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Logan AC, Mishra P. Aggression and Justice Involvement: Does Uric Acid Play a Role? Brain Sci 2025; 15:268. [PMID: 40149789 PMCID: PMC11940041 DOI: 10.3390/brainsci15030268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 02/27/2025] [Accepted: 02/28/2025] [Indexed: 03/29/2025] Open
Abstract
The search for biological markers that can be reliably linked to aggression and antisocial behavior has been central to the work of biological criminology. One such marker, uric acid, has long been suspected to play a causative role in promoting anger, irritability, aggression, and violence. Here, in this perspective article, we revisit some of the historical interest in uric acid as a compound relevant to brain and behavior, and reflect these early accounts off emergent scientific research. Advances in brain sciences, including neuropsychiatry and neuromicrobiology, have allowed for a more sophisticated understanding of potential mechanistic pathways linking uric acid with cognition and behavior. The updated science suggests that some of the early ideas surrounding uric acid and criminology had credibility. The available research strongly suggests that uric acid, as a potential biomarker of risk, is worthy of further research and close scrutiny. Informed by emergent gut-brain-microbiome research, we argue that certain aspects of early-to-mid-20th-century biological criminology were prematurely abandoned. From a legalome perspective, further advances surrounding uric acid and other gut-brain biomarkers can aid in shaping more humane, scientifically grounded policies that recognize the interplay between biology and environment.
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Affiliation(s)
| | - Pragya Mishra
- Department of Law, Central University of Allahabad, Prayagraj 211002, India;
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2
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Jeong SI, Kim SH. Obesity and hypertension in children and adolescents. Clin Hypertens 2024; 30:23. [PMID: 39217385 PMCID: PMC11366140 DOI: 10.1186/s40885-024-00278-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/28/2024] [Indexed: 09/04/2024] Open
Abstract
As childhood obesity rates increase worldwide, the prevalence of obesity-related hypertension is also on the rise. Obesity has been identified as a significant risk factor for hypertension in this age group. National Health Surveys and meta-analyses show increasing trends in obesity and pediatric hypertension in obese children. The diagnosis of hypertension in children involves percentiles relative to age, sex, and height, unlike in adults, where absolute values are considered. Elevated blood pressure (BP) in childhood is consistently associated with cardiovascular disease in adulthood, emphasizing the need for early detection and intervention. The pathogenesis of hypertension in obesity involves multiple factors, including increased sympathetic nervous system activity, activation of the renin-angiotensin-aldosterone system (RAAS), and renal compression due to fat accumulation. Obesity disrupts normal RAAS suppression and contributes to impaired pressure natriuresis and sodium retention, which are critical factors in the development of hypertension. Risk factors for hypertension in obesity include degree, duration, and distribution of obesity, patient age, hormonal changes during puberty, high-sodium diet, sedentary lifestyle, and socioeconomic status. Treatment involves lifestyle changes, with weight loss being crucial to lowering BP. Medications such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers may be considered first, and surgical approaches may be an option for severe obesity, requiring tailored antihypertensive medications that consider individual pathophysiology to avoid exacerbating insulin resistance and dyslipidemia.
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Affiliation(s)
- Soo In Jeong
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sung Hye Kim
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggido, Republic of Korea.
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Akhtar S, Khan S, Aziz N, Imran M, Samad Z, Iqbal R, Almas A. Obesity and risk of hypertension in preadolescent urban school children: insights from Pakistan. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:89. [PMID: 38902813 PMCID: PMC11191163 DOI: 10.1186/s41043-024-00585-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/09/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Childhood obesity and hypertension are growing concerns globally, especially in developing countries. This study investigated the association between overall and central obesity at baseline, and prehypertension or hypertension at follow-up among preadolescent school children in urban Karachi, Pakistan. METHODS This is a sub study with cohort design embedded within a feasibility trial on School Health Education Program in Pakistan (SHEPP) in preadolescents aged 6-11 years, attending two private schools conducted from 2017 to 2019. Hypertension or prehypertension at follow-up were the outcomes and obesity or central obesity at baseline were the exposure variables. Hypertension was defined as systolic blood pressure and/or diastolic blood pressure ≥ 95th percentile for age, sex, and height. Obesity was defined as body mass index for-age and sex ≥ 95th percentile, whereas central obesity was determined by waist circumference measurements ≥ 85th percentile of age, sex, and height specific cut-offs. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to identify risk factors for hypertension and prehypertension. RESULTS Analysis was conducted for 908 participants, evenly distributed with 454 boys and 454 girls. Hypertension was observed in 19.8% of the preadolescents, with rates of 18.5% in boys and 21.0% in girls. Prehypertension was found in 16.8% of preadolescents, with 18% among boys and 16% among girls. Additionally, 12.8% of preadolescents were classified as obese and 29.8% had central obesity. Obesity at baseline was associated with hypertension at followup (OR 8.7, 95% CI 3.5, 20.4) in the final model after adjusting for age, gender, physical activity, sedentary behavior, fruits, vegetable intake and hypertension at baseline. Central obesity at baseline also yielded high odds, with prehypertension (OR 1.9, 95% CI 1.4, 2.8) and hypertension (OR 2.7, 95% CI 1.9, 3.9) at follow up in the final model. CONCLUSION This study highlights a concerning prevalence of hypertension and prehypertension among preadolescent school-going children. Obesity and central obesity at baseline emerged as significant predictive factors for hypertension or prehypertension at followup within this cohort. The findings emphasize the urgency of implementing comprehensive school health education programs aimed at early detection and effective management of hypertension during childhood and adolescence in school settings.
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Affiliation(s)
- Samina Akhtar
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Shahid Khan
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Namra Aziz
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Muhammed Imran
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Zainab Samad
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Romaina Iqbal
- Department of Medicine and Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Aysha Almas
- Department of Medicine, Aga Khan University, Karachi, Pakistan.
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Akhtar S, Khan S, Aziz N, Magsi MI, Samad Z, Iqbal R, Almas A. Obesity and Risk of Hypertension in Preadolescent Urban School Children: Insights from a Developing Country. RESEARCH SQUARE 2024:rs.3.rs-4213965. [PMID: 38659830 PMCID: PMC11042407 DOI: 10.21203/rs.3.rs-4213965/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background Childhood obesity and hypertension are growing concerns globally, especially in developing countries. This study investigated the association between overall and central obesity at baseline, and prehypertension or hypertension at follow-up among preadolescent school children in Karachi, Pakistan. Methods This is a sub study with cohort design embedded within a feasibility trial on School Health Education Program in Pakistan (SHEPP) in preadolescent aged 6-11 years, attending two private schools, were enrolled from 2017 to 2019. Hypertension or prehypertension at follow-up were the outcomes and obesity or central obesity at baseline were the exposure variables. Hypertension was defined as systolic blood pressure and/or diastolic blood pressure ≥ 95th percentile for age, sex, and height. Obesity was defined as body mass index for-age and sex ≥ 95th percentile, whereas central obesity was determined by waist circumference measurements ≥ 85th percentile of age, sex, and height specific cut-offs. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to identify risk factors for hypertension and prehypertension. Results Analysis was conducted for 908 participants, evenly distributed with 454 boys and 454 girls. Hypertension was observed in 19.8% of the preadolescents, with rates of 18.5% in boys and 21.0% in girls. Prehypertension was found in 16.8% of preadolescents, with 18% among boys and 16% among girls. Additionally, 12.8% of preadolescents were classified as obese and 29.8% had central obesity. Obesity at baseline was associated with hypertension (OR 8.7, 95% CI 3.5, 20.4) in the final model after adjusting for age, gender, physical activity, sedentary behavior, fruits, vegetable intake and hypertension at baseline. Central obesity at baseline also yielded high odds, with prehypertension (OR 1.9, 95% CI 1.4, 2.8) and hypertension (OR 2.7, 95% CI 1.9, 3.9) in the final model. Conclusion This study highlights a concerning prevalence of hypertension and prehypertension among preadolescent school-going children. Obesity and central obesity at baseline emerged as significant predictive factors for hypertension within this cohort. The findings emphasize the urgency of implementing comprehensive school health education programs aimed at early detection and effective management of hypertension during childhood and adolescence in school settings.
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Alam MZ, Sheoti IH. The burden of diabetes and hypertension on healthy life expectancy in Bangladesh. Sci Rep 2024; 14:7936. [PMID: 38575655 PMCID: PMC10995204 DOI: 10.1038/s41598-024-58554-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/01/2024] [Indexed: 04/06/2024] Open
Abstract
Diabetes and hypertension are among the leading causes of death in Bangladesh. This study examined hypertension, diabetes, and either or both, free life expectancy, to measure the effect of the diseases on the overall health of individuals in Bangladesh with regional variations. We utilized data from Bangladesh Sample Vital Statistics 2018 for mortality and Bangladesh Demographic and Health Survey 2017-2018 for diabetes and hypertension. The Sullivan method was employed to estimate age-specific hypertension and diabetes-free life expectancy. Altogether, 10.3% of the people aged 18-19 years lived with either diabetes or hypertension. The hypertension-free life expectancy was 40.4 years, and the diabetes-free life expectancy was 53.2 years for those aged 15-19. Overall, individuals would expect to spend 38.7% of their lives with either of the diseases. Females suffered more from hypertension and males from diabetes. Still, females suffered more from the aggregate of both. Rural people had more diabetes and hypertension-free life expectancy than those of urban. Individuals of Mymensingh had the highest life expectancy free of both diseases compared to other divisions of Bangladesh. Diabetes and hypertension affect a considerable proportion of the life of the population in Bangladesh. Policy actions are needed to guide the prevention, diagnosis, and treatment of both diseases, specifically focusing on women and urban populations. Widespread health-enhancing actions need to be taken to diminish the effect of these two diseases in Bangladesh.
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Affiliation(s)
- Md Zakiul Alam
- Department of Population Sciences, University of Dhaka, Dhaka, 1000, Bangladesh.
