The Childhood Role in Development of Primary Hypertension

Non-linear relationship between sleep duration and blood pressure in children with short stature

Background

Evidence regarding the relationship between sleep duration and blood pressure is controversial. Therefore, the aim of this study was to investigate the relationship between sleep duration and blood pressure in children with short stature.

Methods

A total of 1,085 participants with short stature were enrolled from the Affiliated Hospital of Jining Medical University in China. The variables involved in this study included sleep duration, anthropometric indicators and biochemical parameters. Sleep duration was evaluated in a face-to-face interview.

Results

The average age of the 1,085 selected participants was 10.2 ± 3.5 years old, and approximately 763 (70.32%) of them were male. The results of adjusted linear regression showed that sleep duration was negatively associated with systolic blood pressure z scores (SBP-Z) and diastolic blood pressure z scores (DBP-Z) after adjusting for confounders (β -0.07, 95% CI -0.13, -0.01 P = 0.038; β -0.05, 95% CI -0.10, -0.01 P = 0.035, respectively). A nonlinear relationship was detected between sleep duration and blood pressure, including SBP-Z, DBP-Z and mean arterial pressure z scores (MAP-Z). The inflection point of the nonlinear relationship between sleep duration and SBP-Z is 10 h, and the inflection point of DBP-Z and MAP-Z is 8 h.

Conclusion

This study revealed a nonlinear relationship between sleep duration and blood pressure in children with short stature. The findings suggest that the optimal sleep duration in children with short stature was 8-10 h, and sleep durations either too short or too long were associated with increased blood pressure levels.

Prevalence and determinants of primary hypertension in urban and rural children from six Indian states: A multicenter study

OBJECTIVES

Among urban and rural Indian children ages 9 to 18 y, we aimed to assess the prevalence and determinants of primary hypertension (PH), and explore the relationship of fat indices and body composition with hypertension.

METHODS

Data from a multicenter study (2016-2017), representative of children (age 9-18 y) from six states were analyzed (n = 1818; urban n = 895). All anthropometric parameters (Z-scores), blood pressure (BP), body composition, and resting metabolic rate (RMR) were measured. Information from a 2-d 24-h diet recall was collected, nutrient and food group intakes were calculated, and physical activity (PA) was assessed. Children were categorized as normotensive or pre-/hypertensive (>90th percentile), and a regression analysis was carried out for determinants.

RESULTS

Urban children were significantly taller, heavier, more overweight or obese (25% vs. 11%), pre-/hypertensive (18% vs. 10%), adipose, and had lower RMR/weight than rural children. All hypertensive children had higher fat indices, lower muscle mass, and RMR/weight than those who were normotensive (P < 0.05). Rural hypertensive children consumed more junk food, simple carbohydrate (CHO), fat, and sodium than those who were normotensive. RMR (R2 = 33%) was found to be an important predictor of BP in rural children and body mass index (R2 = 46%) in urban children, followed by central and peripheral obesity, PA, and diet.

CONCLUSIONS

Our study highlights that rural children are also at risk of developing PH, especially those with a higher intake of junk food and carbohydrate. Another interesting finding was the negative association of PH with RMR/weight, increasing PA, as well as a micronutrient-rich diet with calcium and magnesium vital to prevent PH. Health care policies need to focus on the increasing prevalence of obesity and PH, not only in urban, but also rural children where different strategies may have to be applied.

Associations of self-reported residential noise exposure with obesity and hypertension in children and adolescents

BACKGROUND

Epidemiologic evidence linking environmental noise to obesity and hypertension remains scarce, especially in children, and the results remain inconclusive. This study aims to examine the cross-sectional associations of self-reported residential noise exposure with obesity and hypertension in children and adolescents.

METHODS

As an ongoing study, a representative sample of the children aged 6-9 years in Chongqing were selected in 2014. In 2019, self-reported residential noise (answer categories: "very quiet," "moderately quiet," "slightly quiet," and "not at all quiet") data were collected, and 3,412 participants with completed data were included in the analyses.

