-one were assigned to the intensive treatment receiving pharmacological SBP reduction to <120 mm Hg upon enrollment. The primary composite outcome was myocardial infarction, and other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. Throughout the 3.06 years of follow-up, a primary outcome event was confirmed in three participants (0.74% per year) in the intensive-treatment group and 8 (1.61% per year) in the standard-treatment group (hazard ratio [HR], 0.19; P = .045). Rates of serious adverse events were not increased by intensive-treatment (HR, 0.83; P = .506). Based on this secondary post hoc analysis, intensive SBP reduction may probably be beneficial for primary prevention of cardiovascular morbidity and mortality in high-risk prehypertensive patients. This finding needs to be evaluated in a larger trial designed specifically to answer this question.

Pediatrician Communication About High Blood Pressure in Children With Overweight/Obesity During Well-Child Visits

OBJECTIVE

Despite recognition that hypertension is associated with childhood obesity, data suggest that high blood pressure (BP) is infrequently diagnosed in children. This study sought to examine provider communication with overweight school-age children regarding BP measurements that were high at well-child visits.

METHODS

Cross-sectional mixed-methods analysis of audio-recorded communication from well-child visits with overweight 6-12-year-olds. Data from the subset of children with elevated BPs were used for this study. Three BP measures obtained at the audio-recorded visit were averaged, paired with historical BPs stored in the health record, and compared to contemporary/Fourth-Report thresholds to determine if children had elevated/hypertensive BPs only at the audio-recorded visit or met hypertension-diagnostic criteria (hypertension-level BP ≥3 separate visits). Two reviewers used visit transcripts to categorize communication about BP as "absent," "unclear," or "direct." Provider use of a billing diagnosis for elevated BP/hypertension in visits with direct-BP-communication was explored.

RESULTS

In 36 of 126 (29%) visit-audio-recordings, children had elevated/hypertensive BPs. Thirty-three of the 36 eligible (92%) had intelligible audio-recordings. Of these, 9 (25%) were overweight and 24 (75%) had obesity. Seventeen (52%) had elevated BPs, and 16 (48%) hypertensive BPs. Ten (30%) met criteria for hypertension diagnosis. BP communication was absent in 20 visits (61%), unclear in 8 (24%), and direct in 5 visits (15%). Billing diagnoses for elevated BP/hypertension were entered at 4 of 5 (80%) visits with direct-BP communication.

CONCLUSIONS

Most overweight children with elevated BPs did not receive communication that BP is high at well-child visits. Relevant billing diagnoses may indicate direct-BP communication.

Elevated blood pressure and its relationship with bodyweight and anthropometric measurements among 8-11-year-old Indonesian school children

Objective: Increased prevalence of elevated blood pressure in children and adolescents was associated with increased body weight and measures. Also, prevalence of elevated blood pressure varies between countries. This study is to investigate the prevalence of elevated blood pressure in Indonesian children and its relationship with bodyweight and anthropometric measures. Methods: This cross-sectional study involved 1010 elementary students aged 8 - 12 years (479 girls, 531 boys). The anthropometric measures and blood pressure were assessed. Elevated blood pressure (EBP) was determined if at the 90^th percentile or above for gender, age, and height. Independent t-test, Chi-square, Pearson correlation, and multivariate logistic regression were applied. Significance was determined at p<0.05. Results: Overall prevalence of EBP was 28.8% (35.9% in girls, 22.4% in boys). BMI, waist circumference (WC), waist to height ratio (WHtR), and abdominal skinfold had significant correlation with EBP. Elevated BP was higher in overweight and obesity than in normoweight (60.5% vs 39.5%, p=0.00). In girls, the OR of EBP for overweight and obesity were 2.33 (95% CI 1.40-3.87, p=0.03) and 3.44 (95% CI 1.98-5.99, p=0.00) whereas in boys were 4.26 (95% CI 2.20-8.28, p=0.00) and 8.82 (95% CI 5.10-15.38, p=0.00). Conclusions: Prevalence of EBP in Indonesian school children aged 8 - 11 years was higher and more prevalent in overweight/ obesity and in girls. Anthropometric measures were correlated with EBP.