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Maryland, 21205, USA.
| | - Isna Haque Sheoti
- Department of Population Sciences, University of Dhaka, Dhaka, 1000, Bangladesh
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Carullo N, Zicarelli M, Michael A, Faga T, Battaglia Y, Pisani A, Perticone M, Costa D, Ielapi N, Coppolino G, Bolignano D, Serra R, Andreucci M. Childhood Obesity: Insight into Kidney Involvement. Int J Mol Sci 2023; 24:17400. [PMID: 38139229 PMCID: PMC10743690 DOI: 10.3390/ijms242417400] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
This review examines the impact of childhood obesity on the kidney from an epidemiological, pathogenetic, clinical, and pathological perspective, with the aim of providing pediatricians and nephrologists with the most current data on this topic. The prevalence of childhood obesity and chronic kidney disease (CKD) is steadily increasing worldwide, reaching epidemic proportions. While the impact of obesity in children with CKD is less pronounced than in adults, recent studies suggest a similar trend in the child population. This is likely due to the significant association between obesity and the two leading causes of end-stage renal disease (ESRD): diabetes mellitus (DM) and hypertension. Obesity is a complex, systemic disease that reflects interactions between environmental and genetic factors. A key mechanism of kidney damage is related to metabolic syndrome and insulin resistance. Therefore, we can speculate about an adipose tissue-kidney axis in which neurohormonal and immunological mechanisms exacerbate complications resulting from obesity. Adipose tissue, now recognized as an endocrine organ, secretes cytokines called adipokines that may induce adaptive or maladaptive responses in renal cells, leading to kidney fibrosis. The impact of obesity on kidney transplant-related outcomes for both donors and recipients is also significant, making stringent preventive measures critical in the pre- and post-transplant phases. The challenge lies in identifying renal involvement as early as possible, as it is often completely asymptomatic and not detectable through common markers of kidney function. Ongoing research into innovative technologies, such as proteomics and metabolomics, aims to identify new biomarkers and is constantly evolving. Many aspects of pediatric disease progression in the population of children with obesity still require clarification. However, the latest scientific evidence in the field of nephrology offers glimpses into various new perspectives, such as genetic factors, comorbidities, and novel biomarkers. Investigating these aspects early could potentially improve the prognosis of these young patients through new diagnostic and therapeutic strategies. Hence, the aim of this review is to provide a comprehensive exploration of the pathogenetic mechanisms and prevalent pathological patterns of kidney damage observed in children with obesity.
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Affiliation(s)
- Nazareno Carullo
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (N.C.); (M.Z.); (A.M.); (T.F.); (G.C.)
| | - Mariateresa Zicarelli
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (N.C.); (M.Z.); (A.M.); (T.F.); (G.C.)
| | - Ashour Michael
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (N.C.); (M.Z.); (A.M.); (T.F.); (G.C.)
| | - Teresa Faga
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (N.C.); (M.Z.); (A.M.); (T.F.); (G.C.)
| | - Yuri Battaglia
- Department of Medicine, University of Verona, 37129 Verona, Italy;
| | - Antonio Pisani
- Department of Public Health, University Federico II of Naples, 80131 Naples, Italy;
| | - Maria Perticone
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (M.P.); (D.C.); (D.B.)
| | - Davide Costa
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (M.P.); (D.C.); (D.B.)
- Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University, 88100 Catanzaro, Italy;
| | - Nicola Ielapi
- Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University, 88100 Catanzaro, Italy;
- Department of Public Health and Infectious Disease, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Giuseppe Coppolino
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (N.C.); (M.Z.); (A.M.); (T.F.); (G.C.)
| | - Davide Bolignano
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (M.P.); (D.C.); (D.B.)
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (M.P.); (D.C.); (D.B.)
- Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University, 88100 Catanzaro, Italy;
| | - Michele Andreucci
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (N.C.); (M.Z.); (A.M.); (T.F.); (G.C.)
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Liu Y, Lin Y, Huang X, Li Y, Liu Y, Shi L. Association of serum transforming growth factor β 1 with left ventricular hypertrophy in children with primary hypertension. Eur J Pediatr 2023; 182:5439-5446. [PMID: 37755472 PMCID: PMC10746758 DOI: 10.1007/s00431-023-05219-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/31/2023] [Accepted: 09/16/2023] [Indexed: 09/28/2023]
Abstract
UNLABELLED The current study was designed to assess the association of serum transforming growth factor β1 (TGF-β1) with left ventricular hypertrophy (LVH) in children with primary hypertension. The present single-center prospective trial examined 182 patients diagnosed with primary hypertension in Children's Hospital, Capital Institute of Pediatrics, between January 2021 and September 2022. Clinical data were analyzed, and ambulatory blood pressure was assessed for 24 h. LVH, the commonest subclinical cardiac feature of hypertension, was assessed by echocardiography. According to left ventricular geometry, cases were assigned to the LVH (n = 44) and normal geometry (n = 138) groups. Serum TGF-β1 amounts were quantitated by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curves were established to analyze various variables for their predictive values in LVH. Among 182 children with primary hypertension, the concentrations of serum TGF-β1 were higher in stage 2 hypertension than in stage 1 (47.3 (38.8, 52.5) vs. 46.0 (38.6, 48.2) ng/L, Z = - 2.376; P = 0.018). Additionally, serum TGF-β1 content showed a positive correlation with BP levels (P < 0.05). TGF-β1 amounts were significantly elevated in the LVH group compared with the normal geometry group (51.7 (46.1, 54.9) vs. 46.1 (38.7, 48.1) ng/L, Z = - 4.324; P = 0.0000). Serum TGF-β1 content was positively associated with LVH (r = 0.321, P = 0.0000). Multivariable logistic regression analysis showed BMI (OR = 1.188, 95% CI 1.082-1.305; P = 0.0000) and elevated serum TGF-β1 content (OR = 1.063, 95% CI 1.016-1.113; P = 0.009) independently predicted LVH. A multivariable logistic regression model considering BMI and TGF-β1 content in LVH prediction was 0.771, with sensitivity and specificity of 72.7% and 70.3%, respectively. CONCLUSION These data revealed an association of serum TGF-β1 with BP in children with primary hypertension. Serum TGF-β1 concentration was positively correlated with hypertensive cardiac damage. Serum TGF-β1 might constitute a valuable molecular marker for the prediction of LVH in children with primary hypertension. The combination of BMI and TGF-β1 has a certain diagnostic and predictive value for LVH in children with primary hypertension, which may provide a new reference index for early clinical identification of hypertensive cardiac damage. WHAT IS KNOWN • Experimental and clinical data indicated TGF-β1 is involved in BP elevation. • TGF-β1 is positively correlated with LVMI and hypertrophy in adults. WHAT IS NEW • Our current study reveals an association of serum TGF-β1 with BP in children with primary hypertension. • Elevated serum TGF-β1 level is positively associated with LVH in children with primary hypertension. • The combination of BMI and TGF-β1 has a certain diagnostic and predictive value for LVH in children with primary hypertension.
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Affiliation(s)
- Yang Liu
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Yao Lin
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Xiaolan Huang
- Central Laboratory, Capital Institute of Pediatrics, Beijing, China
| | - Yaqi Li
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Yanyan Liu
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Lin Shi
- Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
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Huang Z, Li S, Lu F, Tian K, Peng L. Current situation and factors influencing physical fitness among adolescents aged 12 ∼ 15 in Shandong Province, China: A cross-sectional study. Prev Med Rep 2023; 36:102460. [PMID: 37927974 PMCID: PMC10622685 DOI: 10.1016/j.pmedr.2023.102460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Adolescent physical fitness serves not merely as a current barometer of well-being but as a significant prognosticator of future health trajectories. Amidst the tumult of socioeconomic metamorphoses and pronounced lifestyle transitions enveloping China-mirroring global trends-the imperative to elucidate the present landscape of adolescent physical fitness intensifies. Moreover, discerning the myriad determinants underpinning it becomes paramount. In this context, our research endeavored to meticulously delineate the physical fitness milieu of adolescents residing in Shandong Province, systematically unpacking the multifarious influencers thereof. The insights garnered herein furnish an empirical foundation, primed to guide the sculpting of calibrated interventions, targeting the enhancement of health in this pivotal population cohort. In an extensive evaluative survey conducted in 2023 concerning the physical fitness of Shandong's student populace, a cohort of 33,211 adolescents aged 12 to 15 years was delineated utilizing a stratified random cluster sampling technique. This exercise meticulously quantified the physical fitness indices across diverse gender, age, and household registration classifications, subsequently computing the concomitant qualified rates. Employing multivariable logistic regression analysis, this investigation delved into the determinants modulating the adolescents' physical fitness qualified rate. For 2023, the aggregate fitness qualified rate stood at 91.94 % for the adolescents aged 12 ∼ 15 in Shandong Province. Gender-wise, female adolescents registered a qualified rate of 92.25 %, marginally eclipsing their male peers at 91.63 % (P < 0.05). An age-related trend in qualified rates was discernible, with marked variations across different age bands (P < 0.05): 91.37 % for 12-year-olds, 91.79 % for 13-year-olds, 91.81 % for 14-year-olds, and a zenith of 92.87 % for 15-year-olds. A geographical dichotomy emerged wherein rural adolescents distinctly outperformed their urban counterparts, notching up a 92.28 % qualified rate versus 91.64 % in urban settings (P < 0.05). The multivariable logistic regression analysis showed that after adjusting for gender, age, and household registration characteristics, adolescents had a lower odds of failing the physical fitness tests whose parents both liked physical exercises, whose parents supported children's participation in physical exercise, who participated in physical exercise sessions 3 ∼ 5 times per week or more than 5 times per week, who exercised for 0.5 ∼ 1 h each time or more than 1 h each time, who engaged in moderate intensity physical exercise, who slept 6 ∼ 8 h per day or more than 8 h per day, who consumed breakfast 3 ∼ 6 times per week or daily. On the other hand, adolescents had a higher odds of failing the physical fitness tests who always exposed to passive smoking, who spent 1 ∼ 3 h on screen per day or more than 3 h on screen per day, who spent more than 3 h doing homework per day, who consumed fast food 2 ∼ 3 times per week or more than 3 times per week. The physical fitness trajectory of adolescents residing within Shandong Province is tethered to a mosaic of determinants. This underscores the imperative for a synergistic strategy, harmonizing parental, scholastic, and societal vectors, to cultivate the salubrious maturation of this pivotal cohort.
