Higher blood pressure in adolescent boys after very preterm birth and fetal growth restriction

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Objective: To analyze the influence of different number of blood pressure measurement on the detection of elevated blood pressure in Tibetan adolescents and provide scientific reference for standardizing the number of blood pressure measurement and accurately diagnosing elevated blood pressure in adolescents. Methods: Data were from the project "survey of the risk factors for elevated blood pressure among Tibetan adolescents" conducted from August to September 2018 in Shigatse in Tibet. A total of 2 822 Tibetan adolescents aged 12-17 years, including 1 275 boys (45.2%), were recruited by a convenient, stratified cluster sampling method. Each participant underwent three consecutive blood pressure measurements. Elevated blood pressure was defined according to the Health Industry Criterion of China: WS/T 610-2018 "Reference of screening for elevated blood pressure among children and adolescents aged 7-18 years" . Analysis of variance and χ(2) test were used to analyze the effect of different blood pressure measurement on blood pressure levels and detection of elevated blood pressure, respectively. Results: SBP and DBP decreased substantially across three consecutive blood pressure measurements[SBP: (112.7±9.7), (110.7±9.7) and (110.2±9.5) mmHg (1 mmHg=0.133 kPa); DBP: (62.7±8.2), (61.1±8.5) and (60.6±8.5) mmHg; P value for trend<0.001]. The detection rates of elevated blood pressure based on three blood pressure measurements were 12.8%, 8.7% and 7.9%, respectively (P value for trend <0.001). Of note, the difference in the detection of elevated blood pressure based on the second blood pressure measurement or based on the average value of the second and third blood pressure measurements showed no significance (8.7% and 7.2%, P=0.039). Conclusions: Blood pressure levels and the detection of elevated blood pressure in adolescents decreased substantially across three consecutive blood pressure measurements. The second blood pressure measurement might be sufficient for screening elevated blood pressure in adolescents.

Association between perfluoroalkyl substance concentrations and blood pressure in adolescents

The prevalence of high blood pressure in adolescence is increasing with the number of adolescence at risk of overweight or overweight. Due to the known relationship between high blood pressure and increased risk of coronary artery disease (CAD) and stroke, this is an obvious health concern for adolescent children. PURPOSE: To characterize the incidence of high normal blood pressure and hypertension in a large population of ninth grade, physical education students. METHODS: 884 ninth grade, physical education students (14 ± 1 yrs) participated. Blood pressure was initially recorded with an automated device (Omron, HEM-907XL). If the initial automated reading was above 120/80 mmHg, then a manual ausculatory re-measurement was taken. Blood pressure was classified as high normal blood pressure if the reading fell between the 90th and 95th percentile based on the CDC growth charts (National high blood pressure education program working group on high blood pressure in children and adolescents, 2001), while hypertension was defined as a reading above the 95th percentile. Frequency of high normal blood pressure and hypertension was calculated for two groups based on BMI: at risk for being overweight or overweight students and normal weight students. RESULTS: Overall, 8.5% of students were classified as having high normal blood pressure and 4.8% were considered hypertensive. The incidence was greater for high normal blood pressure for the at risk for being overweight or overweight group (11.9%) compared to the normal weight students (7.4%). Hypertension was present in 7.3% of the at risk for being overweight or overweight population and 3.9% of the normal weight population. The at risk for being overweight or overweight group and normal weight group had a mean systolic blood pressure of 117.5 ± 9 mmHg and 112.8 ±10 mmHg, respectively, and a mean diastolic blood pressure of 64.7 ± 7 mmHg and 61.2 ± 8 mmHg, respectively. CONCLUSION: Our data indicates that a large percentage of the at risk for being overweight or overweight population (19.2%) has elevated blood pressure. At risk for being overweight or overweight students have a greater incidence of high normal blood pressure, and are twice as likely as normal weight students to have hypertension. The at risk for being overweight or overweight group also has a higher mean systolic and diastolic blood pressure values. This is alarming because elevated blood pressure is associated with an increased risk of CAD and stroke, and is in itself a progressive chronic disease.