Prevalence, Awareness, and Control of Arterial Hypertension in a Russian Population. The Ural Eye and Medical Study

Background: Applying the criteria recently published by the American College of Cardiology/American Heart Association for the definition of arterial hypertension, we investigated prevalence and awareness of arterial hypertension in Russia. This new definition differentiates between normal BP [SBP (systolic blood pressure)/DBP (diastolic blood pressure) < 120/80 mmHg], elevated BP (SBP 120–129 mmHg; DBP < 80 mmHg), hypertension stage 1 (SBP 130–139 mmHg or DBP 80–89 mmHg), hypertension stage 2 (SBP ≥ 140 and ≤180 mmHg or DBP ≥ 90 and ≤120 mm Hg) and hypertensive crisis (SBP > 180 mmHg and/or DBP > 120).

Methods: The population-based Ural Eye and Medical Study, performed in an urban and rural region in the Russian republic Bashkortostan, included 5,891 (80.5%) individuals aged 40+ years out of 7,328 eligible individuals. The participants underwent a detailed interview and medical examination. Arterial hypertension was defined using the criteria defined by the American College of Cardiology/American Heart Association.

Results: The prevalence of normal blood pressure (BP), elevated BP, hypertension stage 1, stage 2, and hypertensive crisis was 750/5,891 [12.7%; 95% confidence interval (CI): 4.7, 5.9], 312/5, 891 (5.3%; 95% CI: 4.7, 5.9), 2,187/5,891 (37.1%; 95% CI: 35.9, 38.4), 2,484/5,891 (42.2%; 95% CI: 40.9, 43.4), and 158/5,891 (2.7%; 95% CI: 2.3, 3.1), respectively. The overall prevalence of elevated BP/hypertension was 5,141/5,891 (87.3%; 95% CI: 86.4, 88.1). Awareness of elevated BP/hypertension was 2,289/5,223 (45.4%; 95% CI: 44.0, 47.0). Among 1,055 (20.2%; 95% CI: 19.1, 21.3) individuals under anti-hypertensive treatment, 33 (3.1%) individuals had normal BP values. Higher risk of elevated BP/hypertension was associated with older age [odds ratio (OR): 1.04; 95% CI: 1.03,1.05], male gender (OR: 2.56; 95% CI: 2.10, 3.16), urban region (OR: 1.26; 95% CI: 1.05, 1.51), lower educational level (OR: 0.92; 95% CI: 0.87, 0.97), higher body mass index (OR: 1.15; 95% CI: 1.12, 1.18), higher waist-hip circumference ratio (OR: 6.16; 95% CI: 1.89, 20.0), higher prevalence of sitting or reclining for more than 18 h per week (OR: 1.33; 95% CI: 1.10, 1.61), higher prevalence of alcohol consumption (OR: 1.61; 95% CI: 1.27, 2.05), and higher serum concentrations of triglycerides (OR: 1.22; 95% CI: 1.05, 1.43) and glucose (OR: 1.15; 95% CI: 1.07, 1.24). Using the former definition of hypertension (systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg), the prevalence of hypertension was 3,134/5,891 (53.2%; 95% CI: 51.9, 54.5).

Conclusions: Using the new definition of arterial hypertension, the prevalence of elevated BP/hypertension in a typically mixed Russian population aged 40+ years was high (87.3%), with an awareness rate of 45.4% and treatment rate of 20.2%. The rate of therapeutic control of BP elevation in the individuals under treatment was <5%.

Time to Initiation of Antihypertensive Therapy After Onset of Elevated Blood Pressure in Patients With Primary Proteinuric Kidney Disease

Rationale & Objective

The objective of the study was to estimate the prevalence of hypertension in patients with proteinuric kidney disease and evaluate blood pressure (BP) control.

Study Design

Retrospective cohort study.

Setting & Participants

Data from adults and children with proteinuric kidney disease enrolled in the multicenter Kidney Research Network Registry were used for this study.

