Ethnicity and tracking blood pressure in children

Association between systemic inflammation markers and blood pressure among children and adolescents: National Health and Nutrition Examination Survey

BACKGROUND

Few studies have estimated the associations of systemic inflammation markers and high blood pressure (HBP) in the pediatric population.

METHODS

Basing on data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, we assessed the associations between four inflammation-related factors based on blood cell counts: systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and risk for pediatric HBP by estimating odds ratios (ORs) using multivariable logistic regression models.

RESULTS

A total of 17,936 children aged 8-19 years were included in the analysis, representing about 36.7 million American children. The prevalence rates of elevated blood pressure (EBP) and hypertension (HTN) were 15.79% and 6.77%, respectively. The results showed that the ORs for EBP per standard deviation (SD) increment in SII and NLR were estimated at 1.11 [95% confidence interval (95%CI): 1.04, 1.17] and 1.08 (95%CI: 1.02, 1.15), respectively; and the OR for EBP per SD increment in LMP were estimated at 0.90 (95%CI: 0.83, 0.96). These associations were stronger in boys and younger children.

CONCLUSIONS

The study suggested that inflammation-related factors could serve as easily accessible early biomarkers for HBP risk prediction and prevention in children and adolescents.

IMPACT

The study suggested that inflammation-related factors could serve as easily accessible early biomarkers for HBP risk prediction and prevention in children and adolescents. This is the first study that demonstrates the close association between systemic inflammation markers and HBP in children and adolescents using nationally representative population data. The findings have more public health implications and support that systemic inflammation markers based on blood cell counts could serve as easily accessible biomarkers of HBP risk and prevention in earlier identification of the diseases.

Incidence and correlates of high blood pressure from childhood to adulthood: the Birth to Twenty study

BACKGROUND

There is growing evidence from high-income countries suggesting that hypertension developed in childhood and adolescence persists into adulthood. The objective of this study was to investigate the incidence and risk factors of high blood pressure (BP) in urban black children.

METHODS

We used data from the Birth to Twenty (BT20+) cohort in Johannesburg, South Africa constituting of children born in 1990 and who had their growth, development and blood pressure measured at six follow-up periods over the course of 13 years. High BP was classified as at least 95th percentile for age, sex and height. Incidence rate of high BP was calculated using survival analysis and risk factors were determined by use of Cox proportional hazard regression.

RESULTS

Over a follow-up period of 13 years, the overall incidence rate of high BP was 57 cases per 1000 person-years (95% CI 53.2-61.1). Risk for incident high BP increased with rapid relative weight gain in early childhood (hazard ratio =1.11, 95% CI 1.00-1.22), mid-childhood (hazard ratio = 1.13, 95% CI 1.03-1.24) and adolescence (hazard ratio = 1.21, 95% CI 0.99-1.47). Maternal parity significantly increased the risk for incident high BP (hazard ratio = 1.08, 95% CI 1.01-1.15).

CONCLUSION

Maternal parity and relative weight gain were determinants for incident high blood pressure in urban black South African children and adolescents. To reduce the high incidence and the disease burden of high BP, national programs should focus on promoting healthy lifestyle in early stages of life to prevent rapid weight gain and later cardiovascular disease risk. Further research is required to investigate whether incident high BP in childhood predict clinical outcomes in adulthood.

Relationship between High Blood Pressure and Microalbuminuria in Children Aged 6-9 Years in a South African Population

Though the association between high blood pressure and microalbuminuria is well established in adults, there is a paucity of information on microalbuminuria in children. This study investigated the relationship between high blood pressure and microalbuminuria in 6-9-year-old children. A cross-sectional study, which included 306 primary school children of age 6-9 years old from urban areas (n = 154) and rural areas (n = 152) of the Eastern Cape Province of South Africa, was conducted. Participants' anthropometric data were determined and systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured and converted to BP percentiles for age, sex and height. Creatinine and albumin concentrations were assayed in early morning midstream urine and the albumin to creatinine ratio (ACR) was calculated. There was a 42.8% prevalence of elevated blood pressure/high blood pressure (E-BP/H-BP) and a 10.1% prevalence of microalbuminuria. Among the 131 children with E-BP/H-BP, 17 had elevated ACR with a prevalence of 13.95%. SBP and HR increased with increasing range of ACR and, furthermore, SBP was significantly (p < 0.05) higher in children with moderately and severely increased ACR. SBP was associated with ACR and increased SBP predicted microalbuminuria (R2 = 0.42, adj R2 = 0.039, B: 0.120, p = < 0.05). In conclusion, microalbuminuria was present in 6-9-year-old South African children of African Ancestry and a weak association was observed with SBP in children.

