The emerging epidemic of hypertension in Asian children and adolescents

High Hcy regulates fluid shear stress pathway activity through histone H3K79 homocysteinylation in hyperhomocysteinemia-related child hypertension

BACKGROUND

The rise of hypertension in children has been increasingly associated with hyperhomocysteinemia (HHcy), which is recognized as a major risk factor. However, the underlying mechanisms linking homocysteine and hypertension (termed HHYP) are not fully understood.

METHODS

This study utilized plasma samples from 27 control children and 27 children with HHYP (aged 8 ~ 16 years) for TMT6-labeled proteomic quantification, identifying significant altered proteins. Bioinformatics analysis revealed pathway alterations. Verification was carried out via parallel reaction monitoring (PRM) and western blot (WB) analyses. Additionally, a rat model of HHYP induced by high methionine diets, and umbilical vein endothelial cell models exposed to high homocysteine (hcy) levels were developed to investigate the molecular underpinnings further. Protein expression changes and epigenetic modifications were assessed using WB, immunohistochemistry (IHC), and ChIP-qPCR techniques.

RESULTS

Key findings indicated that 357 proteins and 69 pathways were altered in children with HHYP. Specifically, 12 proteins within the fluid shear stress and atherosclerosis (FSSA) pathway showed differential expression, including the downregulation of TRX1 and GPX1 and the upregulation of ICAM1. The same expression patterns were noted in both the HHYP rat aortic tissues and the high hcy cultured endothelial cells. Moreover, elevated H3K79hcy modification levels were observed alongside epigenetic regulation of genes related to the FSSA pathway. Importantly, folic acid (FA), a medication frequently used in the clinical treatment of HHYP, has been demonstrated to effectively reverse H3K79hcy modifications and restore the disrupted FSSA pathway in both animal models and cell cultures.

CONCLUSIONS

The present study suggests that HHcy may contribute to hypertension through the epigenetic dysregulation of the FSSA pathway mediated by H3K79hcy. Furthermore, the pediatric proteomics data gleaned from this study offer new clinical insights into the pathophysiology of HHYP in children.

Maintaining optimal cardiovascular health metrics and carotid intima-media thickness among Korean adolescents

Background

The distribution of cardiovascular health (CVH) and its association with vascular health among Asian adolescents is understudied. We examined the distribution of optimal CVH metrics and their association with carotid intima-media thickness (cIMT) in Korean adolescents.

Methods

We analyzed data from a cohort of 694 healthy Korean adolescents with an average follow-up period of 2.4 years. CVH scores were assessed at baseline and follow-up using 6 metrics from Life's Essential 8 (LE8), excluding diet and sleep. Additionally, we developed an experimental set of 7 metrics by incorporating a psychological health indicator. We examined the association between CVH and cIMT using 2 approaches: 1) aggregated CVH, calculated as the average of the 2 time points, and 2) changes in CVH over time. High cIMT, defined as the highest sex-specific quartile measured at the follow-up visit, was analyzed using multivariable logistic regression.

Results

Among participants (mean age, 15.9 years at baseline), approximately 25% maintained an optimal-level CVH, with physical activity being the most challenging metric. Higher CVH was associated with lower odds of high cIMT; gradually decreasing odds according to higher aggregated CVH were evident. Maintaining optimal CVH resulted in 50% lower odds of high cIMT compared to those with persistently suboptimal CVH. The results remained consistent when the psychological health metric was incorporated into CVH.

Conclusions

Among Korean adolescents, CVH scores for 6 of LE8 metrics, excluding diet and sleep, were comparable to those of non-Hispanic Asian adolescents in the U.S. Higher CVH was associated with lower odds of high cIMT at age 18.

Hypertension prevalence in Korean adolescents according to parental hypertension: data from the Korea National Health and Nutrition Survey

The prevalence of hypertension among children and adolescents has risen to 4% globally in recent decades, presenting a significant public health challenge due to its association with increased cardiovascular risks. Existing research on the transmission of hypertension risk between parents and offspring lacks comprehensive data from general population-based samples with clinically collected measurements spanning generations. This study utilized nationally representative data to assess the risk of developing hypertension in offspring based on parental hypertension status, employing standardized blood pressure measurements rather than relying solely on historical data. A positive correlation exists between the increasing number of hypertensive parents and the risk of hypertension development in offspring. The prevalence of hypertension among individuals aged 10 to 18 years did not substantially increase with age. Adolescents whose parents were affected by hypertension exhibited a 2-fold greater prevalence of hypertension compared to the general population with the same age, with approximately a quarter of boys with both hypertensive parents having hypertension. Among nonobese individuals, the risk of hypertension associated with parental hypertension was comparable to that observed in obese subjects. Blood pressure monitoring from the early stage of life would benefit adolescents with hypertensive parents.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

In utero and postnatal exposure to environmental tobacco smoke, blood pressure, and hypertension in children: the Seven Northeastern Cities study

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.

