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Prentice A, Jarjou LM, Goldberg GR, Schoenbuchner SM, Moore SE, Ward KA, Cole TJ. Effects of maternal calcium supplementation on offspring blood pressure and growth in childhood and adolescence in a population with a low-calcium intake: follow-up study of a randomized controlled trial. Am J Clin Nutr 2024; 119:1443-1454. [PMID: 38839195 DOI: 10.1016/j.ajcnut.2024.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The World Health Organization recommends calcium supplementation (1500-2000 mg/d) during pregnancy for women with a low-calcium intake. OBJECTIVES The purpose of this study was to investigate whether pregnancy calcium supplementation affects offspring blood pressure and growth in The Gambia where calcium intakes are low (300-400 mg/d). METHODS Follow-up of offspring born during a randomized controlled trial of pregnancy calcium supplementation (ISRCTN96502494, 1996-2000) in which mothers were randomly assigned to 1500 mg Ca/d (Ca) or placebo (P) from 20 wk pregnancy to delivery. Offspring were enrolled at age 3 y in studies where blood pressure and anthropometry were measured under standardized conditions at approximately 2-yearly intervals. Mean blood pressure and growth curves were fitted for females and males separately, using the longitudinal SuperImposition by Translation and Rotation (SITAR) mixed effects model. This generates 3 individual-specific random effects: size, timing, and intensity, reflecting differences in size, age at peak velocity, and peak velocity through puberty relative to the mean curve, respectively. RESULTS Five hundred twenty-three singleton infants were born during the trial (maternal group assignment: Ca/P = 259/264). Four hundred ninety-one were enrolled as children (females: F-Ca/F-P = 122/129 and males: M-Ca/M-P = 119/121) and measured regularly from 3.0 y to mean age 18.4 y; 90% were measured on ≥8 occasions. SITAR revealed differences in the systolic blood pressure and height curves between pregnancy supplement groups in females, but not in males. F-Ca had lower systolic blood pressure than F-P at all ages (size = -2.1 ± SE 0.8 mmHg; P = 0.005) and lower peak height velocity (intensity = -2.9 ± SE 1.1%, P = 0.009). No significant pregnancy supplement effects were seen for other measures. CONCLUSIONS This study showed, in female offspring, that pregnancy calcium supplementation may lower systolic blood pressure and slow linear growth in childhood and adolescence, adding to evidence of offspring sexual dimorphism in responses to maternal supplementation. Further research is warranted on the long-term and intergenerational effects of antenatal supplementations. This trial was registered at ISRCTN Registry as ISRCTN96502494.
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Affiliation(s)
- Ann Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia; MRC Nutrition and Bone Health Research Group, Cambridge, United Kingdom; MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
| | - Landing Ma Jarjou
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia
| | - Gail R Goldberg
- MRC Nutrition and Bone Health Research Group, Cambridge, United Kingdom
| | - Simon M Schoenbuchner
- MRC Nutrition and Bone Health Research Group, Cambridge, United Kingdom; Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Sophie E Moore
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia; Department of Women and Children's Health, Kings College London, London, United Kingdom
| | - Kate A Ward
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Tim J Cole
- Department of Population, Policy and Practice Research and Teaching, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Addo J, Davy M, Newlands A, Orford L, Guta P, Scott R, van Hasselt J, Maher-Edwards G. The Africa non-communicable diseases (NCD) Open Lab: Impact of a portfolio of clinical studies to deepen the understanding of NCDs in sub-Saharan Africa. J Glob Health 2024; 14:04065. [PMID: 38695258 PMCID: PMC11063967 DOI: 10.7189/jogh.14.04065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Background Clinical research in sub-Saharan Africa (SSA) has often focussed on communicable diseases. However, with the increasing burden of non-communicable diseases (NCDs), there is a need for Africa-specific NCD research. Methods GSK established the Africa NCD Open Lab in 2014. Three calls for proposals were advertised through various media channels. An external independent scientific advisory board, predominantly representing African scientists and NCD experts, reviewed and selected projects to receive funding. An additional programme in the Africa NCD Open Lab was designed to build statistical capability by supporting training initiatives. We assessed the impact of the Africa NCD Open Lab in three ways: scientific quality with impact; research training and professional development; and research environments. We captured metrics through regular reports/interactions with researchers; via a final report; and through exit interviews with principal investigators. Results Twenty projects in 11 African countries were funded; reports from 18 completed projects are available (data capture is ongoing). Overall, 139 articles have been published in peer-reviewed journals and other data have been presented at conferences and other forums. Most completed projects led to positive outcomes, such as further research, informing policy, or positively impacting clinical care, including three projects that saw changes to regional or national practice guidelines: the CREOLE study in Nigeria; the African Severe Asthma Program in Uganda; and the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension in South Africa. Participation in the Africa NCD Open Lab led to the award of 34 grants related to or influenced by increased research capacity or experience. Significant professional development related to the projects also occurred with higher-level degrees being awarded, including 30 MScs, 30 PhDs, and nine postdoctoral fellowships. Through these projects, research capacity was strengthened across the region by equipping core research facilities, training research staff, strengthening research support services, and supporting the expansion of investigator networks. Conclusions The completed Africa NCD Open Lab projects demonstrate high-quality research outcomes addressing important health challenges with potential benefits to African populations. Based on the success of the Africa NCD Open Lab, additional funding has been secured to extend the Open Lab initiative.