Respective Roles of Preterm Birth and Fetal Growth Restriction in Blood Pressure and Arterial Stiffness in Adolescence

Background: Although within the physiological range, overweight and obese adolescents, who are otherwise normal, have blood pressures at the higher side, whereas underweight adolescents have lower blood pressures when compared with the normal weight individuals. Aims and Objectives: (1) To assess the functional status of the cardiovascular system by measuring the heart rate (HR) and blood pressure in adolescents with different body mass indices (BMI) at rest. (2) To illustrate the response of the cardiovascular system to acute isotonic exercise by recording the HR and blood pressure in normal weight, underweight, and overweight adolescents. Materials and Methods: A total of 44 adolescents, aged between 17 and 19 years with different BMI, are the study group. Subjects are categorized into underweight, normal weight, and overweight/obese group based on their BMI. HR and blood pressure were recorded before and immediately after the acute bicycle ergometer exercise test, with three finger test and sphygmomanometer, respectively. Results: Increase in HR, systolic blood pressure (SBP), and pulse pressure (PP) in diastolic blood pressure (DBP) were observed immediately after the exercise (P = 0.000) among all the subjects. Before the exercise, SBP, DBP, and mean arterial blood pressure (P = 0.002, 0.008, and 0.003) and after the exercise, SBP and PP (P = 0.007 and 0.037) are significant among underweight, normal weight, and overweight subjects. Conclusion: Overweight/obese adolescents are having higher blood pressure at rest. SBP and PP were increased more in overweight/ obese adolescents after the exercise than the normal weight subjects.

This study was intended to clarify the relation between fasting insulin, lipids, and blood pressure in adolescents before the onset of hypertension and to examine the association of these data with similar data obtained in their parents. The participants in this study were 183 adolescents 14 to 18 years old (96 girls) completing a 4-year intervention trial and their parents (164 mothers, 122 fathers). Blood pressure was measured twice on the right arm in a seated position using a random-zero sphygmomanometer. Fasting blood samples were obtained for lipid and insulin analyses. Fasting insulin was significantly correlated with systolic blood pressure in the adolescents and also in the parents before and after adjustment for body mass index. Fasting insulin was correlated significantly with levels of cholesterol, triglycerides, and HDL and LDL cholesterol in the adolescents. It was correlated only with triglycerides and HDL-cholesterol in mothers and fathers. After adjustment for body mass index, the correlations between fasting insulin and lipids in the children were not significant. A significant relation was shown between children's systolic blood pressure and mothers' fasting insulin and systolic blood pressure. Significant correlations were found between the children's and fathers' triglycerides and HDL-cholesterol, whereas significant correlations were found for fasting insulin and all lipids between mothers and children, and these remained significant after adjustment for body mass index. These results show (1) a significant relation between fasting insulin and both lipids and systolic blood pressure in adolescents and (2) a significant relation for these factors between adolescents and their parents. Although weight appears to play an important role in this relation during adolescence, genetic and environmental factors other than those mediated via weight may control insulin metabolism within families. The data support a role for studies during early biological development to address these issues.

BackgroundAnthropometric indicators of obesity have been associated with blood pressure in adolescents. However, the accuracy of anthropometric indicators of obesity for screening for high blood pressure (HBP) in adolescents is not known. Thus, the aim of the present study was to summarize the set of evidence regarding the predictive ability of anthropometric indicators of obesity to identify HBP in adolescents.MethodsSearches were performed in five databases: MEDLINE, Web of Knowledge, Scopus, Scientific Electronic online (SciELO) and SportDiscus. The inclusion criteria for studies were: adolescents aged 10–19 years or mean age included in this range, observational and intervention studies, studies that proposed cutoff points for anthropometric indicators of obesity, and studies in English, Portuguese and Spanish. The methodological quality of studies was assessed using the QUADAS-2 instrument.ResultsTen studies met the inclusion criteria and had their information summarized. Based on the information described in these studies, the anthropometric indicators body mass index (BMI), waist circumference (WC), waist-to-height-ratio (WHtR), triceps skinfold thickness, body adiposity index, C index, body mass, waist-to-arm span ratio, arm fat area, average arm perimeter, fat percentage and arm span were likely to be used in high blood pressure (HBP) screening among adolescents. However, only one study showed acceptable values (moderate to high precision) in relation to the accuracy measurements of described cutoffs.ConclusionCaution is suggested in the use of anthropometric indicators of obesity for HBP screening in adolescents, in which a greater number of studies with accurate diagnostic tools are necessary.