Exposure

Proteinuric kidney disease.

Outcomes

Hypertension and BP control.

Analytical Approach

Patients with white-coat hypertension were excluded. Patients were censored at end-stage kidney disease onset. Patients were defined as hypertensive either by hypertension diagnosis code, having 2 or more encounters with elevated BPs, or treatment with antihypertensive therapy excluding renin-angiotensin-aldosterone system blockade. Elevated BP was defined as greater than 95th percentile for children and >140/90 mm Hg in adults. Sustained BP control was defined as 2 or more consecutive encounters with BPs lower than 95th percentile for children and <140/90 mm Hg for adults. Kaplan-Meier and Cox proportional hazards analyses were used to evaluate the time to initiation of antihypertensive therapy.

Results

842 patients, 69% adults and 31% children, with a total observation period of 6,722 patient-years were included in the analysis. 644 (76%) had hypertension during observation. There was no difference in the prevalence of hypertension between children and adults (74% vs 78%; P = 0.3). Hypertension was most common among those of African American race compared with other races (90% vs 72%-75%; P = 0.003). 504 (78%) patients with hypertension achieved BP control but only 51% achieved control within 1 year. 140 (22%) patients with hypertension never achieved BP control during a median of 41 (IQR, 24-73) months of observation.

Limitations

Differing BP control goals that may lead to overestimation of the controlled patient population.

Conclusions

Hypertension affects most patients with proteinuric kidney disease regardless of age. Time to BP control exceeded 1 year in 50% of patients with hypertension and 22% did not demonstrate control. This study highlights the need to address hypertension early and completely in disease management of patients with proteinuric kidney disease.

Clustering of Elevated Blood Pressure, Elevated Blood Glucose, and Abdominal Obesity Among Adults in Dire Dawa: A Community-Based Cross-Sectional Study

BACKGROUND

Evidence shows that the presence of a single component of the metabolic syndrome (MetS) increases the risk of developing the MetS later in life. This study estimated the prevalence and associated factors of abdominal obesity, elevated blood pressure, elevated blood glucose, and the 3-factor MetS components among urban adults in Dire Dawa, East Ethiopia.

METHODS

Community-based cross-sectional data were collected from 872 adults aged 25-64 years. The joint interim statement (JIS) was used to define the MetS components. The dependent outcome variables were both the individual and the 3-factor MetS components. A robust variance Poisson regression model was used to directly estimate the prevalence ratio (PR) of risk factors.

RESULTS

The prevalence of the 3-factor MetS components (abdominal obesity, elevated blood pressure, and elevated blood glucose) was 9.5% (95% CI: 7.7, 11.7). Women had two times higher prevalence of the 3-factor MetS components compared with men, 11.6% (95% CI: 9.2, 14.5) vs 5.2% (95% CI: 3.2, 8.5). A higher prevalence of abdominal obesity, 46.4% (95% CI: 43.1, 49.8), followed by a raised blood pressure, 42.7% (95% CI: 39.4, 46.0), was observed among study subjects. The presence of a single MetS component had an associated cluster of other components: 33.7% of subjects with elevated blood glucose, 22.3% with elevated blood pressure, and 20.5% with abdominal obesity had also the 3-factor MetS components. Age, sex, body mass index, waist circumference, and physical activity were significantly associated with the individual components or the 3-factor MetS components.

CONCLUSION

A higher prevalence of the individual components and the presence of clustering with a single factor identified call for the need of community screening. Interventions targeting both abdominal and general obesity through physical activity and lifestyle modification can contribute towards reducing cardiometabolic risk factors with due attention given to women and older adults.

Epidemiological characteristics of elevated blood pressure among middle and high school students aged 12-17 years: a cross-sectional study in Jiangsu Province, China, 2017-2018

OBJECTIVE

In this study, we aimed to present the epidemiological characteristics of elevated blood pressure among middle and high school students aged 12-17 years in Jiangsu Province.