RESULTS

Participants living in a quieter area had a significantly lower risk of obesity than those living in a noisy area (very quiet: OR = 0.50, 95%CI: 0.29-0.88, P = 0.015; moderately quiet: OR = 0.61, 95%CI: 0.36-1.02, P = 0.059). Similar associations were observed for abdominal obesity, although did not reach statistical significance. Consistently, residential noise exposure was significantly associated with body mass index (BMI) and waist-to-height ratio. Self-reported residential noise exposure was positively associated with systolic blood pressure (β = -1.808; 95%CI = -3.495, -0.110; P = 0.037). When sleep quality, study stress, BMI, and vegetable/fruits consumption were further adjusted, all effect estimates decreased, and no statistical association was observed between noise exposure and blood pressure. Furthermore, we found that the mediating effects of obesity on the associations of self-reported residential noise exposure with hypertension were 6.8% (% of total effect mediated = 0.068, 95%CI: -2.58, 3.99), although did not reach statistical significance.

CONCLUSIONS

Self-reported residential noise exposure was associated with a higher risk of obesity or abdominal obesity. Also, self-reported residential noise exposure was positively associated with hypertension, and obesity may partially mediate this association, but did not reach statistical significance.

Antihypertensive Effects of IGTGIPGIW Peptide Purified from Hippocampus abdominalis: p-eNOS and p-AKT Stimulation in EA.hy926 Cells and Lowering of Blood Pressure in SHR Model

The aim of this study was to assess the potential hypertensive effects of the IGTGIPGIW peptide purified from Hippocampus abdominalis alcalase hydrolysate (HA) for application in the functional food industry. We investigated the antihypertensive effects of IGTGIPGIW in vitro by assessing nitric oxide production in EA.hy926 endothelial cells, which is a major factor affecting vasorelaxation. The potential vasorelaxation effect was evaluated using 4-amino-5-methylamino-2′,7′-difluorofluorescein diacetate, a fluorescent stain. IGTGIPGIW significantly increased the expression of endothelial-derived relaxing factors, including endothelial nitric oxide synthase and protein kinase B, in EA.hy926 cells. Furthermore, oral administration of IGTGIPGIW significantly lowered the systolic blood pressure (183.60 ± 1.34 mmHg) and rapidly recovered the diastolic blood pressure (143.50 ± 5.55 mmHg) in the spontaneously hypertensive rat model in vivo. Our results demonstrate the antihypertensive activity of the IGTGIPGIW peptide purified from H. abdominalis and indicate its suitability for application in the functional food industry.

Increased Physical Activity at School Benefits Arterial Blood Pressure in Children-A Prospective Follow-Up Cohort Study

(1) Background: A sedentary lifestyle and low physical activity (PA) increase the risk of hypertension in children. The aim of this study was to assess the impact of increased PA at school by elevation of the number of compulsory physical education (PE) lessons on arterial blood pressure in children during a two-year follow-up. (2) Methods: Children (n = 245) born in 2007 attending a standard or elevated number of PE lessons in the school timetable (4 and 10 h a week, respectively) took part in the study. Blood pressure was measured starting from age approx. 10 to 12. (3) Results: Starting from a similar level, after 2 years, the percentage of children with normal blood pressure decreased in the standard-PE children from 83.25% to 78.03% but increased in the elevated-PE ones from 83.15% to 86.13%. The prevalence of both prehypertension and hypertension increased by one-third in the standard-PE children from 16.74% to 21.97% but decreased by one-sixth in the elevated-PE ones from 16.85% to 13.87%. The prevalence of hypertension itself increased by one-third in the standard-PE children from 9.82% to 13.12% but decreased in the elevated-PE ones by one-fifth from 9.60% to 7.75% (4) Conclusions: An increase in PA at school by the elevation of the number of PE lessons benefits children's arterial blood pressure. Early prevention of hypertension in children can be supported by an adequate number of PE lessons in the school timetable.