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Affiliation(s)
| | | | | | | | | | | | - James van Hasselt
- General Medicines Regional Medical Affairs, GSK, Gauteng, South Africa
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Daouda M, Kaali S, Spring E, Mujtaba MN, Jack D, Dwommoh Prah RK, Colicino E, Tawiah T, Gennings C, Osei M, Janevic T, Chillrud SN, Agyei O, Gould CF, Lee AG, Asante KP. Prenatal Household Air Pollution Exposure and Childhood Blood Pressure in Rural Ghana. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:37006. [PMID: 38506828 PMCID: PMC10953816 DOI: 10.1289/ehp13225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 01/18/2024] [Accepted: 02/08/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND The association between prenatal household air pollution (HAP) exposure and childhood blood pressure (BP) is unknown. OBJECTIVE Within the Ghana Randomized Air Pollution and Health Study (GRAPHS) we examined time-varying associations between a) maternal prenatal and b) first-year-of-life HAP exposure with BP at 4 years of age and, separately, whether a stove intervention delivered prenatally and continued through the first year of life could improve BP at 4 years of age. METHODS GRAPHS was a cluster-randomized cookstove intervention trial wherein n = 1,414 pregnant women were randomized to one of two stove interventions: a) a liquefied petroleum gas (LPG) stove or improved biomass stove, or b) control (open fire cooking). Maternal HAP exposure over pregnancy and child HAP exposure over the first year of life was quantified by repeated carbon monoxide (CO) measurements; a subset of women (n = 368 ) also performed one prenatal and one postnatal personal fine particulate matter (PM 2.5 ) measurement. Systolic and diastolic BP (SBP and DBP) were measured in n = 667 4-y-old children along with their PM 2.5 exposure (n = 692 ). We examined the effect of the intervention on resting BP z -scores. We also employed reverse distributed lag models to examine time-varying associations between a) maternal prenatal and b) first-year-of-life HAP exposure and resting BP z -scores. Among those with PM 2.5 measures, we examined associations between PM 2.5 and resting BP z -scores. Sex-specific effects were considered. RESULTS Intention-to-treat analyses identified that DBP z -score at 4 years of age was lower among children born in the LPG arm (LPG β = - 0.20 ; 95% CI: - 0.36 , - 0.03 ) as compared with those in the control arm, and females were most susceptible to the intervention. Higher CO exposure in late gestation was associated with higher SBP and DBP z -score at 4 years of age, whereas higher late-first-year-of-life CO exposure was associated with higher DBP z -score. In the subset with PM 2.5 measurements, higher maternal postnatal PM 2.5 exposure was associated with higher SBP z -scores. DISCUSSION These findings suggest that prenatal and first-year-of-life HAP exposure are associated with child BP and support the need for reductions in exposure to HAP, with interventions such as cleaner cooking beginning in pregnancy. https://doi.org/10.1289/EHP13225.
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Affiliation(s)
- Misbath Daouda
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York, USA
- Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, USA
| | - Seyram Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| | - Emma Spring
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mohammed N. Mujtaba
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| | - Darby Jack
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York, USA
| | - Rebecca Kyerewaa Dwommoh Prah
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Theresa Tawiah
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Musah Osei
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| | - Teresa Janevic
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Steven N. Chillrud
- Lamont-Doherty Earth Observatory of Columbia University, New York, New York, USA
| | - Oscar Agyei
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| | - Carlos F. Gould
- Department of Earth System Science, Stanford University, Stanford, California, USA
| | - Alison G. Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
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Lapidaire W, Proaño A, Blumenberg C, Loret de Mola C, Delgado CA, del Castillo D, Wehrmeister FC, Gonçalves H, Gilman RH, Oberhelman RA, Lewandowski AJ, Wells JCK, Miranda JJ. Effect of preterm birth on growth and blood pressure in adulthood in the Pelotas 1993 cohort. Int J Epidemiol 2023; 52:1870-1877. [PMID: 37354551 PMCID: PMC10749774 DOI: 10.1093/ije/dyad084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 06/01/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Preterm birth has been associated with increased risk of hypertension and cardiovascular disease later in adulthood, attributed to cardiovascular and metabolic alterations in early life. However, there is paucity of evidence from low- and middle-income countries (LMICs). METHODS We investigated the differences between preterm (<37 weeks gestational age) and term-born individuals in birth length and weight as well as adult (18 and 20 years) height, weight and blood pressure in the Brazilian 1993 Pelotas birth cohort using linear regressions. Analyses were adjusted for the maternal weight at the beginning of pregnancy and maternal education and family income at childbirth. Additional models were adjusted for body mass index (BMI) and birthweight. Separate analyses were run for males and females. The complete sample was analysed with an interaction term for sex. RESULTS Of the 3585 babies included at birth, 3010 were followed up in adulthood at 22 years. Preterm participants had lower length and weight at birth. This difference remained for male participants in adulthood, but female participants were no shorter than their term counterparts by 18 years of age. At 22 years, females born preterm had lower blood pressures (systolic blood pressure -1.00 mmHg, 95%CI -2.7, 0.7 mmHg; diastolic blood pressure -1.1 mmHg, 95%CI -2.4, 0.3 mmHg) than females born at term. These differences were not found in male participants. CONCLUSIONS In this Brazilian cohort we found contrasting results regarding the association of preterm birth with blood pressure in young adulthood, which may be unique to an LMIC.