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Affiliation(s)
- Zhihao Huang
- School of Big Data and Fundamental Sciences, Shandong Institute of Petroleum and Chemical Technology, Dongying, China
| | - Shanshan Li
- Mathematical Group, Chenguan Central Middle School in Guangrao County, Dongying, China
| | - Fei Lu
- Physical Education Group, Dongying Experimental Middle School, Dongying, China
| | - Kunzong Tian
- School of Big Data and Fundamental Sciences, Shandong Institute of Petroleum and Chemical Technology, Dongying, China
| | - Lujing Peng
- School of Big Data and Fundamental Sciences, Shandong Institute of Petroleum and Chemical Technology, Dongying, China
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Lucas I, Puteikis K, Sinha MD, Litwin M, Merkevicius K, Azukaitis K, Rus R, Pac M, Obrycki L, Bårdsen T, Śladowska-Kozłowska J, Sagsak E, Lurbe E, Jiménez-Murcia S, Jankauskiene A, Fernández-Aranda F. Knowledge gaps and future directions in cognitive functions in children and adolescents with primary arterial hypertension: A systematic review. Front Cardiovasc Med 2022; 9:973793. [PMID: 36337900 PMCID: PMC9631488 DOI: 10.3389/fcvm.2022.973793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/04/2022] [Indexed: 01/04/2024] Open
Abstract
Arterial hypertension (AH) among adults is known to be associated with worse cognitive outcomes. Similarly, children and adolescents with AH could be expected to underperform during neuropsychological evaluations when compared with healthy peers. Our aims were to review the existing literature on cognitive functioning among children and adolescents with primary AH and to identify what additional evidence may be needed to substantiate the impact of hypertension on poor cognitive outcomes in this population. We conducted a systematic review of articles in PubMed and Web of Science published before 17 January 2022, reporting on cognitive testing among children and adolescents with primary AH. From 1,316 records, 13 were included in the review-7 used battery-testing while other employed indirect measures of cognitive functions. Most of the studies reported worse results among individuals with AH. Results of two prospective trials suggested that cognitive functioning may improve after starting antihypertensive treatment. Ambulatory blood pressure monitoring was shown to be more strongly related to cognitive testing results than office measures of blood pressure. Significant confounders, namely obesity and sleep apnea, were identified throughout the studies. Our review indicates that evidence relating AH with poor cognitive functioning among youth is usually based on indirect measures of executive functions (e.g., questionnaires) rather than objective neuropsychological tests. Future prospective trials set to test different cognitive domains in children and adolescents undergoing treatment for AH are endorsed and should consider using standardized neuropsychological batteries as well as adjust the assessing results for obesity and sleep disorders.
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Affiliation(s)
- Ignacio Lucas
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | | | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- British Heart Foundation Centre, King’s College London, London, United Kingdom
| | - Mieczysław Litwin
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland
| | | | - Karolis Azukaitis
- Faculty of Medicine, Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Rina Rus
- Department of Pediatric Nephrology, Children’s Hospital, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Michał Pac
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Lukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Tonje Bårdsen
- Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Elif Sagsak
- University of Health Sciences Turkey, Clinic of Pediatric Endocrinology, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Empar Lurbe
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pediatric, Consorcio Hospital General, University of Valencia, Valencia, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Augustina Jankauskiene
- Faculty of Medicine, Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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10
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Nazarali S, Robinson CH, Khan F, Pocsai T, Desai D, De Souza RJ, Bhatt G, Dart A, Dionne J, Elmansy S, Kandasamy S, Lear SA, Obeid J, Parekh R, Punthakee Z, Sinha R, Thabane L, Wahi G, Zappitelli M, Anand SS, Chanchlani R. Deriving Normative Data on 24-Hour Ambulatory Blood Pressure Monitoring for South Asian Children (ASHA): A Clinical Research Protocol. Can J Kidney Health Dis 2022; 9:20543581211072329. [PMID: 35127105 PMCID: PMC8808039 DOI: 10.1177/20543581211072329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/28/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The global prevalence of hypertension in children and adolescents has increased over the past 2 decades and is the strongest predictor of adult hypertension. South Asians have an increased prevalence of metabolic syndrome associated risk factors including abdominal obesity, diabetes, and hypertension. All these factors contribute to their increased cardiovascular disease burden. Accurate and early identification of hypertension in South Asian children is a necessary aspect of cardiovascular disease prevention. Ambulatory blood pressure monitoring (ABPM) is considered the gold-standard for pediatric blood pressure (BP) measurement. However, its utilization is limited due to the lack of validated normative reference data in diverse, multiethnic pediatric populations. OBJECTIVE The primary objective is to establish normative height-sex and age-sex-specific reference values for 24-h ABPM measurements among South Asian children and adolescents (aged 5-17 years) in Ontario and British Columbia, Canada. Secondary objectives are to evaluate differences in ABPM measurements by body mass index classification, to compare our normative data against pre-existing data from German and Hong Kong cohorts, and to evaluate relationships between habitual movement behaviors, diet quality, and ABPM measurements. DESIGN Cross-sectional study, quasi-representative sample. SETTING Participants will be recruited from schools, community centers, and places of worship in Southern Ontario (Greater Toronto and Hamilton area, including the Peel Region) and Greater Vancouver, British Columbia. PARTICIPANTS We aim to recruit 2113 nonoverweight children (aged 5-17 years) for the primary objective. We aim to recruit an additional 633 overweight or obese children to address the secondary objectives. MEASUREMENTS Ambulatory BP monitoring measurements will be obtained using Spacelabs 90217 ABPM devices, which are validated for pediatric use. The ActiGraph GT3X-BT accelerometer, which has also been validated for pediatric use, will be used to obtain movement behavior data. METHODS Following recruitment, eligible children will be fitted with 24-h ABPM and physical activity monitors. Body anthropometrics and questionnaire data regarding medical and family history, medications, diet, physical activity, and substance use will be collected. Ambulatory BP monitoring data will be used to develop height-sex- and age-sex-specific normative reference values for South Asian children. Secondary objectives include evaluating differences in ABPM measures between normal weight, overweight and obese children; and comparing our South Asian ABPM data to existing German and Hong Kong data. We will also use compositional data analysis to evaluate associations between a child's habitual movement behaviors and ABPM measures. LIMITATIONS Bloodwork will not be performed to facilitate recruitment. A non-South Asian comparator cohort will not be included due to feasibility concerns. Using a convenience sampling approach introduces the potential for selection bias. CONCLUSIONS Ambulatory BP monitoring is a valuable tool for the identification and follow-up of pediatric hypertension and overcomes many of the limitations of office-based BP measurement. The development of normative ABPM data specific to South Asian children will increase the accuracy of BP measurement and hypertension identification in this at-risk population, providing an additional strategy for primary prevention of cardiovascular disease.
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Affiliation(s)
- Samina Nazarali
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Cal H. Robinson
- Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Farah Khan
- Population Health Research Institute, Hamilton, ON, Canada
| | - Tayler Pocsai
- Population Health Research Institute, Hamilton, ON, Canada
| | - Dipika Desai
- Population Health Research Institute, Hamilton, ON, Canada
| | - Russell J. De Souza
- Population Health Research Institute, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Girish Bhatt
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, India
| | - Allison Dart
- Division of Nephrology, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Janis Dionne
- Division of Nephrology, Department of Pediatrics, BC Children’s Hospital, The University of British Columbia, Vancouver, Canada
| | - Salma Elmansy
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Sujane Kandasamy
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Joyce Obeid
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Rulan Parekh
- Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zubin Punthakee
- Population Health Research Institute, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Rajiv Sinha
- Pediatric Nephrology, Department of Pediatrics, Institute of Child Health, Kolkata, India
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Michael Zappitelli
- Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sonia S. Anand
- Population Health Research Institute, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rahul Chanchlani
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton ON, Canada
- ICES McMaster, McMaster University, Hamilton, ON, Canada
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11
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Lee JW. Obesity and chronic kidney disease: what should pediatric nephrologists know? Clin Exp Pediatr 2021; 64:521-522. [PMID: 34082500 PMCID: PMC8498017 DOI: 10.3345/cep.2021.00556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jung Won Lee
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
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12
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Abstract
Pediatric hypertension is becoming of increasing concern as the incidence rate increases alongside pediatric obesity. Practitioners need to be aware of the screening recommendations for early recognition and management of this disorder. Lifestyle modifications should be addressed early and specialty referral considered if the child is not improving. Further work-up to rule out secondary causes of pediatric hypertension should also be considered in any child with stage 2 hypertension and in those with persistently elevated blood pressures. Early recognition and management are key to not only preventing present complications but also future cardiovascular disease in adulthood.
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Affiliation(s)
- Christopher Fox
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA; Department of Community and Family Medicine, Truman Medical Centers, Kansas City, MO, USA.
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13
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Wang Z, Shao Y, Jin J, Rong X, Qiu H, Wu R, Chu M. Clinical follow-up study of 166 cases of children with hypertension. Transl Pediatr 2021; 10:1834-1842. [PMID: 34430431 PMCID: PMC8349960 DOI: 10.21037/tp-20-446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/24/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Childhood hypertension is a challenge for pediatricians to discover and diagnose. We sought to analyze its clinical characteristics and related risk factors in patients at a single center. METHODS From 2009 to 2019, 166 children with hypertension were retrospectively analyzed, and their clinical manifestations and relevant laboratory data were collected for statistical analysis. RESULTS A total of 120 males and 46 females were included in this study. Males were more common than females (P=0.012), and 86.7% were from rural areas. Hypertension appeared in all age groups, but most of them were puberty (52.4%). Most primary hypertension cases (57/91) had no obvious clinical symptoms, and BMI (OR 1.085, 95% CI: 1.004-1.173, P=0.038) and a family history of hypertension (OR 5.605, 95% CI: 2.229-14.092, P<0.001) were the risk factors. In the 75 secondary hypertension cases, renal hypertension (62.7%) was the main cause and headache and dizziness were the most common symptoms, and the serum urea is a risk factor (OR 1.524, 95% CI: 1.037-2.239, P=0.032). CONCLUSIONS BMI and a family history of hypertension were associated with primary hypertension. The serum urea was related to secondary hypertension. Emphasis on family history, strengthening family health management and education and publicity of hypertension, were important for diagnosis and detection of children with hypertension.