A novel indicator, childhood lipid accumulation product, is associated with hypertension in Chinese children and adolescents

Childhood hypertension has become an important public health issue. This study explored a novel indicator, namely, childhood lipid accumulation product (CLAP), which is associated with hypertension among children and adolescents. A total of 683 children and adolescents aged 8-15 years were measured for body weight, height, waist circumference (WC), abdominal skinfold thickness (AST), triacylglycerol (TG), blood pressure, dietary behaviors, and physical activity time. The novel childhood lipid accumulation product (CLAP) was the product of WC, AST, and TG (CLAP = WC (cm) × AST (mm) × TG (mmol/L)). The logarithmic CLAP (LnCLAP), height, weight, WC, WHtR, BMI, AST, and TG were standardized for sex and age using the z-score method (standardized variables: SLnCLAP, Sheight, Sweight, SWC, SWHtR, SBMI, SAST, and STG). The results showed that the overall prevalence of hypertension was 11.6% (13.1% in boys and 9.7% in girls). SLnCLAP ≥ 1, Sweight ≥ 1, SWC ≥ 1, SWHtR ≥ 1, SBMI ≥ 1, SAST ≥ 1, and STG ≥ 1 increased the statistical risk of childhood hypertension (odds ratio values (95% CI) were 3.70 (2.22-6.16), 2.58 (1.50-4.43), 3.08 (1.84-5.15), 2.33 (1.38-3.93), 2.96 (1.72-5.29), 2.38 (1.41-4.70), and 2.40 (1.38-4.19), respectively). The area under the ROC curve (AUC) for CLAP was higher than that for weight, WC, WHtR, BMI, AST, and TG in the prediction of hypertension. In conclusion, this study showed that CLAP is a novel indicator associated with hypertension in children and adolescents and can more effectively predict childhood hypertension than weight, WC, WHtR, BMI, AST, and TG can.

Type 2 diabetes markers in indigenous Argentinean children living at different altitudes

BACKGROUND

Exposure to hypoxia at high altitude is increasingly being recognized as a risk factor for metabolic diseases.

OBJECTIVE

To determine the association between Type 2 diabetes (T2D) risk factors and altitude in two groups of Argentinean indigenous schoolchildren who live permanently at different altitudes.

METHODS

This cross-sectional study compared 142 schoolchildren from San Antonio de los Cobres (SAC), 3750 m above sea level, with 171 from Chicoana (CH), 1400 m. Data for children's anthropometry, blood pressure and lipids, as well as mothers' height and weight were assessed.

RESULTS

There was not a significant difference in age between SAC (9.0 + 2y) and CH (9.4 + 2y) children. However, mean children's weight (29 vs. 38 kg), height (130 vs. 138 cm), BMI (17 vs. 19 kg/m2), and HDL-C (46 vs. 48 mg/dL) were significantly lower in SAC than in CH, respectively. In contrast, systolic blood pressure (87 vs. 70 mmHg), cholesterol (157 vs. 148 mg/dL), and triglycerides (104 vs. 88 mg/dL) were significantly higher in SAC than in CH, respectively. There was not a significant difference in age (33.2 + 7y vs. 34.4 + 8y) and BMI (26.2 + 4y vs. 28 + 5y) between SAC and CH mothers. Multiple linear regression analyses showed that children's blood pressure (R2 = 0.38), triglycerides (R2 = 0.21), and HDL-C (R2 = 0.16) were significantly associated with altitude, adjusted for confounding variables.

CONCLUSION

This study shows that indigenous Argentinean children living at 3750 meters have higher T2D risk compared with those living at 1400 meters above sea level.

Independent and combined effects of handgrip strength and adherence to a Mediterranean diet on blood pressure in Chilean children

OBJECTIVE

The aim of the study was to examine the combined associations between handgrip strength (HGS) and adherence to a Mediterranean diet with blood pressure (BP) in Chilean children.

METHODS

This cross-sectional study enrolled 1140 children (794 boys and 346 girls) 8 to 12 y of age. HGS was measured using a hand dynamometer with an adjustable grip. Adherence to a Mediterranean diet was assessed with the Kidmed score. Resting BP was measured by an automated monitor using an appropriately sized cuff. Elevated BP was defined as ≥90th percentile, and high HGS was defined as sex- and age-specific normative ≥80th percentile for the HGS.

RESULTS

The prevalence of elevated systolic BP, diastolic BP, and overall BP were 16.6%, 12.9%, and 8.1%, respectively. HGS was negatively associated with BP parameters in an unadjusted and adjusted model after considering potential confounders (age, sex, body mass index z-score, and HGS). Regarding diet adherence, the unadjusted model reveals that children with high adherence to the Mediterranean diet showed lower BP levels (systolic, diastolic, and mean arterial pressure) compared with children with low-medium adherence; however, these differences disappear after considering potential confounders. The combination of high HGS and optimal adherence to a Mediterranean diet was negatively associated with BP.

CONCLUSIONS

Children with a high HGS levels (i.e., ≥80th percentile) may somewhat overcome the deleterious effects of low adherence to a Mediterranean diet. Therefore, these findings suggest that the combination of these two components of a healthy lifestyle, especially HGS may be beneficial to children's BP.

Elevated blood pressure among primary school children in Dar es salaam, Tanzania: prevalence and risk factors

Background

Whilst the burden of non-communicable diseases is increasing in developing countries, little data is available on blood pressure among Tanzanian children. This study aimed at determining the blood pressure profiles and risk factors associated with elevated blood pressure among primary school children in Dar es Salaam, Tanzania.