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Affiliation(s)
- Winok Lapidaire
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alvaro Proaño
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cauane Blumenberg
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Causale Consultoria, Pelotas, Brazil
- Grupo de Pesquisa e Inovação em Saúde, Programa de Pós-Graduação em Saúde Pública, FURG, Universidade Federal do Rio Grande (FURG), Rio Grande, RS, Brasil
| | - Christian Loret de Mola
- Grupo de Pesquisa e Inovação em Saúde, Programa de Pós-Graduação em Saúde Pública, FURG, Universidade Federal do Rio Grande (FURG), Rio Grande, RS, Brasil
- Universidad Científica del Sur, Lima, Peru
| | - Carlos A Delgado
- Faculty of Medicine, Department of Pediatrics, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Neonatal Intensive Care Unit, Instituto Nacional de Salud del Niño, Lima, Peru
| | - Darwin del Castillo
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Helen Gonçalves
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Robert H Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Richard A Oberhelman
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jonathan C K Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- George Institute for Global Health, UNSW, Sydney, NSW, Australia
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Nsanya MK, Abramson R, Kisigo GA, Hickner A, Nyanza EC, Peck RN, Kapiga SH. Hypertension among adolescents in sub-Saharan Africa: a systematic review. Front Cardiovasc Med 2023; 10:1251817. [PMID: 38155990 PMCID: PMC10754047 DOI: 10.3389/fcvm.2023.1251817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/18/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Hypertension (HTN) among adolescents is common in high-income countries, and leads to increased premature cardiovascular diseases (CVD). In sub-Saharan Africa (SSA), the prevalence of HTN among adolescents, associated risk factors and CVD complications are not well-described. Such data is needed for planning public health programs to prevent premature CVD in SSA. Methods We systematically searched 5 databases (MEDLINE, Embase, Google Scholar, Web of Science, and African Index Medicus) from their establishment to December 2021. Key search terms were: adolescent, arterial hypertension, and names of the 48 countries in SSA. We used Covidence® to manage the search results. The review was registered in the Open Science Framework (OSF) https://osf.io/p5sbt/. Results We identified 4,008 articles out of which we screened 3,088 abstracts, and reviewed 583 full-text articles. We finally included 92 articles that were published between 1968 to December 2021. The majority were cross-sectional studies (80%) and conducted in school settings (78%). The risk of bias was low for 59 studies (64.1%), moderate for 29 studies (31.5%), and high for 4 studies (4.3%). Overall, the prevalence of HTN varied widely from 0.18% to 34.0% with a median (IQR) of 5.5% (3.1%, 11.1%). It was relatively higher in studies using automated blood pressure (BP) devices, and in studies defining HTN using thresholds based on percentile BP distribution for one's height, age, and sex. In addition, the prevalence of HTN was significantly higher in studies from Southern Africa region of SSA and positively correlated with the year of publication. Across studies, traditional risk factors such as age, sex, body mass index, and physical inactivity, were commonly found to be associated with HTN. In contrast, non-traditional risk factors related to poverty and tropical diseases were rarely assessed. Only three studies investigated the CVD complications related to HTN in the study population. Conclusion The prevalence of HTN among adolescents in SSA is high indicating that this is a major health problem. Data on non-traditional risk factors and complications are scarce. Longitudinal studies are needed to clearly define the rates, causes, and complications of HTN. Systematic Review Registration https://osf.io/p5sbt/, identifier (10.17605/OSF.IO/P5SBT).
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Affiliation(s)
- Mussa K Nsanya
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
| | - Rachel Abramson
- Weill Cornell Medicine - Cornell University, New York, NY, United States
| | - Godfrey A Kisigo
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andy Hickner
- Weill Cornell Medicine - Cornell University, New York, NY, United States
| | - Elias C Nyanza
- Catholic University of Health and Allied Sciences, School of Public Health, Mwanza, Tanzania
| | - Robert N Peck
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- Weill Cornell Medicine - Cornell University, New York, NY, United States
- Catholic University of Health and Allied Sciences, School of Public Health, Mwanza, Tanzania
| | - Saidi H Kapiga
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Kwarteng EA, Shank LM, Faulkner LM, Loch LK, Fatima S, Gupta S, Haynes HE, Ballenger KL, Parker MN, Brady SM, Zenno A, Tanofsky-Kraff M, Yanovski JA. Influence of puberty on relationships between body composition and blood pressure: a cross-sectional study. Pediatr Res 2023:10.1038/s41390-023-02503-7. [PMID: 36750741 PMCID: PMC10403383 DOI: 10.1038/s41390-023-02503-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 01/03/2023] [Accepted: 01/15/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Fat mass (FM) and fat-free mass (FFM) are positively associated with blood pressure (BP) in youth. Yet, how puberty, independent of age, affects these relationships remains unclear. Given puberty may be a crucial period for cardiometabolic health, we examined how pubertal development moderates the associations of FM/FFM with BP. METHODS Pubertal development, resting BP, and body composition were assessed in a convenience sample of youth (5.5-17 years). General linear models were conducted to assess if pubertal development moderated the relationships between FM/FFM and systolic/diastolic BP standardized for age, sex, and height (SBPz/DBPz). RESULTS Among participants (N = 1405; age: M = 13.3 ± 2.9 years; 65.4% female; 53.2% racial/ethnic minority), FM/FFM were positively associated with SBPz and DBPz (ps ≤ 0.02). Pubertal development moderated the associations between FFM and BPz (ps ≤ 0.01), but not FM (ps > 0.43). For early/mid and late pubertal participants, there were positive associations between FFM and BP (DBPz: βs = 0.10-0.18, ps ≤ 0.01; SBPz: βs = 0.33-0.43, ps < 0.001); however, these relationships were attenuated, especially for prepubertal DBPz (DBPz: β = 0.01, p = 0.91; SBPz: β = 0.24, p = 0.001). CONCLUSIONS Puberty moderated the relationships between FFM and SBPz/DBPz in analyses that separately modeled the contributions of age and sex. These data suggest that the FFM-DBPz association may potentially be impacted by increasing sex hormone concentrations during puberty. IMPACT Fat mass (FM) and blood pressure (BP) were positively associated throughout puberty. Fat-free mass (FFM) and BP were positively associated throughout puberty; however, puberty moderated the FFM-BP relationship, such that there was a positive relationship in early/mid and late puberty, but the relationship was attenuated for prepubertal children. These findings contribute further insight into physiological and cardiometabolic changes occurring during puberty. Changes in hormone concentrations may explain the impact puberty has on the FFM-BP relationship. Understanding predictors of BP are important as childhood BP is associated with future cardiometabolic outcomes.