Hypertension in children and adolescents is under-recognized and under-diagnosed in clinical practice. The 2017 AAP Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents provides updated recommendations that may improve hypertension identification and management. The AAP blood pressure guideline recommends annual screening for hypertension in children at preventive care visits and targeted routine screening in high-risk populations. A simplified blood pressure screening table is provided for easier recognition of blood pressures that may require attention. Normative blood pressure tables have been revised to include only data from normal-weight children as more representative of a healthy population. Classification of blood pressure in adolescents has been simplified to threshold values consistent with adult guidelines. The updated AAP blood pressure guideline has clarified and simplified recommendations for hypertension screening, diagnosis, and management based on a systematic review of current best evidence.

This study investigates sexual maturity as a predictor of resting blood pressures independent of other known predictors, in 179 boys and 204 girls 11-16 years of age from the Heartfelt Study. The sample included youth of African (n = 140), Mexican (n = 117), and European and "other" (n = 126) backgrounds. Sexual maturity was assessed during clinical examination of three standard indicators for each sex. Systolic and diastolic blood pressures were higher in children of maturity stages IV and V, compared to stages I-III, in each gender/ethnic group (P < 0.01 in almost all groups). Boys and girls advanced in sexual maturity for their age group, had significantly higher systolic blood pressures (but not diastolic) than the less advanced in linear models that included height, body mass index (BMI), ethnicity, and age as co-predictors. Diastolic blood pressures were predicted by height in boys and by age and the BMI in girls. This analysis, using a very conservative approach, suggests that sexual maturity provides important and independent information on systolic blood pressure in adolescents. Further investigation of its role in 24-hr blood pressures and in blood pressures taken during physical and emotional stress, is recommended.

This study investigates sexual maturity as a predictor of resting blood pressures independent of other known predictors, in 179 boys and 204 girls 11-16 years of age from the Heartfelt Study. The sample included youth of African (n = 140), Mexican (n = 117), and European and “other” (n = 126) backgrounds. Sexual maturity was assessed during clinical examination of three standard indicators for each sex. Systolic and diastolic blood pressures were higher in children of maturity stages IV and V, compared to stages I–III, in each gender/ethnic group (P < 0.01 in almost all groups). Boys and girls advanced in sexual maturity for their age group, had significantly higher systolic blood pressures (but not diastolic) than the less advanced in linear models that included height, body mass index (BMI), ethnicity, and age as co-predictors. Diastolic blood pressures were predicted by height in boys and by age and the BMI in girls. This analysis, using a very conservative approach, suggests that sexual maturity provides important and independent information on systolic blood pressure in adolescents. Further investigation of its role in 24-hr blood pressures and in blood pressures taken during physical and emotional stress, is recommended. Am. J. Hum. Biol. 13:227–234, 2001. © 2001 Wiley-Liss, Inc.