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Affiliation(s)
- Zhenquan Wang
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yiping Shao
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiahui Jin
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xing Rong
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huixian Qiu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rongzhou Wu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Maoping Chu
- Children's Heart Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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14
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Zhang H, Yu L, Wang Q, Tao Y, Li J, Sun T, Zhang Y, Zhang H. In utero and postnatal exposure to environmental tobacco smoke, blood pressure, and hypertension in children: the Seven Northeastern Cities study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2020; 30:618-629. [PMID: 31140839 DOI: 10.1080/09603123.2019.1612043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/22/2019] [Indexed: 06/09/2023]
Abstract
To evaluate the association of environmental tobacco smoke (ETS) exposure with hypertension and blood pressure (BP) in children, a sample of 9,354 children, aged 5-17 years, was studied from seven northeastern cities of China in 2012-2013. The results showesd that significant associations were observed for hypertension with ETS exposure in utero [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.18-1.57], with current major ETS exposure from fathers (1.38, 1.21-1.57) or anyone (1.26, 1.12-1.42), and with intensity of ETS exposure greater than 1 cigarette per day (ORs ranged from 1.20 to 1.35). For SBP, significant associations were only observed in children with major ETS exposure from father and with cigarettes smoking >10/day. When stratified by sex, more significant associations were found in girls than in boys. In conclusion, prenatal and postnatal ETS exposure was significantly associated with increased odds of hypertension in children, especially in girls.
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Affiliation(s)
- Haishan Zhang
- Department of Cardiology, the First Affiliated Hospital of China Medical University , Shenyang, China
| | - Lujiao Yu
- Department of Geriatrics, the First Affiliated Hospital of China Medical University , Shenyang, China
| | - Qi Wang
- Department of Geriatrics, the First Affiliated Hospital of China Medical University , Shenyang, China
| | - Ye Tao
- Department of Geriatrics, the First Affiliated Hospital of China Medical University , Shenyang, China
| | - Jing Li
- Department of Geriatrics, the First Affiliated Hospital of China Medical University , Shenyang, China
| | - Tingting Sun
- Department of Geriatrics, the First Affiliated Hospital of China Medical University , Shenyang, China
| | - Yousheng Zhang
- General Hospital of Northern Theater Command, Liaoning Provincial Military Clinic , Shenyang, China
| | - Haiyan Zhang
- Department of Geriatrics, the First Affiliated Hospital of China Medical University , Shenyang, China
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15
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Tyner E, Oropeza M, Figueroa J, Peña ICD. Childhood Hypertension and Effects on Cognitive Functions: Mechanisms and Future Perspectives. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2020; 18:677-686. [PMID: 31749437 DOI: 10.2174/1871527318666191017155442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/05/2019] [Accepted: 09/26/2019] [Indexed: 12/23/2022]
Abstract
Pediatric hypertension is currently one of the most common health concerns in children, given its effects not only on cardiovascular but also cognitive functions. There is accumulating evidence suggesting neurocognitive dysfunction in hypertensive children that could persist even into adulthood. Identifying the precise mechanism(s) underlying the association between childhood hypertension and cognitive dysfunction is crucial as it could potentially lead to the discovery of "druggable" biological targets facilitating the development of treatments. Here, we discuss some of the proposed pathophysiological mechanisms underlying childhood hypertension and cognitive deficits and suggest strategies to address some of the current challenges in the field. The various research studies involving hypertensive adults indicate that long-term hypertension may produce abnormal cerebrovascular reactivity, chronic inflammation, autonomic dysfunction, or hyperinsulinemia and hypercholesterolemia, which could lead to alterations in the brain's structure and functions, resulting in cognitive dysfunction. In light of the current literature, we propose that dysregulation of the hypothalamus-pituitaryadrenal axis, modifications in endothelial brain-derived neurotrophic factor and the gut microbiome may also modulate cognitive functions in hypertensive individuals. Moreover, the above-mentioned pathological states may further intensify the detrimental effects of hypertension on cognitive functions. Thus, treatments that target not only hypertension but also its downstream effects may prove useful in ameliorating hypertension-induced cognitive deficits. Much remains to be clarified about the mechanisms and treatments of hypertension-induced cognitive outcomes in pediatric populations. Addressing the knowledge gaps in this field entails conducting not only clinical research but also rigorous basic and translational studies.
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Affiliation(s)
- Emma Tyner
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy, Loma Linda, California, 92350, United States
| | - Marie Oropeza
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy, Loma Linda, California, 92350, United States
| | - Johnny Figueroa
- Center for Health Disparities and Molecular Medicine, and Physiology Division, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California 92350, United States
| | - Ike C Dela Peña
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy, Loma Linda, California, 92350, United States
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16
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Çakıcı EK, Yazılıtaş F, Kurt-Sukur ED, Güngör T, Çelikkaya E, Karakaya D, Bülbül M. Clinical assessment of primary and secondary hypertension in children and adolescents. Arch Pediatr 2020; 27:286-291. [PMID: 32682663 DOI: 10.1016/j.arcped.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/01/2020] [Accepted: 06/23/2020] [Indexed: 01/19/2023]
Abstract
The aim of this study was to compare the clinical features of patients with elevated blood pressure and to detect variables associated with the diagnosis of primary hypertension. We identified 383 (69%) hypertensive children (197 [51.5%] with primary hypertension, and 186 [48.5%] with secondary hypertension) out of 553 children referred to our clinic with a history of elevated blood pressure. The primary hypertension group was significantly older and had higher BMI, positive family history of hypertension, and lower prevalence of preterm birth compared with those with secondary hypertension. No difference was found between the two groups in terms of the frequency of target organ damage. Multiple regression analysis showed that a family history of hypertension, obesity, age over 10 years, elevated uric acid, and presence of higher systolic blood pressure values at admission were independent predictors of primary hypertension; therefore, these parameters can be considered important clues for diagnosing primary hypertension.
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Affiliation(s)
- E K Çakıcı
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey.
| | - F Yazılıtaş
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - E D Kurt-Sukur
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - T Güngör
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - E Çelikkaya
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - D Karakaya
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - M Bülbül
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
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17
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Langhoff AF, Børresen ML, Wason MP, Andersson M, Jeppesen DL, Schmidt IM, Cortes D. National data with high validity and completeness showed that only 0.04% of Danish children had been registered with diagnosed hypertension. Acta Paediatr 2020; 109:1458-1464. [PMID: 31785102 DOI: 10.1111/apa.15116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/22/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022]
Abstract
AIM Hypertension has been reported in up to 4.0% of American children, but no national data exist in Europe. We studied the frequency of registered hypertension in Danish children and evaluated the data. METHODS This 2014-2015 study focused on patients under the age of 16 registered with hypertension in the Danish National Patient Register and 10 paediatric departments in central and eastern Denmark. The diagnoses were coded according to the International Classification of Diseases, 10th revision. All the subjects' medical records were reviewed, including any confirmed diagnoses. RESULTS There were 55 784 children under 16 in the study regions at 30 April 2014. By May 2015, 222 of those had been registered with hypertension: 200 in the Danish National Patient Register and 191 in the 10 paediatric departments. Their medical records confirmed hypertension in 187 and 185 cases, respectively. The prevalence of registered and confirmed hypertension was 222/553 784 (0.04%). The positive predictive values of hypertension were 187/200 (94%) and 185/191 (97%), and the completeness of diagnosed hypertension was 187/222 (84%) and 185/222 (83%). CONCLUSION The registers had high-quality positive predictive values and completeness, but only 0.04% of the Danish children were registered with a verified diagnosis of hypertension.
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Affiliation(s)
- Adam F. Langhoff
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Copenhagen Denmark
| | - Malene Landbo Børresen
- Department of Paediatrics and Adolescent Medicine The Juliane Marie Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Malgorzata P. Wason
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital North Zealand Hillerød Denmark
| | - Mikael Andersson
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
| | - Dorthe L. Jeppesen
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Copenhagen Denmark
- Faculty of Medical and Health Sciences University of Copenhagen Copenhagen Denmark
| | - Ida M. Schmidt
- Department of Paediatrics and Adolescent Medicine The Juliane Marie Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Dina Cortes
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Copenhagen Denmark
- Faculty of Medical and Health Sciences University of Copenhagen Copenhagen Denmark
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18
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Liu Y, Lin Y, Zhang MM, Li XH, Liu YY, Zhao J, Shi L. The relationship of plasma renin, angiotensin, and aldosterone levels to blood pressure variability and target organ damage in children with essential hypertension. BMC Cardiovasc Disord 2020; 20:296. [PMID: 32546130 PMCID: PMC7298948 DOI: 10.1186/s12872-020-01579-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 06/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To investigate the relationships of plasma renin, angiotensin, and aldosterone levels to blood pressure variability and target organ damage in children with essential hypertension. METHODS A case-control study was conducted on 132 children diagnosed with essential hypertension (103 males and 29 females with the mean age of 11.8 ± 2.4 years). The plasma RAAS levels were measured using the enhanced chemiluminescence method, the ambulatory blood pressure was monitored for 24 h, and then the average real variability (ARV) was calculated. Data on indicators were used for assessing cardiac and renal damages. The correlations of plasma renin, angiotensin, and aldosterone (RAAS) levels to blood pressure variability (BPV) and target organ damage (TOD) were studied. A comparison between the groups was conducted using SPSS 20. RESULTS Among the 132 children, 55 cases had target organ damage. The 24-h ARV and the daytime ARV of the systolic blood pressure of the high angiotensin II (AT II) group was significantly higher than that of the normal AT II group (t = 2.175, P = 0.031; t = 2.672, P = 0.009). Plasma AT II and aldosterone levels were significantly associated with the left ventricular mass index (r = 0.329, P = 0.0001; r = 0.175, P = 0.045). Linear regression analysis showed that AT II [β ± s.e. = 0.025 ± 0.006, 95% CI (0.013-0.038), P = 0.0001] and aldosterone [β ± s.e. = 0.021 ± 0.007, 95% CI (0.008-0.034), P = 0.002] were risk factors for LVH. CONCLUSIONS The AT II level in children with essential hypertension affected the variability of the 24-h and the daytime SBP. Plasma AT II and aldosterone levels were associated with cardiac damage. Results from this study indicated that AT II and aldosterone are risk factors for LVH in childhood hypertension and are of great significance for improving the clinical prognosis of pediatric patients with hypertension.