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Affiliation(s)
- Esther A Kwarteng
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Lisa M Shank
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD, USA.,Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, MD, USA.,Metis Foundation, San Antonio, TX, USA
| | - Loie M Faulkner
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Lucy K Loch
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Syeda Fatima
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Suryaa Gupta
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Hannah E Haynes
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA.,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD, USA.,Metis Foundation, San Antonio, TX, USA
| | - Kaitlin L Ballenger
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Megan N Parker
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA.,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD, USA
| | - Sheila M Brady
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Anna Zenno
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA.,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD, USA.,Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, MD, USA
| | - Jack A Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA.
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Abstract
Primary hypertension (PH) is most common during adolescence with increasing prevalence globally, alongside the epidemic of obesity. Unlike in adults, there are no data on children with uncontrolled hypertension and their future risk of hard cardiovascular and cerebrovascular outcomes. However, hypertension in childhood is linked to hypertensive-mediated organ damage (HMOD) which is often reversible if treated appropriately. Despite differing guidelines regarding the threshold for defining hypertension, there is consensus that early recognition and prompt management with lifestyle modification escalating to antihypertensive medication is required to ameliorate adverse outcomes. Unfortunately, many unknowns remain regarding pathophysiology and optimum treatment of childhood hypertension.
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Affiliation(s)
- Emily Haseler
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, 3rd Floor Beckett House, London SE1 7EH, United Kingdom; Kings College London, United Kingdom
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, 3rd Floor Beckett House, London SE1 7EH, United Kingdom; Kings College London, United Kingdom.
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8
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Falkner B. The enigma of primary hypertension in childhood. Front Cardiovasc Med 2022; 9:1033628. [PMID: 36407424 PMCID: PMC9671928 DOI: 10.3389/fcvm.2022.1033628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Beginning in the 1970s, hypertension in children and adolescents has been defined as systolic and/or diastolic blood pressure (BP) that is equal to or greater than the 95th percentile of the normal BP distribution in healthy children. The definition of hypertension in adults is based on longitudinal data that links a BP level with an increased risk for subsequent adverse outcomes related to hypertension including heart failure, kidney failure, stroke, or death. The statistical definition of hypertension continues to be used in childhood because there have been no data that link a BP level in childhood with a heightened risk for adverse outcomes in adulthood. Findings from clinical and epidemiologic research have advanced understanding of high BP in childhood. While hypertension in some children can be secondary to underlying kidney, cardiovascular, or endocrine disorder, it is now known that primary (essential) hypertension can be present in childhood. The prevalence of hypertension in childhood is approximately 2–5% and another 13–18% of children and adolescents have elevated BP and are at heightened risk for developing hypertension. The leading cause of childhood hypertension is primary hypertension, especially in adolescents. For children and adolescents with secondary hypertension, the treatment can focus on managing the underlying cause of hypertension. Less is known about managing primary hypertension in childhood, including diagnosis, evaluation, treatment, and possibilities for prevention. The phenotype of primary hypertension in childhood and recent findings will be discussed.
