The effect of comprehensive intervention on children with anxiety/depression and increased blood pressure

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.

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.

Recent guidelines classified blood pressure above 130/80 mm Hg as hypertension. However, outcome data were lacking. To determine the association between blood pressure in adolescence and the risk for early kidney damage in young adulthood. In this nationwide cohort study, we included 629 168 adolescents aged 16 to 20 who underwent medical examinations before mandatory military service in Israel. We excluded 30 466 adolescents with kidney pathology, hypertension, or missing blood pressure or anthropometric data at study entry. Blood pressure measurements at study entry were categorized according to the Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents: group A (<120/<80 mm Hg; Reference group), group B (120/<80-129/<80 mm Hg), group C (130/80-139/89 mm Hg), and group D (≥140/90 mm Hg). Early kidney damage in young adulthood was defined as albuminuria of ≥30 mg/g with an estimated glomerular filtration rate of 60 mL/(min·1.73 m2) or over. Of 598 702 adolescents (54% men), 2004 (0.3%) developed early kidney damage during a mean follow-up of 15.1 (7.2) years. The adjusted hazard ratios for early kidney damage in blood pressure group C were 1.17 (1.03-1.32) and 1.51 (1.22-1.86) among adolescents with lean (body mass index <85th percentile) and high body mass index (body mass index ≥85th percentile), respectively. Corresponding hazard ratios for kidney disease in group D were 1.49 (1.15-1.93) and 1.79 (1.35-2.38) among adolescents with lean and high body mass index, respectively. Blood pressure of ≥130/80 mm Hg was associated with early kidney damage in young adulthood, especially in adolescents with overweight and obesity.

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.

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.

Association between perfluoroalkyl substance concentrations and blood pressure in adolescents

BackgroundAlthough preterm birth predisposes for cardiovascular disease, recent studies in children indicate normal blood pressure and arterial stiffness. This prospective cohort study therefore assessed blood pressure and arterial stiffness in adolescents born very preterm due to verified fetal growth restriction (FGR).MethodsAdolescents (14 (13–17) years; 52% girls) born very preterm with FGR (preterm FGR; n = 24) and two control groups born with appropriate birth weight (AGA), one in similar gestation (preterm AGA; n = 27) and one at term (term AGA; n = 28) were included. 24-hour ambulatory blood pressure and aortic pulse wave velocity (PWV) and distensibility by magnetic resonance imaging were acquired.ResultsThere were no group differences in prevalence of hypertension or in arterial stiffness (all p ≥ 0.1). In boys, diastolic and mean arterial blood pressures increased from term AGA to preterm AGA to preterm FGR with higher daytime and 24-hour mean arterial blood pressures in the preterm FGR as compared to the term AGA group. In girls, no group differences were observed (all p ≥ 0.1).ConclusionsVery preterm birth due to FGR is associated with higher, yet normal blood pressure in adolescent boys, suggesting an existing but limited impact of very preterm birth on cardiovascular risk in adolescence, enhanced by male sex and FGR.ImpactVery preterm birth due to fetal growth restriction was associated with higher, yet normal blood pressure in adolescent boys.In adolescence, very preterm birth due to fetal growth restriction was not associated with increased thoracic aortic stiffness.In adolescence, very preterm birth in itself showed an existing but limited effect on blood pressure and thoracic aortic stiffness.Male sex and fetal growth restriction enhanced the effect of preterm birth on blood pressure in adolescence.Male sex and fetal growth restriction should be considered as additional risk factors to that of preterm birth in cardiovascular risk stratification.

Despite substantial attention paid to the threat of elevated blood pressure in children and adolescents in high-income countries and the epidemic of hypertension in African adult populations, data on the burden of elevated blood pressure in African children and adolescents have not yet been synthesised. We did a systematic review and meta-analysis to provide estimates of the prevalence of elevated blood pressure and assess associated factors among children and adolescents in Africa. We searched Embase, PubMed, African Journals Online, and African Index Medicus to identify articles published from Jan 1, 1996, to Feb 2, 2017, and searched the reference list of retrieved articles. Each study was independently reviewed for methodological quality. We used a random-effects model to estimate the prevalence of elevated blood pressure across studies and heterogeneity (I2) was assessed via the χ2 test on Cochran's Q statistic. This review is registered with PROSPERO, number CRD42015019029. We included 51 studies in qualitative synthesis and 25 in the meta-analysis reporting data of a pooled sample of 54 196 participants aged 2-19 years. Study quality was high with only four medium-quality studies and no low-quality studies. Prevalence of elevated blood pressure varied widely across studies (range 0·2-24·8%). The pooled prevalence of elevated blood pressure (systolic or diastolic blood pressure ≥95th percentile) was 5·5% (95% CI 4·2-6·9), whereas that of slightly elevated blood pressure (systolic or diastolic blood pressure ≥90th percentile and <95th percentile) was 12·7% (2·1-30·4). The prevalence of elevated blood pressure was largely associated with body-mass index (BMI), with a prevalence of elevated blood pressure six times higher in obese (30·8%, 95% CI 20·1-42·6) versus normal-weight children (5·5%, 3·1-8·4; p<0·0001). This study suggests a high prevalence of elevated blood pressure among children and adolescents in Africa, with overweight and obesity being an important risk factor. Efforts to address this burden of elevated blood pressure in children and adolescents should mainly focus on primary prevention at the community level, by promoting healthy lifestyles and avoiding other cardiovascular risk factors, especially overweight and obesity. This study also stresses the need for more elaborate studies using uniform and reliable diagnostic methods to reliably map the burden of elevated blood pressure in children and adolescents in Africa. None.