SETTING

Hypertension, which is considered a rare disease in children, is an important early precursor to long-term cardiovascular damage, and elevated blood pressure in childhood is a strong predictor of hypertension in adulthood.

PARTICIPANTS

Physical examination and questionnaire investigation among children aged 12-17 years in Jiangsu Province were conducted from 2017 to 2018.

MAIN OUTCOME MEASURES

Physical measurements included height, weight, blood pressure and history of menarche/first spermatorrhoea. Questionnaire investigation included family type, delivery mode, lifestyle habits and psychological test.

RESULTS

In our study we investigated 17 791 middle and high school students, consisting of 8701 female students and 9090 male students. The prevalence of screening elevated blood pressure among students aged 12-17 years was 20.0% (95% CI 19.2% to 20.9%) for female students and 22.3% (95% CI 21.5% to 23.2%) for male students. The prevalence of screening elevated blood pressure for urban male middle and high school students was higher than that of elevated blood pressure for rural male middle and high school students. However, similar phenomenon cannot be observed among female students. For both male and female students, body mass index (BMI), obesity/overweight and menarche/first spermatorrhoea can be a risk factor contributing to elevated blood pressure, and sleep time and regional distribution might be important factors that need to be investigated in depth.

CONCLUSION

We found a relatively high prevalence of screening elevated blood pressure among students aged 12-17 years for both female and male students in Jiangsu Province. The risk factors can be BMI, obesity/overweight and menarche/first spermatorrhoea.

Height-specific blood pressure cutoffs for screening elevated and high blood pressure in children and adolescents: an International Study

Pediatric blood pressure (BP) reference tables are generally based on sex, age, and height and tend to be cumbersome to use in routine clinical practice. In this study, we aimed to develop a new, height-specific simple BP table according to the international child BP reference table based on sex, age and height and to evaluate its performance using international data. We validated the simple table in a derivation cohort that included 58,899 children and adolescents aged 6-17 years from surveys in 7 countries (China, India, Iran, Korea, Poland, Tunisia, and the United States) and in a validation cohort that included 70,072 participants from three other surveys (China, Poland and Seychelles). The BP cutoff values for the simple table were calculated for eight height categories for both the 90th ("elevated BP") and 95th ("high BP") percentiles of BP. The simple table had a high performance to predict high BP compared to the reference table, with high values (boys/girls) of area under the curve (0.94/0.91), sensitivity (88.5%/82.9%), specificity (99.3%/99.7%), positive predictive values (93.9%/97.3%), and negative predictive values (98.5%/97.8%) in the pooled data from 10 studies. The simple table performed similarly well for predicting elevated BP. A simple table based on height only predicts elevated BP and high BP in children and adolescents nearly as well as the international table based on sex, age, and height. This has important implications for simplifying the detection of pediatric high BP in clinical practice.

Elevated blood pressure and its predictors among secondary school students in Sarawak: a cross-sectional study

OBJECTIVES

Hypertension is a health issue affecting adolescents. Accumulating evidence affirms that elevated blood pressure begins in childhood and tracks into adulthood. This cross-sectional study was conducted to determine the prevalence of elevated blood pressure and its predictors among secondary school students in Sarawak, Malaysia.

METHODS

A total of 2,461 secondary school students aged 12-17 years from 19 schools in Sarawak participated in the study. Questionnaire was used to obtain socio-demographic data, parental history of hypertension, and self-reported physical activity. Anthropometric and blood pressure measurements were taken. Data was entered and analysed using SPSS version 23.0.

RESULTS

The prevalence of adolescents with elevated blood pressure, overweight, central obesity, and overfat were 30.1%, 24.3%, 13.5%, and 6.7%, respectively. Multivariate logistic regression demonstrated the predictors significantly associated with elevated blood pressure among respondents: overweight (adjusted odds ratio=3.144), being male (adjusted odds ratio=3.073), being Chinese (adjusted odds ratio=2.321) or Iban (adjusted odds ratio=1.578), central obesity (adjusted odds ratio=2.145), being overfat (adjusted odds ratio=1.885), and being an older adolescent (adjusted odds ratio=1.109). Parental history of hypertension, locality, and physical activity showed no significant associations.