Methods

We conducted a cross sectional survey among 446 children aged 6–17 years from 9 randomly selected primary schools in Dar es Salaam. We measured blood pressure using a standardized digital blood pressure measuring machine (Omron Digital HEM-907, Tokyo, Japan). We used an average of the three blood pressure readings for analysis. Elevated blood pressure was defined as average systolic or diastolic blood pressure ≥ 90th percentile for age, gender and height.

Results

The proportion of children with elevated blood pressure was 15.2% (pre-hypertension 4.4% and hypertension 10.8%). No significant gender differences were observed in the prevalence of elevated BP. Increasing age and overweight/obese children were significantly associated with elevated BP (p = 0.0029 and p < 0.0001) respectively. Similar associations were observed for age and overweight/obesity with hypertension. (p = 0.0506 and p < 0.0001) respectively. In multivariate analysis, age above 10 years (adjusted RR = 3.63, 95% CI = 1.03–7.82) was significantly and independently associated with elevated BP in this population of school age children.

Conclusions

We observed a higher proportion of elevated BP in this population of school age children. Older age and overweight/obesity were associated with elevated BP. Assessment of BP and BMI should be incorporated in school health program in Tanzania to identify those at risk so that appropriate interventions can be instituted before development of associated complications.

High blood pressure and associated risk factors as indicator of preclinical hypertension in rural West Africa: A focus on children and adolescents in The Gambia

Hypertension is fast becoming a major public health problem across sub-Saharan Africa. We sought to determine the prevalence of high blood pressure (BP) and associated risk factors as indicator of preclinical hypertension in a rural Gambian population.We analyzed data on 6160 healthy Gambians cross-sectionally. Attention was given to 5 to <18-year olds (N = 3637), as data from sub-Saharan Africa on this young age group are scarce. High BP was defined as systolic blood pressure (SBP) above the 95th percentile for age-sex specific height z scores in <18-year olds employing population-specific reference values. Standard high BP categories were applied to ≥18-year olds.In <18-year olds, the multivariable analysis gave an adjusted high BP prevalence ratio of 0.95 (95% confidence interval [CI] 0.92-0.98; P = 0.002) for age and 1.13 (95% CI 1.06-1.19; P < 0.0001) for weight-for-height z score (zWT-HT); sex and hemoglobin were not shown to affect high BP. In adults age 1.05 (95% CI 1.04-1.05; P < 0.0001), body mass index z score 1.28 (95% CI 1.16-1.40; P < 0.0001), hemoglobin 0.90 (95% CI 0.85-0.96; P < 0.0001) and high fasting glucose 2.60 (95% CI 2.02-3.36; P < 0.0001, though the number was very low) were confirmed as risk factors for high BP prevalence; sex was not associated.The reported high BP prevalence and associated risk factors in adults are comparable to other studies conducted in the region. The observed high BP prevalence of 8.2% (95% CI 7.4-9.2) in our generally lean young Gambians (<18 years) is alarming, given that high BP tracks from childhood to adulthood. Hence there is an urgent need for further investigation into risk factors of pediatric high BP/hypertension even in rural African settings.

Blood pressure tracking in urban black South African children: birth to twenty cohort

Background

Hypertension is an emerging public health problem in South Africa. Recent evidence from longitudinal studies has shown that hypertension in adulthood can be traced back to childhood. There is scarcity of longitudinal data on paediatric blood pressure (BP) particularly in African populations. The objective of this study is to assess the prevalence of hypertension and evaluate BP tracking between childhood and late adolescence among South African black Children.

Methods

This study utilized data from the Birth to Twenty cohort, which is comprised of children born in Soweto, Johannesburg in 1990 (N = 3273, 78.5 % black). Data on BP and anthropometry were collected at six follow-up periods between ages 5 and 18 years. Blood pressure status was classified using the Fourth report on National High Blood pressure program in children and adolescents. Pearson correlation coefficients and relative risk ratios (RR) were used to describe tracking of BP between childhood and late adolescence.

Results

The overall point prevalence ranged from 9.2 to 16.4 % for prehypertension and 8.4 to 24.4 % for hypertension. Tracking coefficients ranged from 0.20 to 0.57 for SBP and 0.17- 0.51 for DBP in both sexes over the 14 years of measurement. The proportion of children who maintained an elevated BP status between childhood, adolescence and age 18 years ranged from 36.1 % at age 5 years to 56.3 % at age 13 years. Risk of having elevated BP at 18 years ranged from; RR: 1.60 (95 % CI: 1.29–2.00) at 5 years to RR: 2.71 (95 % CI: 2.32–3.17) at 14 years of age.

Conclusions

This study reports high prevalence of elevated BP which tracks from early childhood into late adolescence. These findings emphasize the importance of early identification of children at risk of developing elevated BP and related risk factors plus timely intervention to prevent hypertension in adulthood.

A 24-year follow-up study of blood pressure tracking from childhood to adulthood in Korea: the Kangwha Study

PURPOSE

A number of longitudinal studies have tracked blood pressure over time in children and adults. Although there are a few blood pressure tracking studies for Asian populations, they are all relatively short-term studies with around only 10 years of follow-up. Accordingly, we assessed the stability of blood pressure tracking from childhood to adulthood over a 24-year follow-up period among participants in the Kangwha Study.