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Kang KT, Weng WC, Chiu SN, Lee PL, Hsu WC. Office Blood Pressure Monitoring in Children with Obesity and Obstructive Sleep Apnea. J Pediatr 2022; 246:138-144.e2. [PMID: 35314156 DOI: 10.1016/j.jpeds.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the relative contributions of obesity and obstructive sleep apnea (OSA) to unfavorable blood pressure in children. STUDY DESIGN Children aged 3-18 years with OSA-related symptoms were recruited. All children underwent office blood pressure (BP) monitoring and full-night polysomnography. Obesity was defined as a body mass index ≥95th percentile. OSA severity was divided into primary snoring (apnea-hypopnea index [AHI] <1), mild OSA (5> AHI ≥1), and moderate to severe OSA (AHI ≥5). Age- and sex-adjusted logistic regression analysis was performed to determine the associations among OSA, obesity, and elevated BP. RESULTS This cross-sectional study enrolled 1689 children (66% boys), with a mean age of 7.9 years. Compared with children with primary snoring, children with moderate to severe OSA had significantly higher systolic BP (108.1 mmHg vs 105.6 mmHg), diastolic BP (75.0 mmHg vs 70.4 mmHg), systolic BP percentile (75.0 vs 70.4), and diastolic BP percentile (74.0 vs 69.2). The rate of unfavorable BP (ie, elevated BP or hypertension level BP) also was significantly higher in children with more severe OSA. Children with obesity had higher BP and BP percentile. Logistic regression analysis revealed that children with obesity and moderate to severe OSA have a 3-fold greater risk of unfavorable BP compared with children without obesity and primary snoring. CONCLUSIONS We identified a 3-fold greater risk of unfavorable BP in children with obesity and moderate to severe OSA.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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10
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Chu C, Liao YY, He MJ, Ma Q, Zheng WL, Yan Y, Hu JW, Xu XJ, Fan YN, Yang RH, Mu JJ. Blood Pressure Trajectories From Childhood to Youth and Arterial Stiffness in Adulthood: A 30-Year Longitudinal Follow-Up Study. Front Cardiovasc Med 2022; 9:894426. [PMID: 35845038 PMCID: PMC9278647 DOI: 10.3389/fcvm.2022.894426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to identify the subgroups of individuals sharing similar blood pressure (BP) trajectories from childhood to youth and explore the associations of these trajectories with arterial stiffness in adulthood. Methods A group-based trajectory model was used to identify BP trajectories among 2,082 individuals in the Hanzhong adolescent hypertension cohort by using BP values repeatedly measured at four visits from childhood (6–15 years) to youth (14–23 years). The brachial–ankle pulse wave velocity (baPWV) was examined 30 years after the baseline survey. Mixed linear regression models were used to examine the associations of these trajectories with adult baPWV. Results Among the 2,082 individuals, three trajectory groups of systolic BP were identified as follows: the low-level group (n = 889), medium-level group (n = 1,021), and high-level group (n = 172). The baPWV in adulthood was higher in medium-level and high-level groups compared with the low-level group (1271.4 ± 224.7 cm/s, 1366.1 ± 249.8 cm/s vs. 1190.1 ± 220.3 cm/s, all p < 0.001). After adjustment for potential confounding factors, the association between baPWV and systolic BP trajectories was statistically significant (adjusted β = 49.4 cm/s; p < 0.001 for the medium-level group and β = 107.6 cm/s; p < 0.001 for the high-level group compared with the low-level group). Similar results were obtained for the association of baPWV with the trajectories of diastolic BP and mean arterial pressure (MAP), except for pulse pressure. Conclusion Our investigation demonstrates different BP trajectories from childhood to youth and shows the trajectories of systolic BP, diastolic BP, and MAP are significant predictors of arterial stiffness in adulthood.
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Affiliation(s)
- Chao Chu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Yue-yuan Liao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Ming-jun He
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Qiong Ma
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Wen-ling Zheng
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Yu Yan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Jia-wen Hu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Xian-jing Xu
- Department of Cardiovascular Medicine, Henan Province People’s Hospital, Zhengzhou, China
| | - Ya-ning Fan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
| | - Rui-hai Yang
- Institute of Cardiovascular Sciences, Hanzhong People’s Hospital, Hanzhong, China
| | - Jian-jun Mu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi’an, China
- *Correspondence: Jian-jun Mu,
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11
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Falkner B, Lurbe E. Primary Hypertension Beginning in Childhood and Risk for Future Cardiovascular Disease. J Pediatr 2021; 238:16-25. [PMID: 34391765 DOI: 10.1016/j.jpeds.2021.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Bonita Falkner
- Departments of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA.
| | - Empar Lurbe
- Department of Pediatrics, CIBER Fisiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, University of Valencia, Valencia, Spain
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Mallinson PAC, Lieber J, Kinra S. Childhood Socioeconomic Position and Risk of Cardiovascular Disease in Adulthood: Systematic Review of Evidence From Low- and Middle-Income Countries. Am J Prev Med 2021; 61:e251-e266. [PMID: 34272136 DOI: 10.1016/j.amepre.2021.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/06/2021] [Accepted: 04/21/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Socioeconomic disadvantage in childhood is strongly associated with a higher risk of cardiovascular disease in high-income countries. However, the association in low- and middle-income countries, where childhood poverty remains prevalent, has not been reviewed. METHODS The authors systematically searched Embase, MEDLINE, and Global Health databases for articles on the association between childhood socioeconomic position and risk of cardiovascular disease in adulthood in low- and middle-income countries until September 2020. Outcomes included measures of cardiovascular disease, its subclinical markers (e.g., carotid intima-media thickness), and its major risk factors (e.g., hypertension, dyslipidemia, diabetes). Where available, associations were extracted before and after adjustment for socioeconomic position in adulthood. Results were synthesized qualitatively by outcome. The study protocol is registered on PROSPERO (CRD42018086984). RESULTS The search returned 3,568 unique abstracts, from which 29 eligible articles from 14 middle-income countries were identified, representing >150,000 participants. The most commonly reported outcomes were cardiovascular risk factors; very few studies reported prevalent measures of cardiovascular disease, and no studies reported cardiovascular disease incidence or mortality. Of the 46 reported associations between childhood socioeconomic position and risk of cardiovascular disease, 8 were inverse, 0 were positive, and 38 showed no clear evidence of association. All articles had high (16/29) or medium (13/29) risk of bias. CONCLUSIONS Current evidence from middle-income countries provides little support for an association between childhood socioeconomic position and risk of cardiovascular disease, and evidence from low-income countries is lacking. It would be premature to consider childhood poverty as a target for cardiovascular disease prevention in these settings.