CONCLUSION

The obesity epidemic must be tackled at community and school levels by health education and regulation of school canteen foods.

Bread Consumption Is Associated with Elevated Blood Pressure among Adults Living in Mexico City⁻A Sub-Analysis of the Tlalpan 2020 Study

Excessive dietary sodium is associated with elevated blood pressure (EBP). Bread products are identified as one of the main sources of daily sodium intake. The objective of this cross-sectional study was to evaluate the association between bread and others cereal products consumption with EBP. Frequency intake of a standard serving of bread and other cereal products was recorded and categorized as: ≤3 times/month or never (reference category group) and ≥ once/week. EBP was defined as systolic blood pressure (SBP) ≥120 mmHg and/or diastolic blood pressure (DBP) ≥80 mmHg. Raw and adjusted odds ratios (OR) for the association between consumption of the studied food products and blood pressure status were estimated. Overall, 2011 participants aged 37.3 ± 9.1 years old were included. In the models adjusted for relevant covariates, consumption of one piece of bolillo or telera (OR = 1.39; 95% CI = 1.01–1.89) ≥ once/week was associated with an increased risk of EBP, compared to the reference category. Also, participants consuming one bowl of high-fiber breakfast cereal once/week were less likely to have EBP (OR = 0.73; 95% CI = 0.53–0.98). Initiatives to reduce sodium levels in bread products such as bolillo and telera are needed in Mexico to help manage the cardiovascular risk at the population level.

Surveillance of Pediatric Hypertension Using Smartphone Technology

INTRODUCTION

Elevated blood pressure is becoming increasingly common in the pediatric population. Hypertension costs nearly $51 billion/year, and cardiovascular disease is responsible for 17% of the nation's health care expenditures. Traditionally, time-consuming and complicated interpretation standards result in infrequent pediatric blood pressure screenings. This may lead to the under-diagnosis of pediatric hypertension. Early detection of elevated blood pressure is important in order to prevent hypertension related conditions such as, target organ damage, left ventricular hypertrophy, and cerebrovascular disease. The aim of this study was to observe the prevalence of pediatric hypertension among children and adolescents age 3-18 using the smartphone application Pedia BP®. The purpose of this study was to (1) identify the prevalence of elevated blood pressure in a sample of children and adolescents and (2) evaluate any association between BMI, age, and blood pressure classification.

METHOD

A quantitative, descriptive study was conducted to evaluate the prevalence of pediatric hypertension in 81 preschool and school age children. App users were trained with the online take2heart course available at take2heart.com. The manual systolic and diastolic blood pressure readings were entered into the application, along with the patient's gender, age, height, and weight. Pedia BP® instantly calculated the blood pressure classification of the patient based on percentiles. Quantitative data from the Pedia BP® data repository were analyzed using descriptive statistics.

RESULTS

We found that 54.3% of our sample were normotensive, 23.5% had prehypertension, 13.6% had stage 1 hypertension, and 8.6% had stage 2 hypertension. As seen in Figure 3, the majority of subjects with stage 1 (72.7%) and stage 2 hypertension (57.1%) were found in school-age children. We found that 3.7% of children were underweight, 48.1% were at a healthy weight, 21% were overweight, and 27.2% were obese.

DISCUSSION

Pedia BP® was shown to be an effective screening tool to easily classify blood pressure readings on an individual basis. The prevalence of hypertension in our sample was higher than previously reported in the literature. Annual evaluation of blood pressures in preschool and school age children are warranted to identify and address hypertension. Pedia BP® was shown to be an effective screening tool to easily classify blood pressure readings on an individual basis. Pedia BP® offers benefits not only for patients, but for primary care providers, nurses, economists, insurance companies, hospitals, and clinics. Ultimately, Pedia BP® (1) increases awareness of elevated blood pressures among children and adolescents, (2) engages the health care community to screen for elevated blood pressures, (3) implements innovative technology, and (4) activates the potential for a population-based surveillance tool.