MATERIALS AND METHODS

The Kangwha Study was a community- based prospective cohort study that started in 1986 in Kangwha County, South Korea. The study dataset included 14 blood pressure measurements over a 24-year period from 266 (123 male and 143 female) participants who completed the 2010 examination. All participants were 7 years old when the study began and were followed for the next 24 years.

RESULTS

The tracking coefficient (95% confidence interval) for systolic blood pressure was 0.81 (0.52-1.11) in men and 0.72 (0.51-0.92) in women; diastolic blood pressure was 0.53 (0.26-0.80) in men and 0.33 (0.15-0.52) in women. After adjusting for body mass index, the tracking coefficient for systolic blood pressure was 0.68 (0.39-0.97) in men and 0.67 (0.44-0.89) in women; diastolic blood pressure was 0.51 (0.24-0.78) in men and 0.33 (0.15-0.51) in women. All tracking coefficients were statistically significant (p<0.001).

CONCLUSION

In this 24-year longitudinal study, we confirmed the stability of blood pressure tracking from childhood to adulthood for participants in the Kangwha Study.

Pregnancy glucose levels in women without diabetes or gestational diabetes and childhood cardiometabolic risk at 7 years of age

OBJECTIVE

To estimate the association between pregnancy glucose values in women without recognized pregestational diabetes or gestational diabetes and cardiometabolic risk in their children.

STUDY DESIGN

This longitudinal cohort study of 211 Mexican American mother-child pairs participating in the Center for the Health Assessment of Mothers and Children of Salinas study used multiple logistic regression to estimate the children's risk of nonfasting total cholesterol, nonfasting triglycerides, blood pressure (BP), and waist circumference (WC) ≥75th percentile at 7 years of age associated with a 1-mmol/L (18-mg/dL) increase in maternal pregnancy glucose level, measured 1 hour after a 50-g oral glucose load.

RESULTS

The ORs for children in the upper quartile of diastolic BP, systolic BP, and WC associated with a 1-mmol/L increase in pregnancy glucose level were 1.39 (95% CI, 1.10-1.75), 1.38 (95% CI, 1.10-1.73), and 1.25 (95% CI, 1.02-1.54), respectively. Prepregnancy obesity was independently associated with increased odds of children belonging to the upper quartile of WC; maternal sugar-sweetened beverage consumption and gestational weight gain prior to the glucose test were not independently associated with any of the cardiometabolic outcomes.

CONCLUSION

In Mexican American women without recognized pregestational diabetes or gestational diabetes, we found an association between increasing pregnancy glucose values and the children's diastolic and systolic BPs and WC at 7 years of age. Whether interventions to reduce pregnancy glucose values, even if below levels diagnostic of overt disease, will mitigate high BP and abdominal obesity in late childhood remains to be determined.

Evolution of blood pressure from adolescents to youth in salt sensitivies: a 18-year follow-up study in Hanzhong children cohort

BACKGROUND

Essential hypertension mostly originates from children. Salt Sensitivity (SS) is regarded as the intermediate phenotype of essential hypertension. The present study investigated the effects of salt-sensitivity on evolution of blood pressure (BP) and development to hypertension from adolescents to youth.

METHODS

A baseline survey was carried out in 4,623 adolescents aged 6-15 years old in Hanzhong rural areas in 1987, 310 of whom (mean 9.2 years) were randomly recruited for determination of salt sensitivity using the tests of oral saline load and furosemide sodium-volume depletion. SS was diagnosed in 101 subjects while 209 were determined as non-salt-sensitive (NSS). We made a 18-year followed-up of the cohort in 2005.

RESULTS

The response rate for surviving baseline adolescents was 71.9%. At follow up, BP in youth with baseline SS was higher than that in NSS (SBP:122.9 ± 13.1 VS 117.3 ± 12.4, P < 0.01; DBP: 78.2 ± 10.4 VS 74.7 ± 10.8, P < 0.05). Longitudinal analysis of 18-year BP evolution, subjects in SS had greater Systolic BP change than subjects in NSS(19.6 ± 12.714.7 ± 12.2, P < 0.01). The incidence of hypertension in salt sensitive group was higher than that in NSS group (15.5% VS 6.3%, RR = 2.34, P < 0.05).

CONCLUSION

Our findings indicate that adolescents with higher BP salt-sensitivity have a higher rate of incident hypertension in youth. Salt sensitivity could be at high risk predisposing to development of hypertension from adolescents to youth.

Study of blood pressure profile of school children 6-15 years in a rural setting of Maharashtra

BACKGROUND

High blood pressure in childhood is a major risk factor for heart disease and stroke in adulthood. There is enough evidence to suggest that the roots of essential hypertension in adults extend into childhood. There is a paucity of literature on the blood pressure measurements amongst children. This study was done to study blood pressure profile of school children in rural area of Maharashtra.

AIM & OBJECTIVES

This cross sectional study was carried out to determine the prevalence of hypertension in children 6-15 years and to study the association between selected variables and blood pressure.

MATERIAL & METHODS

This study was done using a predesigned questionnaire and making measurements of height, BMI and Blood pressure using standardized physical instruments following standard guidelines. The data was collected and analyzed using appropriate statistical tests.