Determinantes antropométricos da pressão arterial elevada em escolares do ensino fundamental

Introdução: A hipertensão arterial infantil vem recebendo atenção especial dos pediatras, pois o aumento da pressão arterial na infância contribui para o início precoce da hipertensão arterial essencial na idade adulta e para a mortalidade por doenças cardiovasculares. As medidas antropométricas têm sido úteis para o diagnóstico de sobrepeso e obesidade na infância, e tais condições são consideradas de risco para hipertensão arterial na idade adulta. Quanto mais precoce a identificação desses fatores de risco, seja no ambiente escolar, seja nos serviços de saúde, mais ações preventivas poderão ser desenvolvidas para minimizar tal problemática. Objetivo: Identificar a incidência de pressão arterial elevada e sua associação com medidas antropométricas em escolares do ensino fundamental. Métodos: Estudo longitudinal com 1.116 escolares; destes, 133 participaram de três avaliações no período de 2017 a 2019. As informações demográficas, as medidas antropométricas (peso, altura, circunferência abdominal, índice de massa corporal) e as pressóricas (sistólica e diastólica ajustadas de acordo com os parâmetros do Centro de Controle e Prevenção de Doenças para sexo e idade) foram registradas em formulário. A associação das variáveis com a pressão arterial elevada foi analisada por meio da regressão de Poisson, com ajuste robusto da variância. Resultados: Dos estudantes, 51,6% eram meninos com, em média, 7,9 anos, e 45,4% tinham pressão arterial elevada conforme os critérios do Centro de Controle e Prevenção de Doenças. Entre os que apresentaram circunferência abdominal elevada, 19,4% evoluíram de pressão sistólica normal para elevada e 35,5% de pressão diastólica normal para elevada ao longo dos três anos de acompanhamento. Nos escolares com sobrepeso ou obesidade, a pressão sistólica normal evoluiu para elevada em 20,7 e 21,2%, respectivamente, e a pressão diastólica normal evoluiu para elevada em 24,1 e 42,4%, respectivamente. Os escolares com circunferência abdominal (risco relativo – RR 1,51; intervalo de confiança – IC95% 1,20–1,91; RR 1,58; IC95% 1,25–2,00), peso (RR 1,37; IC95% 1,08–1,74; RR 1,34; IC95% 1,05–1,71) e índice de massa corporal elevado (RR 1,51; IC95% 1,21–1,87; RR 1,50; IC95% 1,20–1,88) apresentaram maior risco para hipertensão sistólica e diastólica, respectivamente. Conclusão: A circunferência abdominal, o peso e o índice de massa corporal estiveram associados com o aumento da pressão arterial sistólica e diastólica nos escolares, e o risco foi maior entre os que tinham circunferência abdominal aumentada.

The pressure's on: understanding neurocognitive and psychological associations with pediatric hypertension to inform comprehensive care

The prevalence of hypertension is increasing in pediatric populations. While clinical data and practice guidelines identify the impact of hypertension on organ dysfunction and emphasize the importance for end-organ damage screening, the bidirectional effects of pediatric hypertension on neurocognitive and psychological outcomes are understudied. The objective of this review is to highlight the association between hypertension and cognition, attention, learning, and mental health in children and adolescents. In doing so, this review provides a framework and toolkit to integrate neuropsychology and psychology into the screening and management stages of pediatric hypertension. By recognizing the effects of hypertension on cognition, behavior, and mental health, screenings and interventions can be implemented to proactively and comprehensively improve the health outcomes for children with blood pressure concerns.

Effect of fat mass index, fat free mass index and body mass index on childhood blood pressure: a cross-sectional study in south China

BACKGROUND

Evidence on how different body composition indexes, such as body mass index (BMI), fat mass index (FMI) and fat free mass index (FFMI), influence blood pressure (BP) in Chinese children and adolescents is sparse. The aim of this study is to assess the effect of different body composition on BP in participants aged 7-18 in south China.

METHODS

A cross-sectional study was conducted in 2013. A total of 1,609 children and adolescents from urban and rural areas in Hainan Province, South China, were selected using multi-stage stratified cluster sampling method. Each participant underwent anthropometric and BP tests. BMI, FMI and FFMI were calculated and analyzed as body composition indexes.