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Affiliation(s)
- Yang Liu
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, 100191, China
| | - Yao Lin
- Department of Cardiology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China
| | - Ming-Ming Zhang
- Department of Cardiology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China
| | - Xiao-Hui Li
- Department of Cardiology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China
| | - Yan-Yan Liu
- Department of Cardiology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China
| | - Jing Zhao
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, 100191, China.
| | - Lin Shi
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, 100191, China.
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19
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Bilal M, Haseeb A, Saeed A, Saeed A, Ghaffar P. Prevalence and Risk Factors of Hypertension Among Children Attending Out Patient Department of a Tertiary Care Hospital in Karachi. Cureus 2020; 12:e7957. [PMID: 32509482 PMCID: PMC7270837 DOI: 10.7759/cureus.7957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: The childhood obesity epidemic has caused the global prevalence of hypertension (HTN) in children to increase from 2% to 4%. However, there is limited data regarding this issue in Pakistan. Hence this cross-sectional study aims to document the prevalence of HTN and its risk factors among children visiting the out patient department (OPD) of a government hospital in Karachi, which is one of the largest cities in Pakistan.
Methods: One thousand children aged between 4 and 12 years who visited the OPD in October 2019 were included. Blood pressures (BPs) for each child were measured manually and recorded. Their guardians were then interviewed to assess the risk factors present in each child. Data collected were analyzed using SPSS (Statistical Package for the Social Sciences).
Results: Among all the children, those between 4 and 7 years of age had a higher prevalence of HTN (19.2%; 9.2% stage 1 and 10.0% stage 2) than children aged between 8 and 12 years (14.5%; 8.0% stage 1 and 6.5% stage 2). Obese children between the age of 4 and 7 years (OR = 3.11) were more likely to develop HTN. Moreover, children with a positive family history of HTN were 1.43 times more likely to have HTN and 1.32 times more likely to have pre-HTN. There was no significant association of gender, artificial feeding, low birth weight, and maternal smoking with HTN.
Conclusion: The prevalence is particularly higher in children aged between 4 and 7 years (19.2%) and there is a strong association between high BMI (body mass index), family history of HTN, and high-fat diet intake with HTN in children. There was no significant variation of prevalence between both genders.
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Affiliation(s)
- Muhammad Bilal
- Internal Medicine/Pediatrics, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK
| | - Abdul Haseeb
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Alina Saeed
- Internal Medicine, Ziauddin University, Karachi, PAK
| | - Aena Saeed
- Internal Medicine, Ziauddin University, Karachi, PAK
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20
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Pérez-Gimeno G, Rupérez AI, Vázquez-Cobela R, Herráiz-Gastesi G, Gil-Campos M, Aguilera CM, Moreno LA, Leis Trabazo MR, Bueno-Lozano G. Energy Dense Salty Food Consumption Frequency Is Associated with Diastolic Hypertension in Spanish Children. Nutrients 2020; 12:nu12041027. [PMID: 32283662 PMCID: PMC7230361 DOI: 10.3390/nu12041027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 01/09/2023] Open
Abstract
High blood pressure (BP) is a risk factor for cardiovascular disease and sodium consumption is related to high BP. Moreover, sugar-sweetened beverages (SSB) and the Dietary Approach to Stop Hypertension (DASH) influence BP. For this reason, we investigated whether: 1) children with risk of elevated BP had a higher consumption frequency (CF) of energy-dense salty foods (EDSF), high-sugary foods (HSF) and SSB or a low DASH score; and 2) children with a higher CF of EDSF showed a worse anthropometric and metabolic profile. Anthropometry, BP and general biochemical parameters were measured in 687 Spanish children (5-16 years) with normal or excess weight. A food frequency questionnaire was used to calculate EDSF, HSF and SSB consumption, and modified DASH score. Results showed that sex and pubertal stage influenced modified DASH score. Diastolic hypertension was associated to higher CF of EDSF in the whole sample and to higher CF of SSB in pubertal children, both independently of nutritional status. In addition, CF of EDSF was positively associated with CF of HSF and SSB and inversely associated with modified DASH score. Targeted policies and intervention programs, specific for different age ranges, should be established that aim to reduce salt consumption from snacks and processed foods, which could reduce HSF and SSB consumption as well.
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Affiliation(s)
- Gloria Pérez-Gimeno
- GENUD Research group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain; (G.P.-G.); (A.I.R.)
| | - Azahara I. Rupérez
- GENUD Research group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain; (G.P.-G.); (A.I.R.)
| | - Rocío Vázquez-Cobela
- Investigation Unit in Nutrition, Growth and Human Development of Galicia GI Pediatric Nutrition-Santiago Health Research Institute (IDIS), Pediatrics Department, Universitary Clinical Hospital of Santiago, Santiago de Compostela University, 15706 Santiago de Compostela, Spain
| | - Gonzalo Herráiz-Gastesi
- Unidad de Endocrinología Pediátrica, Hospital Clínico Lozano Blesa, Facultad de Medicina, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Mercedes Gil-Campos
- Metabolic Pediatric and Investigation Unit, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Concepción M. Aguilera
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Departamento de Bioquímica y Biología Molecular II, Instituto de Nutrición y Tecnología de los Alimentos, Centro de Investigación Biomédica, Universidad de Granada, 18071 Granada, Spain
| | - Luis A. Moreno
- GENUD Research group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain; (G.P.-G.); (A.I.R.)
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María Rosaura Leis Trabazo
- Investigation Unit in Nutrition, Growth and Human Development of Galicia GI Pediatric Nutrition-Santiago Health Research Institute (IDIS), Pediatrics Department, Universitary Clinical Hospital of Santiago, Santiago de Compostela University, 15706 Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-619-019-196
| | - Gloria Bueno-Lozano
- GENUD Research group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain; (G.P.-G.); (A.I.R.)
- Investigation Unit in Nutrition, Growth and Human Development of Galicia GI Pediatric Nutrition-Santiago Health Research Institute (IDIS), Pediatrics Department, Universitary Clinical Hospital of Santiago, Santiago de Compostela University, 15706 Santiago de Compostela, Spain
- Unidad de Endocrinología Pediátrica, Hospital Clínico Lozano Blesa, Facultad de Medicina, Universidad de Zaragoza, 50009 Zaragoza, Spain
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Singh SK, Verma A. Prevalence of hypertension among school going adolescent boys in Najafgarh, Delhi, India. Int J Adolesc Med Health 2020; 33:/j/ijamh.ahead-of-print/ijamh-2019-0005/ijamh-2019-0005.xml. [PMID: 31953993 DOI: 10.1515/ijamh-2019-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/07/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hypertension is a global epidemic. Hypertension has become an increasingly important medical problem in children and adolescents. Evidence shows that hypertension begins in childhood and its associated risk factors like obesity, unhealthy eating habits also emerge in children of school going age. OBJECTIVES To study the prevalence of hypertension among school going adolescent boys in Najafgarh, Delhi and to find out the factors associated with hypertension among them. MATERIALS AND METHODS A cross-sectional study was planned in which a self-administered questionnaire was used to collect information from the study participants. A total of 600 adolescent boys of 9th to 12th classes from four different schools in Delhi, were included in the study over a period of 12 months. Blood pressure, height, weight and waist circumference were measured for all children. Data was analyzed using SPSS software version 21.0 and for qualitative data analysis a chi-square (χ2) test was used. RESULTS The mean age of study subjects was 15.1 years. The majority of the study subjects, 372 (62%), were in the age group of 14-16 years. Among the study subjects, 44 (7.3%) had pre-hypertension and 26 (4.3%) had hypertension. Hypertension was significantly higher in those with a family history of hypertension and who were overweight/obese. CONCLUSION The prevalence of hypertension was significantly high among adolescents of Delhi. Obesity and family history of hypertension were identified as important risk factors prevalent in the study population.
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Affiliation(s)
- Sunil Kumar Singh
- Senior Resident, Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, Phone: +9910147791
| | - Anita Verma
- Professor, Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Carotid Intima-Media Thickness and Metabolic Syndrome Components in Obese Children and Adolescents. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1021:63-72. [PMID: 28456929 DOI: 10.1007/5584_2017_29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Obesity in children and adolescents contributes to increased prevalence of metabolic and hemodynamic complications, which may impair endothelial function and structure. A high resolution B-mode ultrasound measurement of intima-media thickness (IMT) is a useful tool to assess early, preclinical stage of atherosclerosis. The objective of this study was to evaluate the carotid artery IMT in obese children and its association with insulin resistance and other traditional metabolic syndrome components. The study entailed 80 obese children, aged 5.3-17.9 year and a control group of 31 children. Obesity was defined using the International Obesity Task Force (IOTF) criteria. Metabolic syndrome was defined using the International Diabetes Federation (IDF) criteria of 2007. Each patient's anthropometric measurements, blood parameters, and the carotid IMT were evaluated. Insulin resistance indices were calculated. We found that children with metabolic syndrome had a significantly increased IMT compared to children who did not meet the syndrome criteria (0.62 ± 0.09 mm vs. 0.55 ± 0.18 mm, p = 0.03) and compared to control group (0.62 ± 0.09 vs. 0.52 ± 0.14, p = 0.02). In a multivariable linear regression analysis, IMT correlated with systolic blood pressure (p = 0.005). The results did not show an association between IMT and insulin resistance. We conclude that abdominal obesity and the accompanying components of metabolic syndrome lead to increased carotid IMT. The enhanced systolic blood pressure plays a major role in changing the carotid IMT.