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Affiliation(s)
- Poppy Alice Carson Mallinson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Judith Lieber
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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13
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Li Y, Dong Y, Zou Z, Gao D, Wang X, Yang Z, Dong B, Ma J. Association between pubertal development and elevated blood pressure in children. J Clin Hypertens (Greenwich) 2021; 23:1498-1505. [PMID: 34216538 PMCID: PMC8678653 DOI: 10.1111/jch.14315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 11/27/2022]
Abstract
Blood pressure (BP) increased with age and height development, but little was known about the effect of pubertal development on blood pressure in children. A cross‐sectional study was performed among 4146 children aged 7–12 years old in China. Pubertal development was assessed based on breast stages and testicular volume. The associations of pubertal development with BP levels and the rate of elevated blood pressure (EBP) were quantified using multiple linear and logistic regressions. We found that pubertal developmental level was positively correlated with BP, and children who experienced puberty onset and early pubertal timing had higher BP levels and prevalence of EBP. After adjusting for covariates, children experienced puberty onset had 3.84 and 2.24 mmHg increase in systolic blood pressure and diastolic blood pressure, and 70%, 53%, and 62% increased odds of EBP, ESBP, and EDBP, respectively, compared with those without puberty onset. Similar results were observed for children who had early pubertal timing. The change of BP in puberty is greater and the association between pubertal development and BP is stronger in girls than boys. These findings suggested that pubertal development could be an important independent factor and one critical period for the EBP progress. Monitoring and management of pubertal development are necessary particularly among girls.
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Affiliation(s)
- Yanhui Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Di Gao
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Xijie Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Zhaogeng Yang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
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14
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Jiang Y, Dou Y, Chen H, Zhang Y, Chen X, Wang Y, Rodrigues M, Yan W. Performance of waist-to-height ratio as a screening tool for identifying cardiometabolic risk in children: a meta-analysis. Diabetol Metab Syndr 2021; 13:66. [PMID: 34127061 PMCID: PMC8201900 DOI: 10.1186/s13098-021-00688-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/08/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To provide the latest evidence of performance and robustness of waist-to-height ratio (WHtR) in discriminating clusters of cardiometabolic risk factors (CMRs) and promote WHtR in routine primary health care practice in children, a meta-analysis was used. METHODS Searches was performed in eight databases from inception to July 03, 2020. Inclusion criteria were: (1) observational study, (2) children and adolescents, (3) provided WHtR measurements, (4) had CMRs as outcomes, and (5) diagnostic studies. Exclusion criteria were: (1) non-original articles, (2) unable to extract 2 × 2 contingency tables, (3) not in English or Chinese language, (4) populations comprising clinical patients, or (5) duplicate articles. WHtR cutoff points, 2 × 2 contingency tables were extracted from published reports. Outcomes included: CMR clusters of at least three CMRs (CMR3), two (CMR2), one (CMR1), and CMR components. Bivariate mixed-effects models were performed to estimate the summarised area under the curves (AUSROC) with 95% CIs and related indexes. We conducted subgroup analyses by sex and East Asian ethnicity. RESULTS Fifty-three observational studies were included. The AUSROC reached 0.91 (95% CI: 0.88-0.93), 0.85 (95% CI: 0.81, 0.88) and 0.75 (95% CI: 0.71, 0.79) for CMR3, CMR2, and CMR1, respectively. The pooled sensitivity and specificity for CMR3 reached 0.84 and exceeded 0.75 for CMR2. For CMR1, the sensitivity achieved 0.55 with 0.84 for specificity. We had similar findings for our subgroup and sensitivity analyses. CONCLUSIONS WHtR shows good and robust performance in identifying CMRs clustering across racial populations, suggesting its promising utility in public health practice globally.
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Affiliation(s)
- Yuan Jiang
- Department of Clinical Epidemiology and Clinical Trial Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Yalan Dou
- Department of Clinical Epidemiology and Clinical Trial Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
| | - Hongyan Chen
- Department of Clinical Epidemiology and Clinical Trial Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
| | - Yi Zhang
- Department of Clinical Epidemiology and Clinical Trial Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaotian Chen
- Department of Clinical Epidemiology and Clinical Trial Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Yin Wang
- Department of Clinical Epidemiology and Clinical Trial Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Myanca Rodrigues
- Health Research Methodology Graduate Program, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Weili Yan
- Department of Clinical Epidemiology and Clinical Trial Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China.
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China.