RESULTS

The prevalence of hypertension in the study was found to be 4.4% with 3.5% in females and 5.1% in males.

CONCLUSION

In the study, hypertension in students was found to be significantly associated with higher BMI and with family history of hypertension. Age, height and BMI were found to correlate positively with Blood pressure levels in this study.

Childhood cardiovascular risk factors in South Asians: A cause of concern for adult cardiovascular disease epidemic

Cardiovascular risk factors in children are increasing at an alarming rate in the western world. However, there is limited information regarding these in the South Asian children. This review attempts at summarizing such evidence. South Asians are remarkable for the earlier onset of adult cardiovascular disease (CVD) by almost a decade compared to the Caucasians. We identified published literature, mainly on PubMed, Embase and Cochrane library using specific search terms such as lipid abnormalities, high blood pressure, hyperglycemia, tobacco use, obesity, physical inactivity, and unhealthy dietary practices. Atherosclerotic CVD processes begin early in childhood and are influenced over the life course by genetic and potentially modifiable risk factors and environmental exposure. 80% of adult CVD burden will fall on the developing nations by 2020. The concept of primordial prevention is fast emerging as a necessary prevention tool to curb adult CVD epidemic. Established guidelines and proven preventive strategies on cardiovascular health exist; however, are always implemented half-heartedly. Composite screening and prediction tools for adults can be adapted and validated in children tailored to South Asian population. South Asian children could be at a greater risk of developing cardiovascular risk factors at an earlier stage, thus, timely interventions are imperative.

Tracking of blood pressure from childhood to adolescence in a Greek cohort

BACKGROUND

Studies have reported tracking of blood pressure (BP) from childhood to adulthood but with inconsistent results mainly due to methodological and ethnic differences. We aimed to examine BP tracking during a 7-year period in a Greek cohort.

METHODS

This is a longitudinal school-based study conducted during 1990-96 in Athens, Greece. Children underwent BP and anthropometric measurements on two to three visits annually (averaged to annual values) for 7 years.

RESULTS

A total of 166 children with complete yearly follow-up data for the examined period were included (mean baseline age 9 ± 1.7 years, range: 5-12 years, 89 boys). At baseline, the prevalence of pre- and hypertension was 22.9 and 24.1% respectively and at the end of the follow-up 24.1% (P = NS vs. baseline) and 13.3% (P = 0.02 vs. baseline) respectively. Systolic/diastolic BP tracking correlation coefficients between 1990 and 1996 were 0.38 (P < 0.001)/0.20 (P = 0.06) for boys and 0.30 (P = 0.007)/0.22 (P = 0.06) for girls. Among children with baseline BP ≥90th centile (systolic and/or diastolic), 44% remained in the same BP range after 7 years. In stepwise multiple regression analysis, baseline systolic BP, male gender, baseline body mass index (BMI) and change in BMI from baseline to the end of the follow-up (ΔBMI) were significant predictors of systolic BP levels at the end of the follow-up. Baseline diastolic BP, baseline BMI and ΔBMI were significant predictors of diastolic BP at the end of the follow-up.

CONCLUSIONS

These data suggest that the risk of developing high BP during adolescence can be predicted by BP and BMI at childhood.

Cardiovascular disease risk factors in adolescent British South Asians and whites: a pilot study

BACKGROUND

Cardiovascular disease (CVD) and associated mortality are more common in British South Asians than in the British white population. Most of the aspects of the cardiovascular risk profile are modifiable, and are thought to be established in childhood. However, the role of genetics and ethnicity has not been fully elucidated.

OBJECTIVES

This pilot study compared cardiovascular risk profiles in British South Asian and British white adolescents, and investigated the relationships between physical activity, cardiorespiratory fitness, nutrition, and CVD risk profile in both ethnic groups.

METHODS

Cardiovascular risk factors included systolic and diastolic blood pressure, body composition, fasting glucose, cholesterol, and triglycerides. Physical activity was measured using 7-day accelerometry; diet was measured from a 3-day dietary record. Fitness was assessed from running economy, submaximal exercise lactate response, and peak oxygen uptake. Body composition was determined through a bioelectrical impedance analyzer (BIA). Finger-prick blood samples were taken for fasting glucose, cholesterol, and triglycerides.

RESULTS

Twelve British South Asian males (aged 15.2 ± 0.3 years) and 11 British white males (aged 15.1 ± 0.3 years) were recruited. Mean systolic blood pressure in British South Asian adolescents was 6.9 mm Hg higher (95% confidence interval [CI], -13.4 to 0.4 mm Hg) than in their British white counterparts. Following multifactorial adjustment, this increased to 12.4 mm Hg. Fasting blood triglycerides were 1.04 mmol/L (0.52-1.57 mmol/L) higher in Asians; this was nonsignificant following adjustment for dietary factors. The British South Asian adolescents' diet contained 42 g (23-61 g) more fat per day.

CONCLUSIONS

Differences in cardiovascular risk profile between British South Asian and British white males are present in adolescence, with higher fasting blood triglycerides in British South Asian adolescent males being attributed to a higher proportion of dietary fat. Interventions may thus be developed to influence dietary choices during childhood, and therefore potentially reduce CVD in adulthood.