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Jurko A, Jurko T, Minarik M, Mestanik M, Mestanikova A, Micieta V, Visnovcova Z, Tonhajzerova I. Endothelial function in children with white-coat hypertension. Heart Vessels 2018; 33:657-663. [DOI: 10.1007/s00380-017-1107-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/11/2017] [Indexed: 12/12/2022]
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Bramley H, Foley KC, Williams R, Lewis MM, Kong L, Silvis M. Impact of Body Mass Index on Postconcussion Symptoms in Teenagers Aged 13 to 18 Years. Perm J 2018; 22:17-211. [PMID: 30005723 PMCID: PMC6045505 DOI: 10.7812/tpp/17-211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Adolescent obesity and sports-related concussion are rising in prevalence, yet there is minimal research exploring the relationship between these two conditions. OBJECTIVE To assess the impact of body mass index (BMI) percentile on duration of recovery and reported symptoms after sports-related concussion in adolescents. DESIGN Retrospective chart review at a regional concussion program located at an academic medical center. Medical records of all patients aged 13 to 18 years treated from March 2006 through January 2012 were reviewed. Two hundred fifty-two patients met the inclusion criteria of sports-related concussion and having BMI data. MAIN OUTCOME MEASURES Outcome variables included reported emotional symptoms, sleep-related symptoms, physical symptoms (headache), and time to recovery after a concussion. Explanatory variables in this analysis were BMI percentile and sex. RESULTS More male patients were obese and overweight than were females (42% vs 27%, p = 0.02). There was no statistically significant difference in recovery time between obese and overweight patients and others. Obese and overweight patients were more likely than healthy-weight patients to report symptoms of irritability (p = 0.05) and impulsivity (p = 0.01), and less likely to report headache (p = 0.03). CONCLUSION After concussion, irritability and impulsivity may be more likely than headaches in overweight and obese patients. There was no difference in recovery time between obese and healthy-weight teens. These findings may have importance in the evaluation, treatment, and anticipatory guidance of patients with concussions.
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Affiliation(s)
- Harry Bramley
- Associate Professor of Pediatrics at Penn State Hershey Children's Hospital in PA.
| | - Kathryn C Foley
- Resident at Alfred I DuPont Hospital for Children in Wilmington, DE.
| | - Ronald Williams
- Professor of Pediatrics and Medicine at Penn State Hershey Children's Hospital in PA.
| | - Mechelle M Lewis
- Associate Professor of Neurology at Penn State Health Milton S Hershey Medical Center in PA.
| | - Lan Kong
- Professor of Biostatistics in Public Health Services at Penn State Health Milton S Hershey Medical Center in PA.
| | - Matthew Silvis
- Professor of Family and Community Medicine and Orthopedics and Rehabilitation Medicine at Penn State Health Milton S Hershey Medical Center in PA.
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de Almeida MMS, Guimarães RA, Jardim PCBV, Sousa ALL, de Souza MM. Association between arterial hypertension and nutritional status in adolescents from Goiânia, Goiás, Brazil. PLoS One 2017; 12:e0188782. [PMID: 29253900 PMCID: PMC5734768 DOI: 10.1371/journal.pone.0188782] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 11/13/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Adolescents are a population with unique lifestyle challenges, including physical inactivity, inadequate nutrition, and obesity, all of which increase the risk of developing hypertension (HTN). The objective of this study has been to estimate the prevalence of factors associated with hypertension in adolescents in the city of Goiânia City, Central Brazil. METHODS Between 2013and2014, a cross-sectional population study on cardiovascular risk in adolescents, was conducted with the participation of 1,586 adolescents in 108 classes at 36 schools (public and private) in Goiânia city. All of the adolescents were interviewed to establish their sociodemographic and behavioral characteristics related to hypertension and nutritional status. Anthropometric and blood pressure data were collected following a protocol. A Poisson regression, stratified by gender, was used to verify the factors associated with HTN. RESULTS In this mixed-gender group of 1,586 students, the prevalence of HTN was 6.2% (95% CI: 4.6-8.2%) in girls and 14.0% (95% CI: 10.2-18.8%) in boys-about twice as high in boys as in girls (p <0.001). Obesity was independently associated with HTN in both genders. Being overweight was a risk factor for HTN. In addition, there was a positive correlation between the SBP/SBP percentile and the BMI Z-score/Nutritional status (NS)in both genders. A high prevalence of physical inactivity was also observed in the adolescents investigated, especially in the girls. On the other hand, more boys than girls were found to be obese. CONCLUSION The results of this investigation revealed the need for strategies to prevent and control HTN and its risk factors, especially in Brazil's schools. In addition to the constant surveillance of HTN prevalence and risk factors (in particular, being overweight or obese), information should be distributed to promote beneficial health behaviors among adolescents.
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Affiliation(s)
| | - Rafael Alves Guimarães
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
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Ewald DR, Bond SH, Haldeman LA. Hypertension in Low-Income Adolescents. Glob Pediatr Health 2017; 4:2333794X17741819. [PMID: 29204459 PMCID: PMC5703095 DOI: 10.1177/2333794x17741819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/03/2017] [Indexed: 12/27/2022] Open
Abstract
Disadvantaged adolescents are at higher risk for undiagnosed and untreated obesity and hypertension. Using nurse-measured weight, height, and blood pressure (BP) as well as self-reported age and activity/lifestyle behaviors, we assessed the prevalence of obesity and hypertension in 573 adolescent patients aged 13.0 to 17.9 years (females: n = 267, 46.6%; males: n = 306, 53.4%) from a clinic serving low-income, ethnically diverse pediatric patients. Body mass index distribution was as follows: 11, underweight (1.9%); 330, healthy weight (57.6%); 105, overweight (18.3%); and 127, obese (22.2%). The age-adjusted height percentile was normally distributed, but distribution by BP category was 326 normotensive (56.9%), 147 prehypertensive (25.7%), 60 with stage 1 hypertension (10.5%), and 40 with stage 2 hypertension (7.0%). Activity and lifestyle behaviors did not adequately explain obesity and hypertension rates. Efforts to prevent/reduce childhood overweight, obesity, and hypertension in underserved populations need to include dietary education, weight control interventions, and physical activity programs specifically tailored to overweight/obese youth and parents.
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Affiliation(s)
- D Rose Ewald
- The University of North Carolina at Greensboro, NC, USA
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Pocobelli G, Dublin S, Enquobahrie DA, Mueller BA. Birth Weight and Birth Weight for Gestational Age in Relation to Risk of Hospitalization with Primary Hypertension in Children and Young Adults. Matern Child Health J 2017; 20:1415-23. [PMID: 26979614 DOI: 10.1007/s10995-016-1939-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction Low birth weight has been associated with an increased risk of hypertension in children. Less clear is whether high birth weight is also associated with risk. We evaluated overall and age-specific risks of primary hypertension in children and young adults associated with birth weight and birth weight for gestational age. Methods We conducted a population-based case-control study using linked Washington State birth certificate and hospital discharge data from 1987 to 2003. Cases were persons hospitalized with primary hypertension at 8-24 years of age (n = 533). Controls were randomly selected among those born in the same years who were not hospitalized with hypertension (n = 25,966). Results Birth weight was not related to risk of primary hypertension overall, except for a suggestion of an increased risk associated with birth weight ≥4500 g relative to 3500-3999 g (odds ratio (OR) 1.55; 95 % confidence interval (CI) 0.96-2.49). Compared to children born appropriate weight for gestational age, those born small (SGA) (OR 1.32; 95 % CI 1.02-1.71) and large for gestational age (LGA) (OR 1.30; 95 % CI 1.00-1.71) had increased risks of primary hypertension. These overall associations were due to increased risks of hypertension at 15-24 years of age; no associations were observed with risk at 8-14 years of age. Discussion In this study, both SGA and LGA were associated with increased risks of primary hypertension. Our findings suggest a possible nonlinear (U-shaped) association between birth weight for gestational age and primary hypertension risk in children and young adults.
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Affiliation(s)
- Gaia Pocobelli
- Department of Epidemiology, University of Washington, Box 357236, 1959 NE Pacific Street, Health Sciences Building F-262, Seattle, WA, 98195-7236, USA.
| | - Sascha Dublin
- Department of Epidemiology, University of Washington, Box 357236, 1959 NE Pacific Street, Health Sciences Building F-262, Seattle, WA, 98195-7236, USA
- Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Daniel A Enquobahrie
- Department of Epidemiology, University of Washington, Box 357236, 1959 NE Pacific Street, Health Sciences Building F-262, Seattle, WA, 98195-7236, USA
- Cardiovascular Health Research Unit, University of Washington, 1730 Minor Ave, Suite 1360, Seattle, WA, 98101, USA
| | - Beth A Mueller
- Department of Epidemiology, University of Washington, Box 357236, 1959 NE Pacific Street, Health Sciences Building F-262, Seattle, WA, 98195-7236, USA
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Box 358080, 1100 Fairview Ave N., Arnold Building, Mailstop: M4-C308, P.O. Box 1192024, Seattle, WA, 98109-1024, USA
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Tiu AC, Bishop MD, Asico LD, Jose PA, Villar VAM. Primary Pediatric Hypertension: Current Understanding and Emerging Concepts. Curr Hypertens Rep 2017; 19:70. [PMID: 28780627 PMCID: PMC6314210 DOI: 10.1007/s11906-017-0768-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The rising prevalence of primary pediatric hypertension and its tracking into adult hypertension point to the importance of determining its pathogenesis to gain insights into its current and emerging management. Considering that the intricate control of BP is governed by a myriad of anatomical, molecular biological, biochemical, and physiological systems, multiple genes are likely to influence an individual's BP and susceptibility to develop hypertension. The long-term regulation of BP rests on renal and non-renal mechanisms. One renal mechanism relates to sodium transport. The impaired renal sodium handling in primary hypertension and salt sensitivity may be caused by aberrant counter-regulatory natriuretic and anti-natriuretic pathways. The sympathetic nervous and renin-angiotensin-aldosterone systems are examples of antinatriuretic pathways. An important counter-regulatory natriuretic pathway is afforded by the renal autocrine/paracrine dopamine system, aberrations of which are involved in the pathogenesis of hypertension, including that associated with obesity. We present updates on the complex interactions of these two systems with dietary salt intake in relation to obesity, insulin resistance, inflammation, and oxidative stress. We review how insults during pregnancy such as maternal and paternal malnutrition, glucocorticoid exposure, infection, placental insufficiency, and treatments during the neonatal period have long-lasting effects in the regulation of renal function and BP. Moreover, these effects have sex differences. There is a need for early diagnosis, frequent monitoring, and timely management due to increasing evidence of premature target organ damage. Large controlled studies are needed to evaluate the long-term consequences of the treatment of elevated BP during childhood, especially to establish the validity of the current definition and treatment of pediatric hypertension.