RESULTS

In the population level stratified by sex, FFMI had the highest r-value (Partial Spearman correlations) of correlation with systolic BP in boys (r_s=0.305, P<0.001) and girls (r_s=0.237, P<0.001). FMI was found to have the highest r-value of correlation with DBP in boys (r_s=0.154, P<0.001). The quantile regression model indicated that, within each age group, all body composition indexes was positively associated with systolic BP, and FFMI has the greatest value of regression coefficient (4.38, 95% CI: 3.81-4.95). But for diastolic BP, positive associations with BMI, FMI and FFMI were only observed in the 11-12 years group. Restrict cubic spline models showed that there were both linear and non-linear relations between BMI, FMI and BP, but for FFMI, there was only linear association with BP.

CONCLUSIONS

The relation between BP and FFMI was stronger than with BMI and FMI. Combined measurement of body composition should be considered to help health professionals interpret body mass data from children and adolescents with varied stature and age.

High prevalence of systemic hypertension in pediatric patients with moyamoya disease years after surgical treatment

OBJECTIVE

Although an association between moyamoya disease (MMD) and renovascular hypertension has been acknowledged, the literature on systemic hypertension without renal artery stenosis among patients with MMD is scarce. The authors aimed to evaluate the prevalence and risk factors of hypertension using data from MMD patients who visited an outpatient clinic of a pediatric neurosurgical department in 2016.

METHODS

The authors evaluated the blood pressure (BP) of pediatric MMD patients at their postsurgical appointment following the American Academy of Pediatrics clinical practice guideline on high BP, in which hypertension was defined as BP measurements higher than the value of age-, sex-, and height-specific 95th percentile of the general population from at least 3 separate visits. Growth of patients was determined using 2017 Korean National Growth Charts for children and adolescents. The cutoff value of the 95th percentile of BP was determined by referring to normative BP tables of Korean children and adolescents. A logistic regression model was used to assess the associations between patients' clinical characteristics and prevalent hypertension.

RESULTS

In total, 131 surgically treated pediatric MMD patients were included, of whom 38.9% were male and the median age at diagnosis was 8.0 years (range 1.2-15.0 years). The definition of hypertension was met in 38 patients, with a prevalence of 29.0% (95% CI 21.2%-36.8%). A tendency was observed for a higher prevalence of hypertension in male patients (31.4%), in patients with posterior cerebral artery (PCA) involvement (47.8%), and in cases in which infarction was shown on initial MRI (37.3%). Age at diagnosis (adjusted OR [aOR] 0.82, 95% CI 0.70-0.97), PCA involvement (aOR 3.81, 95% CI 1.29-11.23), body mass index (aOR 1.30, 95% CI 1.13-1.51), and years of follow-up since surgery (aOR 0.80, 95% CI 0.68-0.94) were related to systemic hypertension.

CONCLUSIONS

A high prevalence of hypertension was demonstrated in pediatric MMD patients. Therefore, adequate attention should be paid to reduce BP and prevent subsequent events.

Dairy Consumption in Relation to Hypertension Among a Large Population of University Students: The MEPHASOUS Study

BACKGROUND

Hypertension is a chronic condition that its prevalence is increasing at an alarming rate. Findings on the association between dairy consumption and hypertension are conflicting and few data are available in the Middle East.

AIM

To assess the association between dairy consumption and hypertension among a large population of university students.

MATERIALS AND METHODS

The current study was performed in the framework of the Mental and Physical Health Assessment of University Student (MEPHASOUS) project. Overall, 67,011 university students with complete information were included in the statistical analysis. To assess dairy consumption, a self-administered dietary habits questionnaire was employed. Blood pressure was measured using a standard protocol. The systolic/diastolic blood pressure of ≥140/90 mmHg was considered hypertension.