Health-related fitness in children and adolescents

PURPOSE

The American Physical Therapy Association Section on Pediatrics developed a task force to summarize fitness guidelines for children and adolescents. The purposes of this article were to review components, measurement methods, and consequences of physical fitness, and to summarize evidence-based activity recommendations for youth.

SUMMARY OF KEY POINTS

Health-related fitness is comprised of body composition, flexibility, cardiorespiratory endurance, and muscular strength and endurance. Each of these components is reviewed in terms of definition, assessment, normative values, and recommendations.

CONCLUSIONS

The task force supports the guidelines of the US Department of Health and Human Services, which state that to promote overall health and wellness, youth should participate in 60 minutes or more of physical activity every day.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Physical therapists should apply research relevant to health-related fitness when treating youth. Promoting fitness, health, and wellness in our communities is a responsibility all therapists should assume.

Prevalence of Prehypertension and Hypertension among Adolescent High School Girls in Tabriz, Iran

Background

There are few studies of the prevalence of elevated blood pressure that include Iranian adolescent girls.

Objective

The aim of this cross-sectional study was to determine the blood pressure status and its relationship with body mass index (BMI) in adolescent girls attending high school in Tabriz, Iran.

Methods

A sample of 985 girls was selected by stepwise random sampling from five districts of Tabriz. Blood pressure, weight, and height of the subjects were measured and BMI was calculated. Blood pressure measurements were categorized as normal, prehypertension, or hypertension using the 2004 Fourth Report blood pressure screening recommendations. Overweight and obesity were defined according to International BMI Cut Off Points for adolescents.

Results

The prevalence rates of of prehypertension and hypertension were 13.9% and 19.4%, respectively. Obesity and overweight were seen in 2.8% and 16.4% of subjects, respectively. The prevalence rates of hypertension and prehypertension increased with increasing BMI.

Conclusions

Hypertension and prehypertension were highly prevalent in the studied adolescent girls. Obesity was associated with an increased risk of elevated blood pressure. Further studies are needed to identify other risk factors for high blood pressure in our studied population. Routine blood pressure measurements in adolescent girls of our community are suggested to prevent high blood pressure in adolescence and its complications in later life.

Questionnaire survey on pediatric hypertension in Japan and Korea

BACKGROUND

Hypertension (HTN) is no longer viewed as an adult disease. The purpose of the present study was to understand how hypertensive children are evaluated and managed, by surveying pediatricians in Japan and South Korea.

METHODS

A questionnaire was mailed to 109 Japanese (JA) and 159 Korean (KO) pediatric cardiologists, pediatric nephrologists, and other pediatricians.

RESULTS

A total of 127 replies were received (response rate 47%). Most of respondents did not check blood pressure (BP) routinely in outpatient clinics (JA 77%, KO 88%). A mercury sphygmomanometer was the most commonly used method for BP measurements (JA 72%, KO 62%). BP treatment goals were usually set at the 95th percentile for age, gender, and height (JA 47%, KO 54%). More KO used a lower goal in children with primary HTN than JA. KO respondents preferred angiotensin-converting enzyme inhibitors (ACEI) as initial agents regardless of underlying diseases whereas JA respondents chose various medications, that is, calcium channel blockers, diuretics, and ACEI. For BP monitoring, self-monitoring was found to be most frequent in both countries (JA 80%, KO 57%). Ambulatory BP monitoring was not frequently utilized in both countries (JA 33% KO 34%).

CONCLUSION

The current assessment, management and differing trends in pediatric HTN in Japan and Korea have been identified in the present study. Pediatricians should be aware of the growing implications of HTN in children.

Blood pressure and body mass index in an ethnically diverse sample of adolescents in Paramaribo, Suriname

BACKGROUND

High blood pressure (BP) is now an important public health problem in non-industrialised countries. The limited evidence suggests ethnic inequalities in BP in adults in some non-industrialised countries. However, it is unclear whether these ethnic inequalities in BP patterns in adults reflect on adolescents. Hence, we assessed ethnic differences in BP, and the association of BP with body mass index (BMI) among adolescents aged 12-17 years in Paramaribo, Suriname.

METHODS

Cross-sectional study with anthropometric and blood pressure measurements. A random sample of 855 adolescents (167 Hindustanis, 169 Creoles, 128 Javanese, 91 Maroons and 300 mixed-ethnicities) were studied. Ethnicity was based on self-reported ethnic origin.

RESULTS

Among boys, Maroons had a lower age- and height-adjusted systolic BP than Creoles, and a lower diastolic BP than other ethnic groups. However, after further adjustment for BMI, only diastolic BP in Maroons was significantly lower than in Javanese (67.1 versus 70.9 mmHg). Creole boys had a lower diastolic BP than Hindustani (67.3 versus 70.2 mmHg) and Javanese boys after adjustment for age, height and BMI. Among girls, there were no significant differences in systolic BP between the ethnic groups. Maroon girls, however, had a lower diastolic BP (65.6 mmHg) than Hindustani (69.1 mmHg), Javanese (71.2 mmHg) and Mixed-ethnic (68.3 mmHg) girls, but only after differences in BMI had been adjusted for. Javanese had a higher diastolic BP than Creoles (71.2 versus 66.8 mmHg) and Mixed-ethnicity girls. BMI was positively associated with BP in all the ethnic groups, except for diastolic BP in Maroon girls.