Quality improvement project for managing elevated blood pressure in a primary care setting

Elevated blood pressure (BP) and prehypertension increase the risk of cardiovascular diseases, a national health concern. This article presents a quality improvement project implemented within a primary care setting that aimed at lowering cardiovascular risk by improving the identification, treatment, and follow-up of patients with elevated BP. This project was designed and implemented to address the identified deficiencies contributing to poor identification and follow-up of patients with elevated BP. The intervention was multi-pronged and comprised a staff educational program, introduction of a new method for measuring BP using the BpTRU™ device, and patient educational intervention. A significant improvement in staff BP knowledge scores was achieved following the intervention (p<0.05). Patient participants also exhibited a significant improvement in post-intervention BP measurements (p<0.05). This project showed that the implementation of a quality improvement project in a primary care setting can lead to significant improvements in staff BP knowledge and patient BP readings. However, future research in this area is required to determine whether particular lifestyle changes are directly associated with the reduction in BP.

Predicting Hypertension Among Children With Incident Elevated Blood Pressure

OBJECTIVE

To develop a model to predict hypertension risk among children with incident elevated blood pressure (BP); to test the external validity of the model.

METHODS

A retrospective cohort study was conducted in 3 organizations: Kaiser Permanente Colorado was the model derivation site; HealthPartners of Minnesota and Kaiser Permanente Northern California served as external validation sites. During study years 2006 through 2012, all children aged 3 through 17 years with incident elevated BP in an outpatient setting were identified. The predictor variables were demographic and clinical characteristics collected during routine care. Cox proportional hazards regression was used to predict subsequent hypertension, and diagnostic statistics were used to assess model performance.

RESULTS

Among 5598 subjects at the derivation site with incident elevated BP, 160 (2.9%) developed hypertension during the study period. Eight characteristics were used to predict hypertension risk: age, sex, race, BP preceding incident elevated BP, body mass index percentile, systolic BP percentile, diastolic BP percentile, and clinical setting of the incident elevated BP. At the derivation site, the model discriminated well between those at higher versus lower risk of hypertension (c-statistic = 0.77). At external validation sites, the observed risk of hypertension was higher than the predicted risk, and the model showed poor discrimination (c-statistic ranged from 0.64 to 0.67).

CONCLUSIONS

Among children with incident elevated BP, a risk model demonstrated good internal validity with respect to predicting subsequent hypertension. However, the risk model did not perform well at 2 external validation sites, which might limit transportability to other settings.

Elevated Blood Pressure and Its Associated Risk Factors among Adolescents of a North Indian City - A Cross-sectional Study

Context:

Amidst the uncertainty in childhood blood pressure (BP) thresholds, besides the ambiguity in levels and duration of BP elevation causing organ damage, hypertension is present in substantial number of asymptomatic children and adolescents with only a few studies disclosing the setup. With projection of deaths due to noncommunicable diseases in 2030 rising to 52 million, it is necessary to know about the knowledge of present adolescents about BP and its modifiable risk factors.

Aims:

(1) To assess the prevalence of elevated BP among adolescents and to ascertain the associated risk factors. (2) To assess adolescent's knowledge about BP and its modifiable factors.

Settings and Design:

A community-based cross-sectional study was conducted on school going adolescents of Lucknow, from September 2014 to August 2015.

Subjects and Methods:

BP, height, and weight were measured following standard protocols, Centers for Disease Control and Prevention charts for finding respective cut-off values and oral questionnaire for assessing lifestyle risk factors were used.

Statistical Analysis:

Chi-square, unpaired t-test, and logistic regression were used.

Results:

Of the 1041 participants, elevated BP (BP percentile ≥90) was prevalent in 24.2%. On regression, factors such as obesity (adjusted odds ratio [aOR] = 5.8, 95% confidence interval [CI] = 3.6–9.4), low fruit diet (aOR = 3.3, 95% CI = 2.1–5.4), and frequent junk food consumption (aOR = 1.9, 95% CI = 1.3–2.8) raised the odds of elevated BP while it was lowered by being physically active (aOR = 0.67, 95% CI = 0.46–0.97). Of 86.3% of children (n = 898) who were fathomed of BP, only less than third (33% and 21.9%) acquainted of BP raising and lowering practices, respectively.

