Comparison of blood pressure in children from three ethnic groups

Short-term effects of corticosteroid therapy on cardiac and skeletal muscles in muscular dystrophies

BACKGROUND

Duchenne muscular dystrophy (DMD) is the most common muscular dystrophy of childhood. It leads to progressive deterioration in cardiac and skeletal muscles. Corticosteroids are considered an effective therapy.

OBJECTIVE

This study aimed to evaluate the role of short-term prednisone therapy in improving left ventricular (LV) systolic function, LV mass (LVM), and motor power in cases of muscular dystrophies.

PATIENTS AND METHODS

Twenty-five cases of muscular dystrophy including 17 cases of DMD, 3 cases of Becker muscular dystrophies, and 5 cases of female patients with DMD-like phenotype were included in the study. The diagnosis of 12 patients was confirmed by muscle biopsy with immunohistochemistry; the patients were subjected to motor assessment, measurement of creatine kinase level, and echocardiographic examination before and after prednisone therapy. Transthoracic echocardiographic assessment of the LV systolic function (fractional shortening) was done. Myocardial performance index and LVM were calculated. Intermittent dosage of prednisone was administered 5 mg/kg per day on 2 consecutive days weekly for 3 months.

RESULTS

Fractional shortening improved on prednisone therapy (P = 0.009) and LVM increased (P = 0.012); improvement in walking was detected in 77% of the patients, climbing stairs improved in 88.9%, Gower sign improved in 70%, and rising from chair improved in 60%. Prednisone had no effect on the patients with marked motor impairment (on wheelchair). The creatine kinase level was significantly lower after steroid therapy (P = 0.04).

CONCLUSIONS

Three months of intermittent prednisone therapy could improve cardiac and skeletal muscle function in congenital muscular dystrophy.

Auscultatory measured normative blood pressure of korean adolescents: using the korean national health and nutrition examination survey 2001-2007

Background and Objectives

In Korea, there hasn't been any previous literature that describes auscultatory blood pressure (BP) normative tables for adolescents. Using BP data, from the Korean National Health and Nutrition Examination Survey (KNHANES), we created normative auscultatory BP percentile tables for Korean adolescents.

Subjects and Methods

A total of 3508 adolescents (boys 1852, girls 1656), aged 10-17 in 2001, 2005 and 2007 from the KNHANES database years, were included. Auscultatory BP measurement was performed, using a Baumanometer Mercury Gravity Sphygmomanometer.

Results

The mean systolic BP of boys was higher than that of girls in adolescents older than 13 years of age, and the mean diastolic BP of boys was higher than that of girls in those older than 15 years. Systolic and diastolic BP was correlated with weight, height and age. Age-specific normative auscultatory systolic and diastolic BP percentiles for boys and girls were completed. The graph that showed age-specific prehypertensive and hypertensive systolic and diastolic BP for boys and girls was presented. For adolescents, the height-specific auscultatory BP percentiles for boys and girls were completed. A graph that shows the height-specific prehypertensive and hypertensive BP for boys and girls was also made.

Conclusion

The auscultatory age-and height-specific BP percentiles for Korean adolescents are established. These can be useful in screening the prehypertension and hypertension of Korean adolescents in a clinical setting.

Monitoring of standard hemodynamic parameters: heart rate, systemic blood pressure, atrial pressure, pulse oximetry, and end-tidal CO2

BACKGROUND

Continuous monitoring of various clinical parameters of hemodynamic and respiratory status in pediatric critical care medicine has become routine. The evidence supporting these practices is examined in this review.

METHODOLOGY

A search of MEDLINE, EMBASE, PubMed, and the Cochrane Database was conducted to find controlled trials of heart rate, electrocardiography, noninvasive and invasive blood pressure, atrial pressure, end-tidal carbon dioxide, and pulse oximetry monitoring. Adult and pediatric data were considered. Guidelines published by the Society for Critical Care Medicine, the American Heart Association, the American Academy of Pediatrics, and the International Liaison Committee on Resuscitation were reviewed, including further review of references cited.

RESULTS AND CONCLUSIONS

Use of heart rate, electrocardiography, noninvasive and arterial blood pressure, atrial pressure, pulse oximetry, and end-tidal carbon dioxide monitoring in the pediatric critical care unit is commonplace; this practice, however, is not supported by well-controlled clinical trials. Despite the majority of literature being case series, expert opinion would suggest that use of routine pulse oximetry and end-tidal carbon dioxide is the current standard of care. In addition, literature would suggest that invasive arterial monitoring is the current standard for monitoring in the setting of shock. The use of heart rate, electrocardiography. and atrial pressure monitoring is advantageous in specific clinical scenarios (postoperative cardiac surgery); however, the evidence for this is based on numerous case series only.

Trends of elevated blood pressure among children and adolescents: data from the National Health and Nutrition Examination Survey1988-2006

BACKGROUND

Elevated blood pressure (EBP) in children and adolescents increases future risk of cardiovascular disease. Among children and adolescents, increased weight is associated with EBP.