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15
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Nsanya MK, Ayieko P, Hashim R, Mgema E, Fitzgerald D, Kapiga S, Peck RN. Sustained high blood pressure and 24-h ambulatory blood pressure monitoring in Tanzanian adolescents. Sci Rep 2021; 11:8397. [PMID: 33864003 PMCID: PMC8052360 DOI: 10.1038/s41598-021-87996-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/30/2021] [Indexed: 12/20/2022] Open
Abstract
Estimates for prevalence of high blood pressure (BP) among adolescents in Africa vary widely and few studies, if any, have documented the results of the recommended stepwise BP screening. In this cross-sectional study in Tanzania, we aimed to estimate prevalence of sustained high BP in 3 public secondary schools using the American Academy of Pediatrics BP screening strategy. On Day 1, one screening automated office BP (AOBP) measurement (Step 1) was followed by two more AOBP measurements (Step 2). Repeat AOBP measurements were obtained after about one month on adolescents with high AOBP measurements on Day 1 (Step 3). Participants with sustained high BP underwent 24-h ambulatory BP monitoring (step 4). Of all 500 enrolled participants, the prevalence of high blood pressure at each step in the process was 36.6% (183), 25.6% (128), 10.2% (51), and 2.6%(13) respectively for Steps 1-4. All except 6 students completed all 4 steps of the BP screening algorithm as indicated. We conclude that diagnosis of hypertension in African adolescents should use multiple AOBP measurements over multiple days followed by 24-h ABPM. Screening for high BP in school settings appears to be feasible and could provide a platform for cardiovascular disease education and health promotion.
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Affiliation(s)
- Mussa K Nsanya
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania.
| | - Philip Ayieko
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ramadhan Hashim
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
| | - Ezekiel Mgema
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
| | | | - Saidi Kapiga
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, UK
| | - Robert N Peck
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- Weill Cornell Medical College, New York, USA
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16
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Allen NB, Khan SS. Blood Pressure Trajectories Across the Life Course. Am J Hypertens 2021; 34:234-241. [PMID: 33821941 DOI: 10.1093/ajh/hpab009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/16/2021] [Indexed: 12/15/2022] Open
Abstract
High blood pressure (BP) is a strong modifiable risk factor for cardiovascular disease (CVD). Longitudinal BP patterns themselves may reflect the burden of risk and vascular damage due to prolonged cumulative exposure to high BP levels. Current studies have begun to characterize BP patterns as a trajectory over an individual's lifetime. These BP trajectories take into account the absolute BP levels as well as the slope of BP changes throughout the lifetime thus incorporating longitudinal BP patterns into a single metric. Methodologic issues that need to be considered when examining BP trajectories include individual-level vs. population-level group-based modeling, use of distinct but complementary BP metrics (systolic, diastolic, mean arterial, mid, and pulse pressure), and potential for measurement errors related to varied settings, devices, and number of readings utilized. There appear to be very specific developmental periods during which divergent BP trajectories may emerge, specifically adolescence, the pregnancy period, and older adulthood. Lifetime BP trajectories are impacted by both individual-level and community-level factors and have been associated with incident hypertension, multimorbidity (CVD, renal disease, cognitive impairment), and overall life expectancy. Key unanswered questions remain around the additive predictive value of BP trajectories, intergenerational contributions to BP patterns (in utero BP exposure), and potential genetic drivers of BP patterns. The next phase in understanding BP trajectories needs to focus on how best to incorporate this knowledge into clinical care to reduce the burden of hypertensive-related outcomes and improve health equity.
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Affiliation(s)
- Norrina B Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sadiya S Khan
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Dior UP, Karavani G, Bursztyn M, Paltiel O, Calderon-Margalit R, Friedlander Y, Youssim I, Manor O, Hochner H. Birth Weight and Maternal Body Size as Determinants of Blood Pressure at Age 17: Results from the Jerusalem Perinatal Study Cohort. Matern Child Health J 2020; 25:162-171. [PMID: 33247825 DOI: 10.1007/s10995-020-03096-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the effect of birth weight (BW) and maternal pre-pregnancy BMI (mBMI) on blood pressure (BP) in adolescence. METHODS A Population-based cohort of 11,729 births in Jerusalem during 1974-1976, with archival data on maternal and birth characteristics was performed. Measurements at age 17 were assessed and linear regression models were used to evaluate the associations of birth characteristics with BP outcomes. RESULTS BW was inversely associated with both systolic (SBP) and diastolic (DBP) BP at age 17 (SBP: B = - 0.829, p = 0.002; DBP: B = - 0.397, p = 0.033). The interaction term between BW and weight at age 17 was significant for DBP (p = 0.017) and pulse pressure (p = 0.005). mBMI yielded significant positive associations with BP, independent of BW. CONCLUSIONS FOR PRACTICE Our findings indicate that there are at least two distinct pathways linking early life characteristics with subsequent BP: Intrauterine growth, as reflected by BW and other genetic or environmental factors, reflected by mBMI and maternal education, contribute to offspring adolescent BP. These results warrant replication in other birth cohorts and underline the need to explore specific mechanisms that account for these associations.
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Affiliation(s)
- Uri P Dior
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel. .,Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel.
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Michael Bursztyn
- Hypertension Unit, Department of Medicine, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yechiel Friedlander
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Iaroslav Youssim
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Hagit Hochner
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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18
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Overweight or obesity and abdominal obesity and their association with cardiometabolic risk factors in Brazilian schoolchildren: A cross-sectional study. Nutrition 2020; 78:110780. [DOI: 10.1016/j.nut.2020.110780] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 01/28/2020] [Accepted: 02/07/2020] [Indexed: 11/20/2022]
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Abstract
PURPOSE OF REVIEW Hypertension is a common finding in children, and increases the risk for future cardiovascular events. This review focuses on recent advances in pediatric hypertension research including changes in hypertension guidelines, epidemiology, predictors of hypertension, blood pressure (BP) measurement, effects on target organs, and treatment of hypertension. RECENT FINDINGS Changes in the 2017 hypertension guidelines by the American Academy of Pediatrics (AAP) have resulted in increased prevalence of elevated BP and hypertension in the United States, and there is no international consensus on these changes. Despite rising pediatric overweight and obesity in China, hypertension prevalence is stable, suggesting multifactorial effects on childhood BP. Maternal diabetes and exposure to particulate matter are associated with higher childhood BP, and body size in infancy and early childhood is a determinant of adult high BP. Children with elevated BP have evidence of target organ damage with altered retinal vasculature and pulse wave velocity parameters compared to normotensive patients. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be the best antihypertensive medications for the pediatric population even for African-American patients. SUMMARY Research continues to illuminate contributors to pediatric hypertension and demonstrates opportunities for further study on the effects of hypertension and its management in children.