Conclusions:

Prevalence of high BP is colossal with only a few children knowing its amendable nature. Strenuous efforts targeting detrimental behaviors and imparting the sense of healthy lifestyle enhancing practices are vital to control this epidemic.

Trends in Elevated Blood Pressure Among US Children and Adolescents: 1999-2012

BACKGROUND

The prevalence of elevated blood pressure (BP) has been reported to increase significantly among the US children and adolescents from 1988-1994 to 1999-2008. We aimed to examine the recent trends in BP levels and prevalence of elevated BP, as well as related influencing factors among US children and adolescents.

METHODS

Data of National Health and Nutrition Examination Survey (NHANES) 1999-2012 were combined into 3 time periods (1999-2002, 2003-2008, and 2009-2012) for the analysis. A total of 14,270 US children and adolescents aged 8-17 years were included in the current analysis. The sex-, age-, and height-BP standards recommended by the US Fourth Report were used to define high BP and elevated BP (including pre-HBP and HBP).

RESULTS

Mean systolic BP (SBP) and diastolic BP (DBP) decreased by 0.7 and 4.2mm Hg from 1999-2002 to 2009-2012, respectively. In 2009-2012, the prevalence of elevated BP and HBP in children and adolescents were 9.6% and 1.6%, with the absolute reduction of 2.8% and 1.3% from 1999-2002 to 2009-2012, respectively. In addition, daily intakes of total energy, carbohydrate, total saturated fatty acids, and caffeine decreased during the period between 1999-2002 and 2009-2012 (all P < 0.05), whereas daily intake of total polyunsaturated fatty acids and dietary fiber increased (P < 0.05).

CONCLUSIONS

Mean BP levels as well as the prevalence of elevated BP and HBP among US children and adolescents have declined during the past decade. In addition, there might be an associated change in dietary factors.

Lifestyle Patterns Are Associated with Elevated Blood Pressure among Qatari Women of Reproductive Age: A Cross-Sectional National Study

Women of childbearing age are particularly vulnerable to the adverse effects of elevated blood pressure (BP), with dietary and lifestyle habits being increasingly recognized as important modifiable environmental risk factors for this condition. Using data from the National STEPwise survey conducted in Qatar in year 2012, we aimed to examine lifestyle patterns and their association with elevated BP among Qatari women of childbearing age (18–45 years). Socio-demographic, lifestyle, dietary, anthropometric and BP data were used (n = 747). Principal component factor analysis was applied to identify the patterns using the frequency of consumption of 13 foods/food groups, physical activity level, and smoking status. Multivariate logistic regression analyses were used to evaluate the association of the identified lifestyle patterns with elevated BP and to examine the socio-demographic correlates of these patterns. Three lifestyle patterns were identified: a “healthy” pattern characterized by intake of fruits, natural juices, and vegetables; a “fast food & smoking” pattern characterized by fast foods, sweetened beverages, and sweets, in addition to smoking; and a “traditional sedentary” pattern which consisted of refined grains, dairy products, and meat in addition to low physical activity. The fast food & smoking and the traditional & sedentary patterns were associated with an approximately 2-fold increase in the risk of elevated BP in the study population. The findings of this study highlight the synergistic effect that diet, smoking and physical inactivity may have on the risk of elevated BP among Qatari women.

Blood pressure evaluation in children treated with laser surgery for twin-twin transfusion syndrome at 2-year follow-up

OBJECTIVE

Twin survivors of twin-twin transfusion syndrome (TTTS) may be at risk for early onset of cardiovascular disease. The aim of this study was to determine prevalence and risk factors for elevated blood pressure (BP) among children treated with selective laser photocoagulation of communicating vessels.