CONCLUSION

The study findings indicate higher mean BP levels among Javanese and Hindustani adolescents compared with their African descent peers. These findings contrast the relatively low BP reported in Javanese and Hindustani adult populations in Suriname and underscore the need for public health measures early in life to prevent high BP and its sequelae in later life.

Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis

BACKGROUND

A large number of studies have examined the tracking of blood pressure (BP) from childhood to adulthood, but the reported findings are inconsistent and few systematic analyses have been conducted.

METHODS AND RESULTS

We conducted a systematic search of PubMed for studies that examined the tracking of BP from childhood to adulthood published between January 1970 and July 2006. From 301 retrieved papers, 50 cohort studies met our inclusion criteria and provided 617 data points (Pearson/Spearman correlation coefficients) for systolic BP (SBP) and 547 data points for diastolic BP (DBP) for our meta-analysis. Information on sample characteristics and BP measurement protocols was extracted. Fisher z transformation and random-effects meta-regression analysis were conducted. The reported BP tracking correlation coefficients varied from -0.12 to 0.80 for SBP and from -0.16 to 0.70 for DBP, with an average of 0.38 for SBP and 0.28 for DBP. BP tracking varied significantly by baseline age and length of follow-up. The strength of BP tracking increased with baseline age by 0.012 for SBP (P<0.001) and 0.009 for DBP (P<0.001) and decreased with follow-up length by 0.008 for SBP (P<0.001) and 0.005 for DBP (P<0.001). BP tracking did not vary markedly across the number of BP measurements or race/population groups.

CONCLUSIONS

Data from diverse populations show that the evidence for BP tracking from childhood into adulthood is strong. Childhood BP is associated with BP in later life, and early intervention is important.

Action Schools! BC: a school-based physical activity intervention designed to decrease cardiovascular disease risk factors in children

OBJECTIVE

Our primary objective was to determine whether a novel 'active school' model--Action Schools! BC--improved the cardiovascular disease (CVD) risk profile in elementary-school children. Our secondary objective was to determine the percentage of children with elevated CVD risk factors.

METHODS

We undertook a cluster-randomized controlled school-based trial with 8 elementary schools across 1 school year, in British Columbia, Canada, beginning in 2003. Boys and girls (n=268, age 9-11 years) were randomly assigned (by school) to usual practice (UP, 2 schools) or intervention (INT, 6 schools) groups. We assessed change between groups in cardiovascular fitness (20-m Shuttle Run), blood pressure (BP), and body mass index (BMI, wt/ht(2)). We evaluated total cholesterol (TC), total:high-density cholesterol (TC:HDL-C), low-density lipoprotein, apolipoprotein B, C-reactive protein and fibrinogen on a subset of volunteers (n=77).

RESULTS

INT children had a 20% greater increase in fitness and a 5.7% smaller increase in BP compared with children attending UP schools (P<0.05). Forty five percent of children had at least one elevated risk factor (fitness, BP or BMI) at baseline. There were no significant differences between groups for change in BMI or in any of the blood variables.

CONCLUSION

Action Schools! BC was an effective school-based physical activity model for improving the CVD risk profile of elementary-school children. Our multi-component intervention exposed children to fitness enhancing physical activity. It may be important for education stakeholders to adequately resource the delivery of the active school models if cardiovascular health benefits are to be achieved on a population basis.

Birth weight, postnatal growth, and risk for high blood pressure at 7 years of age: results from the Collaborative Perinatal Project

OBJECTIVE

A physiologic predisposition toward hypertension is theorized to result from the combination of intrauterine growth restriction followed by rapid catch-up growth. The objective of this study was to evaluate the effects of birth weight and weight gain during childhood on the risk for high blood pressure in childhood and to identify discrete periods of catch-up growth that put children with intrauterine growth restriction at increased risk for the development of high blood pressure later in life.

METHODS

The US Collaborative Perinatal Project (1959-1974) studied 55,908 pregnancies in an observational cohort at 12 medical centers in the United States and followed the offspring through 7 years of age. All white or black children who were born at term and completed the follow-up without kidney or heart disease were included in this posthoc analysis. z scores were calculated for weight at birth, 4 months, 1 year, 4 years, and 7 years on the basis of study means and SD. Changes in z scores were calculated for each interval.

RESULTS

Each 1-kg increase in birth weight increased the odds for high systolic blood pressure by 2.19 and high diastolic blood pressure by 1.82 when race and change in weight z scores were also included in the regression model. An increase in weight z score of 1 SD above the previous weight z score increased the odds for high systolic blood pressure at 7 years by 1.65 (birth to 4 months), 1.79 (4 months to 1 year), 1.71 (1-4 years), and 1.94 (4-7 years) in the full model. White race increased the odds for high systolic blood pressure by 1.51.

CONCLUSIONS

In this large biracial US cohort, infants who were small for gestational age were not at increased risk for high blood pressure at 7 years of age. However, children who crossed weight percentiles upward during early childhood did demonstrate an increased risk.