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20
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Sebati B, Monyeki K, Makgae P. An Assessment of the Relationship between Anthropometric Parameters and Blood Pressure among Polokwane Private School Children. CHILDREN-BASEL 2020; 7:children7040029. [PMID: 32260220 PMCID: PMC7231101 DOI: 10.3390/children7040029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 12/30/2022]
Abstract
High blood pressure (HBP) among children and adolescents has been associated with elevated risk of cardiovascular diseases later in life. The aim of this study was to determine the relationship between body composition and blood pressure among Polokwane private school children. Mean body fat % was significantly (P < 0.05) higher in girls (23.74) than the boys (16.77). There was a significant (P < 0.05) association between systolic blood pressure (BP) and waist circumference (WC) unadjusted (OR = 1.125) and adjusted (OR = 1.097) for age and gender. This study included a total of 1665 children and adolescents (846 boys and 819 girls) aged 5 to 15 years old. Anthropometric measurements including weight, height, hip circumference (HC) and waist circumference (WC) were taken according to standard procedures. Descriptive statistics were done to determine the prevalence of hypertension and mean of all the variables. Pearson correlation, linear regression and logistic regression were all done to determine the association between blood pressure (BP) and the anthropometric measurements. All statistical analysis were done using SPSS. There was a significant association between body composition and blood pressure among Polokwane Private School children. Lowering the risk factors of high BP in children and adolescents will lower their risk of cardiovascular diseases in adulthood.
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Guttier MC, Barcelos RS, Ferreira RW, Bortolotto CC, Dartora WJ, Schmidt MI, Matijasevich A, Tovo-Rodrigues L, Santos IS. Repeated high blood pressure at 6 and 11 years at the Pelotas 2004 birth cohort study. BMC Public Health 2019; 19:1260. [PMID: 31510953 PMCID: PMC6739988 DOI: 10.1186/s12889-019-7544-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/25/2019] [Indexed: 12/05/2022] Open
Abstract
Background We evaluated the prevalence and the factors associated with repeated high systolic (SBP) and diastolic blood pressure (DBP) at 6- and 11-year follow-ups of children from the Pelotas (Brazil) 2004 Birth Cohort. Methods All live births to mothers living in the urban area of Pelotas were enrolled in the cohort. Blood pressure (BP) values were transformed into Z-scores by sex, age, and height. High SBP and DBP were defined as repeated systolic and diastolic BP Z-scores on the ≥95th percentile at the two follow-ups. Prevalence (95% confidence interval) of repeated high SBP, DBP, and both (SDBP) were calculated. Associations with maternal and child characteristics were explored in crude and adjusted logistic regression analyses. Results A total of 3182 cohort participants were analyzed. Prevalence of repeated high SBP, DBP and SDBP was 1.7% (1.2–2.1%), 2.3% (1.8–2.9%) and 1.2% (0.9–1.6%), respectively. Repeated high SBP was associated with males, gestational diabetes mellitus (2.92; 1.13–7.58) and obesity at 11 years (2.44; 1.29–4.59); while repeated high DBP was associated with females, family history of hypertension from both sides (3.95; 1.59–9.85) and gestational age < 34 weeks (4.08; 1.52–10.96). Repeated high SDBP was not associated with any of the characteristics investigated. Conclusion Prevalence of repeated high SBP, DBP, and SDBP were within the expected distribution at the population level. Nonetheless, gestational diabetes mellitus, obesity, family history of hypertension, and prematurity increased the risk of repeated high blood pressure measured at two occasions 5 years apart.
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Messerli FH, Rexhaj E, Scherrer U. Letter by Messerli et al Regarding Article "Early Life Factors and Longitudinal Blood Pressure Trajectories Are Associated With Elevated Blood Pressure in Early Adulthood: BT20 Cohort". Hypertension 2019; 73:e83. [PMID: 31067202 DOI: 10.1161/hypertensionaha.119.12753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Franz H Messerli
- Department of Cardiology, Inselspital, University of Bern, Switzerland
| | - Emrush Rexhaj
- Department of Cardiology, Inselspital, University of Bern, Switzerland
| | - Urs Scherrer
- Department of Cardiology, Inselspital, University of Bern, Switzerland
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Hypertension Editors' Picks. Hypertension 2019; 73:e67-e82. [PMID: 31030605 DOI: 10.1161/hypertensionaha.119.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schutte AE. Early Detection of Cardiovascular Risk in Children. Hypertension 2018; 73:282-283. [PMID: 30580692 DOI: 10.1161/hypertensionaha.118.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aletta Elisabeth Schutte
- From the Hypertension in Africa Research Team (HART), Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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