STUDY DESIGN

Data were prospectively collected from surviving children treated for TTTS with laser surgery from 2008 through 2010. Systolic BP (SBP) and diastolic BP (DBP) were obtained from 91 child survivors at age 24 months (±6 weeks) and evaluated based on age, sex, and height percentile. BP percentiles were calculated for each patient and categorized as normal (<95%) or abnormal (>95%). Clinical variables were evaluated using multilevel regression models to evaluate risk factors for elevated BP.

RESULTS

BP was categorized as normal in 38% and abnormal in 62% of twin survivors based on percentile for sex, age, and height; a comparable distribution was found for DBP elevation. There were no differences between donor and recipient twins for absolute SBP and DBP or BP classification. In a multivariate analysis, significant risk factors for higher SBP included prematurity (β -0.54; 95% confidence interval [CI], -0.99 to -0.09; P = .02), higher weight percentile (β 0.24; 95% CI, 0.05-0.42; P = .01), and presence of cardiac disease (β 0.50; 95% CI, 0.10-0.89; P = .01). Prematurity was also a significant risk for abnormal DBP (odds ratio, 0.89; 95% CI, 0.80-1.00; P = .05).

CONCLUSION

Child survivors of TTTS had elevated SBP and DBP measurements at 2 years of age, with no differences seen between former donor and recipient twins. Prematurity may be a risk factor for elevated BP measurements in this population. Future studies are warranted to ascertain whether these cardiovascular findings persist over time.

Correlation between Subclinical Heart Disease and Cardiovascular Risk Profiles in an Urban Emergency Department Population with Elevated Blood Pressures: A Pilot Study

BACKGROUND

Uncontrolled hypertension is a primary risk factor for development of cardiovascular complications.

OBJECTIVE

Determine the point prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction in an urban emergency department (ED) population with elevated blood pressures (BP) and examine correlations between subclinical disease and patient cardiovascular risk profiles.

METHODS

A convenience sample of patients with EBP (>140/90 on two measurements) had limited bedside echocardiograms (LBE). Subclinical hypertensive heart disease was classified as the presence of: LVH, abnormal ejection fraction (EF), or diastolic dysfunction.

RESULTS

Thirty-nine patients with EBP were enrolled. The mean age was 46 years (SD = 10.9), 59% were women, 21% were smokers, and 92% had a history of hypertension. The average body mass index was 30.7 (SD = 8.7). Patients were 67% African American, 23% Latino, 5% Caucasian, 3% Asian, and 3% Native American. Subclinical disease was found in 39%: 31% had LVH, 15% had diastolic dysfunction, and 8% had abnormal EF. On bivariate analysis, elevated BP (p = 0.039) and blood urea nitrogen (p = 0.016) were correlated with subclinical heart disease. After adjusting for other covariates, receiving oral/intravenous antihypertensive medications in the ED (p = 0.005) was associated with subclinical heart disease.

CONCLUSIONS

We found a point prevalence of subclinical heart disease of 39% in this urban ED population, using LBE. Real-time identification of subclinical heart disease at early stages in the ED in conjunction with abnormal renal function can help emergency physicians identify those patients in need of more aggressive therapy and urgent follow-up.

Management of hypertension in hospitalized patients

Elevated blood pressure (BP) is a common problem in patients hospitalized for reasons other than hypertension. Unexpected elevations commonly result in calls to physicians who too often prescribe medication to reduce the numbers without evaluating the patient or determining the cause of the elevation. This may result in unnecessary and sometimes harmful treatment. Such BP elevation has many potential causes. These include anxiety, post-operative salt and volume overload, failure to administer the patient's known antihypertensive medication, inability to give oral antihypertensive medication to patients who cannot take pills by mouth, incipient heart failure, previously unrecognized renal failure, obstructive uropathy and other causes. These must be identified and treated prior to addressing only the elevated BP numbers. We present an algorithm for evaluating hospitalized patients with elevated BP in order to assist physicians in identifying the true cause of the elevation, treating the identified cause, and giving appropriate drug treatment. We also note that this is a golden opportunity for communication with the outpatient providers who will follow the patient.