Racial disparities in the association between birth weight in the term infant and blood pressure at age 7 years: results from the collaborative perinatal project

BP has been inversely associated with birth weight in studies worldwide, but few studies have included black individuals. The US National Collaborative Perinatal Project followed 58,960 pregnant women and their resultant offspring for 7 yr. In this post hoc analysis, all term white or black children without kidney or heart disease were included (n = 29,710). The effect of birth weight and other risk factors on systolic (SBP) and diastolic BP (DBP) was evaluated at 7 yr. Mean birth weight and body mass index at 7 yr were slightly lower for black compared with white children (birth weight 3.14 +/- 0.48 versus 3.32 +/- 0.46 kg [P < 0.001]; body mass index 15.8 +/- 2.0 versus 16.3 +/- 2.0 [P < 0.001]). Compared with white mothers, black mothers were less likely to smoke (41 versus 52%), were more anemic (23 versus 7%), and were more likely to live in poverty (72 versus 39%). In linear regression, there was significant interaction between race and birth weight in predicting SBP (P = 0.002). In bivariate analysis, birth weight was positively associated with SBP (beta = 0.87) and DBP (beta = 1.14) in black children (P < 0.001) but not associated with either in white children. With maternal poverty, educational level, and anemia during pregnancy added to the model, birth weight remained a significant positive predictor of SBP (beta = 0.89, P < 0.001) in black but not in white children (beta = 0.02, P = 0.17). The association between birth weight and SBP differs between black and white children. The cause of intrauterine growth restriction-associated hypertension seems to be race sensitive; therefore, future studies of racial disparities in the "Barker hypothesis" may help in the understanding of the mechanism of fetal programming of hypertension.

The association between intrauterine growth restriction in the full-term infant and high blood pressure at age 7 years: results from the Collaborative Perinatal Project

OBJECTIVE

To use neonatal and placental anthropometry as proxy measures of intrauterine growth restriction (IUGR) and to relate these to blood pressure later in childhood.

STUDY DESIGN

A post hoc analysis of full-term white and black children from the Collaborative Perinatal Project, followed from birth until age 7 years (n = 29,710). Blood pressure above the 90th percentile by gender and race was considered high blood pressure. Anthropometric measures at birth included birth weight, ponderal index (PI, birth weight/birth length(3)), head to chest circumference (HCC) ratio, and placental ratio percentage (PRP, placental weight(*)100/birth weight).

RESULTS

Among anthropometric measures, PI, HCC, and birth weight were not associated with high systolic blood pressure at age 7 years, but PRP was. In multiple logistic regression, high systolic blood pressure and widened pulse pressure were both predicted by increased PRP [odds ratio (OR) 1.03 and 1.04, P < 0.001] but not by birth weight, when adjusted for gender, race, and maternal education. High diastolic blood pressure was weakly predicted by birth weight (OR 1.10, P = 0.05) but not by PRP.

CONCLUSIONS

PRP is associated with an increased risk for high systolic blood pressure and pulse pressure later in childhood, whereas birth weight, PI, and HCC are not. The proportion of placental weight to birth weight is a useful marker of IUGR for studying the developmental origins of adult disease hypothesis.

Children in South Asia Have Higher Body Mass–Adjusted Blood Pressure Levels Than White Children in the United States

BACKGROUND

Blood pressure during childhood is an established predictor of adult blood pressure, which in turn increases mortality as a result of cardiovascular disease. Adult South Asian populations are particularly predisposed to cardiovascular disease compared with whites, but the prevalence of high blood pressure and determinants of blood pressure in South Asian children have not been explored or compared with those of white children.

METHODS AND RESULTS

Analyses were performed on 5641 South Asian children 5 to 14 years old included in the nationally representative National Health Survey of Pakistan (NHSP) (1990-1994) and on 4756 white children 5 to 14 years old included in Third National Health and Nutrition Examination Survey (NHANES III) (1988-1994). Anthropometric measurements were obtained. Blood pressure was measured twice in the seated position with a mercury sphygmomanometer and an appropriate-size cuff. High blood pressure was defined as a systolic or diastolic blood pressure level that was > or =95th percentile of age-, sex-, and height-percentile-specific reference level for the US population. Mean body mass index (BMI)-adjusted blood pressure values were compared among children in 2 data sets by use of linear regression analysis. The overall prevalence (95% CI) of high blood pressure in South Asian children 5 to 14 years old was 12.2% (11.3% to 13.1%): 15.8% (14.5% to 17.1%) in boys and 8.7% (7.6% to 9.8%) in girls. This is in sharp contrast with the predicted 5% prevalence of high blood pressure in children in the United States (P<0.001). The mean BMI-adjusted systolic blood pressure levels (SD) were 100 (11) versus 99 (11) mm Hg (P<0.001), and diastolic blood pressure levels (SD) were 63 (10) versus 52 (12) mm Hg (P<0.001) in NHSP versus NHANES III, respectively.

CONCLUSIONS

South Asian children have higher body-mass-adjusted blood pressure levels than white children in the United States. Further studies are needed to determine factors responsible for these differences. Immediate attention is needed to address high blood pressure and its risk factors in native South Asian children.