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Affiliation(s)
- Andrew C Tiu
- Division of Renal Diseases and Hypertension, The George Washington University School of Medicine and Health Sciences, 2300 I Street, N.W. Washington, DC, 20037, USA.
| | - Michael D Bishop
- Division of Renal Diseases and Hypertension, The George Washington University School of Medicine and Health Sciences, 2300 I Street, N.W. Washington, DC, 20037, USA
| | - Laureano D Asico
- Division of Renal Diseases and Hypertension, The George Washington University School of Medicine and Health Sciences, 2300 I Street, N.W. Washington, DC, 20037, USA
| | - Pedro A Jose
- Division of Renal Diseases and Hypertension, The George Washington University School of Medicine and Health Sciences, 2300 I Street, N.W. Washington, DC, 20037, USA
| | - Van Anthony M Villar
- Division of Renal Diseases and Hypertension, The George Washington University School of Medicine and Health Sciences, 2300 I Street, N.W. Washington, DC, 20037, USA
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Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis. LANCET PUBLIC HEALTH 2017; 2:e375-e386. [PMID: 29253478 DOI: 10.1016/s2468-2667(17)30123-8] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 06/04/2017] [Accepted: 06/09/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite substantial attention paid to the threat of elevated blood pressure in children and adolescents in high-income countries and the epidemic of hypertension in African adult populations, data on the burden of elevated blood pressure in African children and adolescents have not yet been synthesised. We did a systematic review and meta-analysis to provide estimates of the prevalence of elevated blood pressure and assess associated factors among children and adolescents in Africa. METHODS We searched Embase, PubMed, African Journals Online, and African Index Medicus to identify articles published from Jan 1, 1996, to Feb 2, 2017, and searched the reference list of retrieved articles. Each study was independently reviewed for methodological quality. We used a random-effects model to estimate the prevalence of elevated blood pressure across studies and heterogeneity (I2) was assessed via the χ2 test on Cochran's Q statistic. This review is registered with PROSPERO, number CRD42015019029. FINDINGS We included 51 studies in qualitative synthesis and 25 in the meta-analysis reporting data of a pooled sample of 54 196 participants aged 2-19 years. Study quality was high with only four medium-quality studies and no low-quality studies. Prevalence of elevated blood pressure varied widely across studies (range 0·2-24·8%). The pooled prevalence of elevated blood pressure (systolic or diastolic blood pressure ≥95th percentile) was 5·5% (95% CI 4·2-6·9), whereas that of slightly elevated blood pressure (systolic or diastolic blood pressure ≥90th percentile and <95th percentile) was 12·7% (2·1-30·4). The prevalence of elevated blood pressure was largely associated with body-mass index (BMI), with a prevalence of elevated blood pressure six times higher in obese (30·8%, 95% CI 20·1-42·6) versus normal-weight children (5·5%, 3·1-8·4; p<0·0001). INTERPRETATION This study suggests a high prevalence of elevated blood pressure among children and adolescents in Africa, with overweight and obesity being an important risk factor. Efforts to address this burden of elevated blood pressure in children and adolescents should mainly focus on primary prevention at the community level, by promoting healthy lifestyles and avoiding other cardiovascular risk factors, especially overweight and obesity. This study also stresses the need for more elaborate studies using uniform and reliable diagnostic methods to reliably map the burden of elevated blood pressure in children and adolescents in Africa. FUNDING None.
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Akbari M, Moosazadeh M, Ghahramani S, Tabrizi R, Kolahdooz F, Asemi Z, Lankarani KB. High prevalence of hypertension among Iranian children and adolescents: a systematic review and meta-analysis. J Hypertens 2017; 35:1155-1163. [PMID: 28151773 DOI: 10.1097/hjh.0000000000001261] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND High blood pressure in children is a public health problem and the most important risk factor for cardiovascular disease at an older age. Several preliminary studies have been published regarding the prevalence of high blood pressure in which there was significant disparity. OBJECTIVE This study aimed to estimate the prevalence of hypertension in Iranian children using the meta-analysis approach. METHODS A systematic search of national and international databases was conducted through September 30, 2015, for population studies providing estimates on the prevalence of hypertension in Iranian children and adolescents. From the extracted prevalence rates, the heterogenic index of the studies was determined using Cochran's (Q) and Chi-squared (I2) tests, and on the basis of the heterogenetic results, a fixed or random effects model was employed to estimate the pooled prevalence rate of hypertension. Meta-regression was performed to determine those factors suspected of generating heterogeneity. RESULTS Of 2360 articles initially identified, 17 were considered eligible. The meta-analyses included 79 231 children and adolescents aged between 3 and 18 years. The pooled prevalence of hypertension among children and adolescents was estimated to be 8.9% [95% confidence interval (95% CI): 7.5-10.3] in overall, 10.3% (95% CI: 7.5-12.6) in males and 9.1% (95% CI: 7.4-10.7) in females. The prevalence rates of high DBP and SBP were estimated at 6.6% (95% CI: 3.9-9.2) and 6.9% (95% CI: 5.6-8.2), respectively. CONCLUSION There is a high prevalence of hypertension among Iranian children and adolescents. Although it is slightly higher among boys than girls, the difference was not statistically significant.
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Affiliation(s)
- Maryam Akbari
- aHealth Policy Research Center, Shiraz University of Medical Sciences, Shiraz bHealth Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari cHealth Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran dIndigenous and Global Health Research, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada eResearch Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan fHealth Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Kim GH, Shin SW, Lee J, Hwang JH, Park SW, Moon JS, Kim HJ, Ahn HS. Red meat and chicken consumption and its association with high blood pressure and obesity in South Korean children and adolescents: a cross-sectional analysis of KSHES, 2011-2015. Nutr J 2017; 16:31. [PMID: 28532405 PMCID: PMC5441095 DOI: 10.1186/s12937-017-0252-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/08/2017] [Indexed: 01/15/2023] Open
Abstract
Background The impact of meat consumption on high blood pressure (HBP) and obesity in children and adolescents is a subject of debate. The aim of this study was thus to evaluate the association between meat consumption and both HBP and obesity in this group. Methods We performed a cross-sectional analysis using nationally representative samples of children and adolescents aged 9, 12, and 15 years old (n = 136,739) who were included in the Korea School Health Examination Survey (KSHES) for the 2011–2015 period. Multiple linear and logistic regression analysis was used to determine the factors influencing systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI, kg/m2) levels, and to test the strength of these relationships. Results Adjusted for covariates, 6.3% of those subjects who consumed >5 servings of meat (including beef, pork, and chicken) per week were obese, compared with 9.1% of the subjects who consumed <1 serving of meat/wk (obesity adjusted odds ratio [OR]: 1.44; 95% confidence interval [CI]: 1.21–1.70; P ≤0.001). Those who consumed <1 serving of meat/wk had an HBP prevalence of 8.2%, compared with 7.2% for subjects who consumed >5 servings of meat/wk (systolic HBP adjusted OR: 1.30; 95% CI: 1.05–1.62; P ≤0.01, diastolic HBP adjusted OR: 1.25; 95% CI: 1.02–1.54; P <0.05). Obese subjects were estimated to have a higher SBP (β = 7.497, P < 0.001) and DBP (β = 4.123, P <0.001) than subjects who had no excess weight. Compared to subjects who consumed >5 servings of meat/wk, those who consumed <3 servings of meat/wk had a higher SBP (β = 0.574, P <0.001) and DBP (β = 0.376, P = 0.003) after adjusting for BMI. The intake of milk, fruit, and vegetables was not associated with either SBP or DBP (P >0.05). In contrast, BMI was significantly associated with milk, fruits, and vegetables (P <0.01). Conclusions Among children and adolescents, a higher level of meat consumption was associated with lower SBP, DBP, and BMI, and greater height, suggesting that consuming an appropriate amount of meat is important for healthy growth at a young age.
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Affiliation(s)
- Geum Hee Kim
- Department of School Health Education, Sanggye High School, 432, Nohaero Nowon-gu, Seoul, 01761, Republic of Korea.,Department of Preventive Medicine, College of Medicine, Korea University, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Sang Won Shin
- Department of Medicine, College of Medicine, Korea University, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Juneyoung Lee
- Department of Biostatistics, College of Medicine, Korea University, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Jun Hyun Hwang
- Department of Preventive Medicine, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea
| | - Soon-Woo Park
- Department of Preventive Medicine, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea
| | - Jin Soo Moon
- Division of Pediatric Gastroenterolgy, Hepatology and Nutrition, Department of Pediatrics, Seoul National University, Children's Hospital, 101 Daehakro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
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Daley MF, Reifler LM, Johnson ES, Sinaiko AR, Margolis KL, Parker ED, Greenspan LC, Lo JC, O’Connor PJ, Magid DJ. Predicting Hypertension Among Children With Incident Elevated Blood Pressure. Acad Pediatr 2017; 17:275-282. [PMID: 28254479 PMCID: PMC5384864 DOI: 10.1016/j.acap.2016.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/16/2016] [Accepted: 09/25/2016] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Liza M. Reifler
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
| | - Eric S. Johnson
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Alan R. Sinaiko
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | | | | | - Joan C. Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - David J. Magid
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
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Quist JS, Sjödin A, Chaput JP, Hjorth MF. Sleep and cardiometabolic risk in children and adolescents. Sleep Med Rev 2016; 29:76-100. [DOI: 10.1016/j.smrv.2015.09.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 08/31/2015] [Accepted: 09/02/2015] [Indexed: 12/22/2022]
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Ewald DR, Haldeman PhD LA. Risk Factors in Adolescent Hypertension. Glob Pediatr Health 2016; 3:2333794X15625159. [PMID: 27335997 PMCID: PMC4784559 DOI: 10.1177/2333794x15625159] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 11/27/2015] [Accepted: 11/30/2015] [Indexed: 12/12/2022] Open
Abstract
Hypertension is a complex and multifaceted disease, with many contributing factors. While diet and nutrition are important influences, the confounding effects of overweight and obesity, metabolic and genetic factors, racial and ethnic predispositions, socioeconomic status, cultural influences, growth rate, and pubertal stage have even more influence and make diagnosis quite challenging. The prevalence of hypertension in adolescents far exceeds the numbers who have been diagnosed; studies have found that 75% or more go undiagnosed. This literature review summarizes the challenges of blood pressure classification in adolescents, discusses the impact of these confounding influences, and identifies actions that will improve diagnosis and treatment outcomes.