RESULTS

Hypertension was prevalent among 6.9% of students. A significant inverse association was found between dairy consumption and the odds of hypertension; such that after taking potential confounders into account, individuals in the highest levels of dairy consumption had 85% lower odds for having hypertension compared with those in the lowest levels (odds ratio (OR): 0.15, 95% confidence interval (CI): 0.13-0.18). Such an inverse association was also seen among males (OR: 0.14, 95% CI: 0.11-0.18) and females (OR: 0.16, 95% CI: 0.12-0.21), normal-weight students (OR: 0.15, 95% CI: 0.12-0.18) and those with overweight or obesity (OR: 0.15, 95% CI: 0.11-0.21), and individuals with (OR: 0.13, 95% CI: 0.11-0.16) and without (OR: 0.24, 95% CI: 0.17-0.35) family history of hypertension.

CONCLUSION

Our results support the previous findings on the inverse association between dairy consumption and hypertension among university students.

Sleep duration and blood pressure in children: Analysis of the pan-European IDEFICS cohort

The present study aims to examine the cross-sectional and longitudinal association between self-reported nocturnal sleep duration, blood pressure, and hypertension in European children, aged 2-9.9 years, participating in the IDEFICS project. Blood pressure (BP) and the main anthropometric indices were measured according to standardized procedures. Childhood elevated BP and hypertension were defined according to the European Society of Hypertension Guidelines for children and adolescents. Parents reported lifestyle and socio-demographic data. Nocturnal sleep duration was assessed as part of a parental 24-h recall and categorized as follows: (a) ≤9 hours/night; (b) >9 hours to ≤10 hours/night; (c) >10 hours to ≤11 hours/night; and (d) >11 hours/night. A complete set of variables included in the present analysis was provided by 7974 participants (boys/girls = 4049/3925) at the baseline survey (T0). Of them, 5656 were re-examined 2 years later at follow-up (T1). Children reporting shorter sleep duration at T0 had significantly higher BP values (P for trend < 0.001) compared to those who slept more. Prospective analyses showed that shorter sleep duration at baseline predicted, over the 2-year follow-up, higher increases in systolic blood pressure and diastolic blood pressure, after adjustment for age, sex, country of origin, BMI z-score, parental education, physical activity, screen time, and T0 value of the examined outcome variables (P for trend < 0.001). Our findings reveal that shorter sleep duration is associated with higher BP in childhood, suggesting that sleep may be a potential risk factor for hypertension later in life.

Body Composition and Serum Total Calcium Were Associated With Blood Pressure Among Children and Adolescents Aged 7-18 in China: A Cross-Sectional Study

Background: This study aimed to assess the prevalence of childhood pre-hypertension and hypertension (elevated blood pressure, EBP) and explore their risk factors, especially the role of body composition and serum total calcium on EBP. Methods: From Nov 2013 to Jul 2014, a cross-sectional study was conducted in Hainan and Shaanxi Provinces in China. Two thousand two hundred eighty-three children and adolescents aged 7-18 underwent anthropometric and blood pressure measurements. Fasting blood was collected and serum total calcium was tested. Blood pressure standards from the updated Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents were used to classify BP groups based on age, sex and stature. Results: The overall prevalence of pre-hypertension and hypertension were 8.36 and 7.06%, respectively. Boys, older age, living in Hainan Province, excess adiposity and higher level of serum total calcium were found to be associated with EBP. Lean subjects had an average 3.87 mmHg decrease in systolic blood pressure (SBP) than normal weight groups. In contrary, overweight/obesity had increased SBP (3.69 mmHg) and diastolic blood pressure (DBP) (2.58 mmHg) than the normal weight group. Participants with high-level serum total calcium had a 1.60 mmHg increased SBP and 1.77 mmHg increased DBP than the low-level group. Compared with normal weight individuals, lean subjects appeared to have decreased odds of EBP (OR = 0.65, 95% CI: 0.43-0.98) but overweight/obese individuals were more likely to have EBP (OR = 2.67, 95% CI: 1.68-4.25). High-level of serum total calcium was associated with increased odds of EBP, the OR (95% CI) was 1.51 (1.17-1.94). The restrict cubic spline presented a linear relationship between serum total calcium and OR of EBP (P < 0.001). Conclusions: Body composition and serum total calcium were positively associated with blood pressure in children and adolescents. Serum calcium could be considered as an untraditional risk factors for high blood pressure screening along with other body composition indexes in clinical settings.