METHODS

National cross-sectional data for children and adolescents aged 8-17 years from the National Health and Nutrition Examination Surveys (NHANESs): 1988-1994, 1999-2002, and 2003-2006. The main outcome measures were EBP and pre-EBP estimates.

RESULTS

Overweight boys (odds ratio (OR) 1.54, confidence interval (CI) 1.11-2.13) and both obese boys and girls were significantly more likely to be classified as pre-EBP (boys, OR 2.81, CI 2.13-3.71; girls, OR 2.55, CI 1.75-3.73) and having EBP (boys aged 8-12 years, OR 6.06, CI 2.73-13.44, boys aged 13-17, OR 9.62 CI 4.86-19.06; girls, OR 2.33, CI 1.31-4.13) when compared to the reference weight and controlling for all other covariates.During 2003-2006, 13.6% (s.e. = 1.2) of boys aged 8-17 years and 5.7% (s.e. = 0.7) of the girls aged 8-17 years were classified as pre-EBP and 2.6% (s.e. = 0.5) of the boys aged 8-17 and 3.4% (s.e. = 0.7) of the girls aged 8-17 were having EBP. After controlling for age, race/ethnicity, and body mass index (BMI), girls only were significantly more likely to have EBP during 2003-2006 than during 1988-1994 (OR 2.17, CI 1.05-4.49). In contrast, adolescent boys aged 13-17 years were significantly less likely to be having EBP during 2003-2006 than during 1988-1994 (OR 0.32, CI 0.13-0.81).

CONCLUSIONS

Obesity is strongly, positively, and independently associated with EBP and pre-EBP among youths. However, controlling for all covariates including BMI, EBP has increased among girls but decreased among adolescent boys aged 13-17, during 2003-2006 when compared with 1988-1994.

Oscillometric blood pressure standards for children

We previously reported blood pressure (BP) readings obtained by the Dinamap (DIN) (Model 8100) were 10 mmHg higher than those obtained by auscultatory methods and thus were not interchangeable. DIN BP data on 7208 schoolchildren ages 5 to 17 were analyzed to generate normative DIN BP standards and to examine the rational for presenting BP standards according to age and height percentiles. Three BP measurements were taken in the sitting position using a BP cuff width 40% to 50% of the circumference of the arm. Boys' systolic pressures (SP) were significantly (p < 0.05) greater (up to 11 mmHg) than those of the girls in subjects age 13 to 17 years. SP levels were most closely correlated with weight (r = 0.595), followed by height (r = 0.560) and age (r = 0.518). When BP levels were adjusted for age and weight, the correlation coefficient of DIN SP with height was negligible (r = 0.026 for boys; r = 0.085 for girls), whereas when adjusted for age and height, the correlation of SP with weight remained high (r = 0.303 for boys; r = 0.216 for girls), indicating that height is not an important independent predictor of BP levels. In conclusion, Dinamap-specific BP standards presented in this report are the only standards that have been generated according to the current BP guidelines recommended by national committees. We found no rational for presenting BP standards according to age and height percentiles.

Differences in resting cardiovascular parameters in 10- to 15-year-old children of different ethnicity: the contribution of physiological and psychological factors

BACKGROUND

The health status of children in the North West Province of South Africa was examined using the Transition and Health during Urbanization in South Africa in Children study. This is an epidemiological, cross-sectional study for which 1,244 children between 10 and 15 years of age were recruited from 44 schools.

PURPOSE

Our objective was to investigate whether differences exist between resting cardiovascular parameters of Black, White, colored, and Indian children and evaluate the contribution of physiological and psychological factors.

METHODS

Blood pressure was monitored with the Finapres apparatus. By means of the Fast Modelflo software program, the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure, heart rate, cardiac output (CO), total peripheral resistance (TPR), and "Windkessel" compliance (Cw) of the arterial system were obtained. The psychological data were obtained by validated questionnaires.

RESULTS

After correction for body mass index, the SBP of the White children was significantly higher (p < .05) than the SBP of the other ethnic groups. The DBP showed no significant differences. The TPR measurements of the Black and colored children were significantly higher (p < .05) than the TPR of the White children, and the Cw measurements of the Black and colored children were significantly lower than the Cw of the White children. Significant correlations (p < .05) were found between the SV, CO, TPR, Cw, and the total score on violence in the Black and colored children.

CONCLUSIONS

There are differences in the resting cardiovascular parameters in the different ethnic groups studied. The higher levels of violence to which the Black and colored children are exposed could alter vascular sensitivity to sympathetic stimulation. This may contribute via the higher -adrenergic sensitivity to the pathogenesis of hypertension in their later lives.

Ethnicity and tracking blood pressure in children

There is growing evidence that hypertension, one of the major modifiable risk factors for cardiovascular disease (CVD), is established early in life. Given this, it is important to discover when hypertension first becomes apparent. Further, it is of particular importance to examine the ethnic differences in blood pressure (BP) in children, given the variation in rates of CVD morbidity and mortality among adults from different ethnic groups.