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Affiliation(s)
- D Rose Ewald
- The University of North Carolina at Greensboro, NC, USA
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Lava SAG, Bianchetti MG, Simonetti GD. Salt intake in children and its consequences on blood pressure. Pediatr Nephrol 2015; 30:1389-96. [PMID: 25127918 DOI: 10.1007/s00467-014-2931-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 07/23/2014] [Accepted: 07/24/2014] [Indexed: 02/07/2023]
Abstract
Sodium is the most abundant extracellular cation and therefore pivotal in determining fluid balance. At the beginning of life, a positive sodium balance is needed to grow. Newborns and preterm infants tend to lose sodium via their kidneys and therefore need adequate sodium intake. Among older children and adults, however, excessive salt intake leads to volume expansion and arterial hypertension. Children who are overweight, born preterm, or small for gestational age and African American children are at increased risk of developing high blood pressure due to a high salt intake because they are more likely to be salt sensitive. In the developed world, salt intake is generally above the recommended intake also among children. Although a positive sodium balance is needed for growth during the first year of life, in older children, a sodium-poor diet seems to have the same cardiovascular protective effects as among adults. This is relevant, since: (1) a blood pressure tracking phenomenon was recognized; (2) the development of taste preferences is important during childhood; and (3) salt intake is often associated with the consumption of sugar-sweetened beverages (predisposing children to weight gain).
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Affiliation(s)
- Sebastiano A G Lava
- Division of Pediatric Nephrology, University Children's Hospital Bern, Bern, Switzerland
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Abstract
Hypertension has become a serious global public health burden because of its high incidence and concomitant risk of cardiovascular disease. Many studies have verified that risk factors, such as hypertension and obesity which are responsible for cardiovascular disease, start in early childhood. In Asian countries, the prevalence of hypertension in the pediatric age group has become more prevalent than ever before with the increasing obesity epidemic. To tackle the epidemic of cardiovascular disease, a leading cause of death and disability of non-communicable diseases in Asian countries, population-based measures aiming at reducing harmful environmental factors to blood pressure and body weight must be applied to individuals in their early childhood, as early as the fetal stage. This review focused on the prevalence of pediatric hypertension in Asian countries and outlined several considerations for accurate blood pressure (BP) measurement and evaluation, along with an overview of pathophysiology of fetal programming and obesity related with childhood hypertension.
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Feto-maternal interactions: a possible clue to explain the 'missed heritability' in arterial hypertension. Curr Opin Cardiol 2015; 30:391-2. [PMID: 26049387 DOI: 10.1097/hco.0000000000000195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Goharian TS, Gimsing AN, Goetze JP, Faber J, Andersen LB, Grøntved A, Jeppesen JL. Mid-regional pro-atrial natriuretic peptide and blood pressure in adolescents: effect of gender and pubertal stage. Blood Press 2015; 24:347-52. [PMID: 25968593 DOI: 10.3109/08037051.2015.1045703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Little is known about blood pressure in relation to circulating natriuretic peptide concentrations and gender in generally healthy adolescents. We studied 15-year-old females and males (n = 335) from the Danish site of the European Youth Heart Study (EYHS). Blood pressure was measured using a standardized protocol, sexual maturity was assessed according to Tanner stage, and as a surrogate for atrial natriuretic peptide, we measured mid-regional pro-atrial natriuretic peptide (MR-proANP) in plasma. Compared with boys, girls had lower systolic blood pressure (SBP) (mean ± SD: 109.6 ± 9.9 mmHg vs 116.9 ± 11.4 mmHg, p < 0.0001) and higher plasma MR-proANP concentrations [median (interquartile range): 42.1 pmol/l (31.9-50.2 pmol/l) vs 36.6 pmol/l (30.6-44.9 pmol/l), p = 0.0046]. When female adolescents were further subdivided according to Tanner stage, there were no differences in blood pressure and plasma MR-proANP concentrations between post-pubertal and pubertal girls (p > 0.17). In contrast, after similar subdivision, post-pubertal boys had higher SBP (mean ± SD: 117.7 ± 11.7 mmHg vs 111.4 ± 7.9 mmHg, p = 0.029) and lower plasma MR-proANP concentrations [median (interquartile range): 36.2 pmol/l (30.6-43.1 pmol/l) vs 46.4 pmol/l (30.3-51.1 pmol/l), p = 0.043] compared with pubertal boys. Given their higher SBP, boys had lower than expected plasma concentrations of MR-proANP compared with girls, and given their higher SBP, post-pubertal boys had lower than expected plasma concentrations of MR-proANP compared with pubertal boys.
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Affiliation(s)
- Tina S Goharian
- a Department of Internal Medicine , Glostrup Hospital, University of Copenhagen , Glostrup , Denmark
| | - Anders N Gimsing
- a Department of Internal Medicine , Glostrup Hospital, University of Copenhagen , Glostrup , Denmark
| | - Jens P Goetze
- b Department of Clinical Biochemistry , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Jens Faber
- c Department of Medicine O , Endocrine Unit, Herlev Hospital, University of Copenhagen , Herlev , Denmark
| | - Lars B Andersen
- d Research Unit for Exercise Epidemiology, Department of Sport Science and Clinical Biomechanics , Centre of Research in Childhood Health, University of Southern Denmark , Odense , Denmark
| | - Anders Grøntved
- d Research Unit for Exercise Epidemiology, Department of Sport Science and Clinical Biomechanics , Centre of Research in Childhood Health, University of Southern Denmark , Odense , Denmark
| | - Jørgen L Jeppesen
- a Department of Internal Medicine , Glostrup Hospital, University of Copenhagen , Glostrup , Denmark
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Ding W, Cheung WW, Mak RH. Impact of obesity on kidney function and blood pressure in children. World J Nephrol 2015; 4:223-229. [PMID: 25949935 PMCID: PMC4419131 DOI: 10.5527/wjn.v4.i2.223] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
In recent years, obesity has become an increasingly important epidemic health problem in children and adolescents. The prevalence of the overweight status in children grew from 5% to 11% from 1960s to 1990s. The epidemic of obesity has been paralleled by an increase in the incidence of chronic kidney disease (CKD) and hypertension. Results of several studies have demonstrated that obesity and metabolic syndrome were independent predictors of renal injury. The pathophysiology of obesity related hypertension is complex, including activation of sympathetic nervous system, renin angiotensin aldosterone system, hyperinsulinemia and inflammation. These same mechanisms likely contribute to the development of increased blood pressure in children. This review summarizes the recent epidemiologic data linking obesity with CKD and hypertension in children, as well as the potential mechanisms.
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Increased ambulatory arterial stiffness index in obese children. Atherosclerosis 2015; 238:185-9. [DOI: 10.1016/j.atherosclerosis.2014.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/15/2014] [Accepted: 12/01/2014] [Indexed: 01/23/2023]
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Abstract
Hypertension in children and adolescents, once thought to be rare, has been estimated at a current prevalence of between 1% and 5% in the United States. The prevalence of primary hypertension continues to increase with the increasing body mass index of the pediatric population. Who is at risk? If and when to screen? When and how to treat? These controversial questions are important to the physician in primary care practice.
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Affiliation(s)
- Debra Ahern
- Department of Community and Family Medicine, TMC Lakewood, 7900 Lee's Summit Road, Kansas City, MO 64139, USA.
| | - Emily Dixon
- Bethesda Family Practice and Sports Medicine Fellowship, Trihealth Orthopedic and Spine Institute, 8311 Montgomery Rd, Cincinnati, OH 45236, USA
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Feber J, Ruzicka M, Geier P, Litwin M. Autonomic nervous system dysregulation in pediatric hypertension. Curr Hypertens Rep 2014; 16:426. [PMID: 24633841 DOI: 10.1007/s11906-014-0426-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Historically, primary hypertension (HTN) has been prevalent typically in adults. Recent data however, suggests an increasing number of children diagnosed with primary HTN, mainly in the setting of obesity. One of the factors considered in the etiology of HTN is the autonomous nervous system, namely its dysregulation. In the past, the sympathetic nervous system (SNS) was regarded as a system engaged mostly in buffering major acute changes in blood pressure (BP), in response to physical and emotional stressors. Recent evidence suggests that the SNS plays a much broader role in the regulation of BP, including the development and maintenance of sustained HTN by a chronically elevated central sympathetic tone in adults and children with central/visceral obesity. Consequently, attempts have been made to reduce the SNS hyperactivity, in order to intervene early in the course of the disease and prevent HTN-related complications later in life.
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Affiliation(s)
- Janusz Feber
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Ontario, K1H 8 L1, Canada,
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Childhood Obesity, Arterial Stiffness, and Prevalence and Treatment of Hypertension. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:339. [DOI: 10.1007/s11936-014-0339-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Leisman D, Meyers M, Schnall J, Chorny N, Frank R, Infante L, Sethna CB. Blood Pressure Variability in Children With Primary vs Secondary Hypertension. J Clin Hypertens (Greenwich) 2014; 16:437-41. [DOI: 10.1111/jch.12322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/06/2014] [Accepted: 03/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel Leisman
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Melissa Meyers
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Jeremy Schnall
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Nataliya Chorny
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Rachel Frank
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Lulette Infante
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Christine B. Sethna
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
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