Risk factors and predictive biomarkers of early cardiovascular disease in obese youth

Obesity in childhood and adolescence continues to be a major health issue due to significant health implications and to the economic burden that arise from treating this disease and its complications. Current data show that childhood obesity is no longer just a concern for developed countries, but more significantly affecting developing countries. In adult population, cardiovascular disease is the main cause of mortality and morbidity among obese patients. It is therefore believed that risk factors found in adult patients could also be observed in obese youth. These risk factors will then persist and become progressively worse if obese youth remain obese as they reach adulthood. However, risk reduction is achievable through various prevention and management strategies of obesity and obese children who become nonobese in adulthood have a significant reduction in their risk of developing cardiovascular disease. New biomarkers to improve risk assessment in obese youth are an open research field, which will eventually lead to a more targeted approach in prevention and treatment. Nevertheless, there is still a need for continuous research in understanding the roles of these biomarkers and their potential in risk prediction. Cardiovascular risk modification of childhood obesity depends on a more concerted effort among the various parties involved and particularly a global collaboration to stop the rising prevalence of the epidemic in developing countries.

The effect of remote health intervention based on internet or mobile communication network on hypertension patients: Protocol for a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

To systematically review the impact of remote health interventions based on an internet or mobile communication network on patients with hypertension and to provide a theoretical basis for hypertension patients with the implementation of remote health interventions.

METHODS

Data were retrieved from a total of 4 Chinese databases and 3 foreign databases. The Chinese databases included: China National Knowledge Infrastructure (CNKI), WanFang Data, Chinese Biomedical Database (SinoMed), and Chongqing Chinese Science and Technology Journey database (VIP). The foreign language databases included PubMed, The Cochrane Library, and EMbase, and the date range for the search was from the date the database became active to December 1, 2018. After screening and extracting the materials and evaluating the risk of bias in each study (conducted by 2 researchers), the quality of the selected literature was evaluated by Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014, and the statistical analysis was applied by Stata 12.0 software.

RESULT

This study will provide high-quality evidence-based medicine research evidence for remote health interventions on hypertensive patients based on the Internet and mobile communication network using systematic evaluation and meta-analysis methods.

CONCLUSION

This systematic review will provide a scientific conclusion as to whether the remote health intervention model based on an internet or mobile communication network can better control blood pressure and improve patient compliance than the traditional nursing intervention model for hypertensive patients.

ETHICS AND DISSEMINATION

This protocol for a systematic review and meta-analysis of randomized controlled trials does not require ethical approval and the results of this paper will be published in an open form in internationally influential academic journals.

PROTOCOL AND REGISTRATION

A protocol had been registered in PROSPERO CRD42019122404.

Phthalate exposure as a risk factor for hypertension

Phthalates are ubiquitous in environment. Hypertension is a major risk factor for cardiovascular diseases. Phthalate exposure is associated with hypertension in multiple studies. This review aims to summarize the scientific literature on associations between phthalate exposure and hypertension and discuss the mechanisms in the relationship. We identified and reviewed original articles published to March 2018, using PubMed and Web of Science to search the terms "phthalate(s)," "phthalic acid," "blood pressure," "high blood pressure," "hypertension," "prehypertension," and "cardiovascular disease." Findings were summarized based on the relevance to the themes, including presentation of main phthalates and their major metabolites as well as associations of phthalate exposure with blood pressure in epidemiological and experimental studies. We identified ten population-based investigations and five toxicological experiments. Epidemiological data underscored a possible correlation between phthalate exposure and hypertension in adults, whereas individual study in children stands on the opposite. Experimental studies mainly targeted the increasing effect of phthalates on blood pressure. This review suggested some underlying mechanisms of phthalate-associated hypertension. Considering the current evidence, phthalate might be risk factors of hypertension. However, the effect of phthalate exposure in early life on blood pressure in later life or adulthood is still unclear. Well-designed longitudinal and molecular mechanism studies are indispensable.

Primary Pediatric Hypertension: Current Understanding and Emerging Concepts

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.

Obesity, non-communicable disease (NCD) risk factors and dietary factors among Chinese school-aged children

BACKGROUND AND OBJECTIVES

China's nutrition transition is characterized by dramatic increases in overweight and cardiometabolic (CM) risk. The burden of obesity, CM risk factors and dietary intake among Chinese children were explored.

METHODS AND STUDY DESIGN

Children 7-12 y old from the 2009 China Health and Nutrition Survey with available dietary intake data, anthropometry, blood pressure, and fasting blood samples were included (n=663). CM risk prevalence was calculated; logistic regression was used to investigate the association of nutrient intakes with CM risk, adjusting for age, gender, physical activity, area of residence and income.

RESULTS

14% of Chinese school-aged children and ~20% of those from urban areas and higher income households had overweight/obesity (p<0.05). The prevalence of prehypertension was ~20% while hypertension was 14%. Around 20% of all children and >=30% of those from urban areas and higher income households had impaired glucose/ HbA1c (p<0.05). More than half of the studied children had pre-dyslipidemia (i.e. at least one lipid measurement above borderline levels) and 21% of children had dyslipidemia. Approximately 30% of all children had energy intakes above requirements and 38% of them had excessive proportions of dietary fat and saturated fat. Children with higher intakes of total daily energy and total and added sugars had a greater likelihood of having impaired blood pressure and glucose/HbA1c.

CONCLUSIONS

Childhood overweight and CM risk is prevalent in urban and rural areas of China and across different socioeconomic groups although disparities between classes still pervade. Several dietary factors such as sugars were significant correlates of CM risk.