Background: Obesity is associated with increased risk for high blood pressure (BP). Although a routine BP measurement is indicated for all children visiting pediatric practice, recognition of children particularly at risk may save times. The aim of this study was to assess the cut-off point for body mass index (BMI) and waist-to-height ratio (WHtR) to predict high BP in adolescents. Methods: We conducted a cross-sectional study on 928 children aged 11 to 16 years in Yogyakarta. BP were measured using standard technique described by The Fourth Report on The Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. BMI was adjusted for age and sex using the WHO 2007 growth reference. WHtR was ratio of waist circumference related to height in centimeters. Receiver operating characteristic (ROC) curves were used to estimate the best cut-offs. Results: The best cut-off point for BMI-for-age Z-score (BMIZ) to predict high BP was 0.51 with sensitivity and specificity of 82% (95% CI = 78-86) and 76% (95% CI = 67-78) for systolic BP and sensitivity and specificity of 82% (95% CI = 78-86) and 72% (95% CI = 68-76) for diastolic BP. The best cut-off point for WHtR was 0.45, with sensitivity of 76% (95% CI = 67-78) and specificity of 74% (95% CI = 71-79) for systolic BP and sensitivity of 76% (95% CI = 72-80) and specificity of 70% (95% CI = 61-75) for diastolic BP.Conclusion: BMIZ of 0.51 and WHtR of 0.45 are the best cut-off point to predict high BP in adolescents.

Níveis elevados de pressão arterial (PA) na infância e adolescência têm sido freqüentemente associados a outros fatores de risco cardiovasculares, além de hipertensão arterial na fase adulta da vida. O presente estudo objetivou identificar fatores de risco associados à PA elevada em adolescentes. Participaram do estudo 674 adolescentes de escolas públicas e privadas, de ambos os sexos (303 rapazes e 371 moças), com idade de 14 a 17 anos (16,5 DP 0,9), da cidade de João Pessoa, Paraíba. Mediante aplicação de um questionário, foram levantadas informações sobre: a) indicadores sociodemográficos; b) nível de prática da atividade física; c) hábitos alimentares; c) índice de massa corporal; e) fumo e bebidas alcoólicas; e foram realizadas medidas de PA. A prevalência de PA elevada foi de 7,4%, sendo maior nos rapazes (10,2%) quando comparada com a das moças (5,1%, p &lt; 0,01). Os resultados da análise multivariada demonstraram que adolescentes com excesso de peso apresentaram probabilidade cerca de cinco a seis vezes maior de ter PA elevada, comparados com os de baixo peso/peso normal (rapazes: OR = 5,5; IC 95% = 1,11-27,53 e moças: OR = 4,8; IC 95% = 1,51-15,45). As demais variáveis não se mostraram associadas à PA elevada. Nesse estudo, entre os diversos fatores de risco analisados, o excesso de peso corporal se apresentou como o único fator de risco potencial para elevação da PA em adolescentes.

Physiological and Lifestyle Factors Associated With Abnormal Blood Pressure in Adolescents Before and After a School-Based Wellness Program in Michigan: A Report From Project Healthy Schools

This paper studies the relationship between birthweight for gestational age and blood pressure in adolescents aged 14-15 years in southern Brazil. A sample of 1076 adolescents belonging to a cohort of over 6000 children born in 1982 in Pelotas, southern Brazil, was studied in 1997. All households in a sample of 25% of the city's census tracts were visited and all adolescents born in 1982 were interviewed, weighed, and their blood pressures were measured twice. Data from the adolescents were linked to the database through their names and dates of births. High diastolic and systolic pressure (defined as >95th percentile) were significantly more frequent among adolescents who were born below the 10th percentile of birthweight for gestational age. No association was found between high blood pressure and low birthweight or preterm births. In a multiple linear regression analysis, the association between birthweight for gestational age and blood pressure was not statistically significant after adjusting for age, sex, skin colour and family income. However, when the current body mass index and height were added to the model both diastolic and systolic pressure were significantly associated with birthweight for gestational age, and adolescents who were small for gestational age at birth presented a mean elevation of 3.08 mmHg for diastolic pressure and 2.89 mmHg for systolic pressure. There is an inverse association between birthweight for gestational age and blood pressure during adolescence. This association, however, is only disclosed when the negative confounding effect of the body mass index is controlled for. The same association is not found when the effects of birthweight and gestational age on blood pressure are analysed separately. It appears therefore that the elevation of blood pressure during adolescence only occurs when there was intra-uterine growth retardation.