Objective: To investigate the prevalence trend of high normal blood pressure and elevated blood pressure in children and adolescents aged 7 to 17 years in China from 2010 to 2019. Methods: Students aged 7-17 years were selected from the Chinese National Survey on Students' Constitution and Health from 2010 to 2019. High normal blood pressure and elevated blood pressure were determined according to the "Reference of screening for elevated blood pressure among children and adolescents aged 7-18 years" (WS/T 610-2018). The Chi-square test was performed to determine whether there was a difference in the prevalence of high normal blood pressure and elevated blood pressure by gender, residence and age group. Results: In 2019, the prevalence of high normal blood pressure in children and adolescents aged 7-17 years was 15.3% (29 855/195 625), which was higher in boys (20.2%, 19 779/97 847) and rural areas (15.4%, 15 066/97 567) than that in girls (10.3%, 10 076/97 778) and urban areas (15.1%, 14 789/98 058), respectively (all P<0.05). The prevalence of elevated blood pressure was 13.0% (25 377/195 625), which was higher in girls (13.2%, 12 925/97 778) and rural areas (14.1%, 13 753/97 567) than that in boys (12.7%, 12 452/97 847) and urban areas (11.9%, 11 624/98 058) (all P<0.05). From 2010 to 2019, the prevalence of high normal blood pressure showed an increasing trend, with an annual average growth rate from 1.14% to 3.18%. The overall prevalence of elevated blood pressure also showed an increasing trend from 2010 to 2019 but decreased in 2014. The annual average growth rate of elevated blood pressure was-1.07% from 2010 to 2014 and 9.33% from 2014 to 2019. About 17 provinces had an increasing trend in the prevalence of elevated blood pressure from 2010 to 2014, and 22 provinces with an increasing trend from 2014 to 2019. There were obvious regional differences in the annual average growth rate of the prevalence of high normal blood pressure and elevated blood pressure. The regions with the highest annual average growth rate of the prevalence of high normal blood pressure were the Northeast (5.47%) from 2010 to 2014 and the Western region (5.21%) from 2014 to 2019. For elevated blood pressure, the Northeast had the highest annual average growth rate from 2010 to 2014 (12.35%), while the Central (15.79%) and Western (12.87%) had the highest growth rate from 2014 to 2019. Conclusion: From 2010 to 2019, the prevalence of high normal blood pressure and elevated blood pressure in Chinese Han children and adolescents aged 7 to 17 shows an increasing trend, with regional disparities.

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.

Objective To study the psychological changes and the effect of psychological intervention and to discuss the influence of psychological rehabilitation on carcinoma patients after comprehensive interventional therapy.Methods 100 carcinoma patients were divided into two groups randomly:the psychological intervention group(50 casea) received both psychological intervention therapy and comprehensive intervention therapy;the control group (50 cases) received only comprehensive interventional therapy;Curative effects were assessed with the Symptom Checklist90(SCL-90) ,the Self Rating Depression Scale(SDS) and the Self Rating Anxiety Scale(SAS) for each patient. Results For the psychological intervention group, SCL-90 scores after therapy was significantly lower than that before therapy ( P < 0. 05 ), and were also significantly lower than that ( without anxiety agent) of the control group. The scores of SDS and SAS in post-therapy patients were significantly lower than that of pre-therapy patients in the psychological intervention group. The scores of SDS had no statistical difference between post-therapy patients and pre-therapy patients in the control group. The scores of SAS in post-therapy patients was significantly lower than that of pre-therapy patients in the control group. Both scores of SDS and SAS in the control group were significantly higher than that of the psychological intervention group after therapy. Conclusion Psychological intervention for carcinoma patients after comprehensive interventional therapy played an promotional role in psychological rehabilitation in the community. Key words: Cancer; Interventional therapy; Anxiety; Depression; Community; Psychological intervention

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Identifying dietary factors associated with blood pressure (BP) in children and adolescents would help guide recommendations for prevention of elevated BP, which is a major public health problem. This paper reviews 46 reports of studies examining relationships between dietary nutrients and BP in children and adolescents, many of which studied more than one nutrient. Sodium is the most extensively studied nutrient, with 25 observational and 12 intervention studies identified. Although many studies suffer from methodological problems, the results suggest that higher sodium intake is related to higher BP in children and adolescents. The results of 13 observational and 2 intervention studies of potassium and BP do not provide a clear picture of a relationship. The results of 8 observational and 1 intervention study of calcium and BP are inconclusive. Five observational studies of magnesium and BP provide evidence of an inverse relationship, but no intervention studies were identified. Nine studies of macronutrients and food groups or dietary patterns are inconclusive. Additional research is needed to provide more information about the relationships between dietary nutrients and BP in children and adolescents. Recommendations are provided for methodological features of additional research on diet and BP in children and adolescents.

To assess determinants of blood pressure and racial differences in blood pressure in hyperlipidemic children, and to compare blood pressure in hyperlipidemic and random recall groups of children, studies were carried out on 513 school children (ages 6 through 19 years), and 309 adults (ages 20 through 64), recalled by virtue of elevated cholesterol or triglyceride levels in the Cincinnati Lipid Research Clinic's Princeton School prevalence study. For systolic and diastolic blood pressure in children, there were positive simple correlations with plasma triglyceride and inverse correlations with plasma high density lipoprotein cholesterol. Race did not enter the multiple regression equations as a significant explanatory variable for children's systolic or diastolic blood pressures, but was a significant variable for adults' blood pressures; blacks had higher pressures. Major explanatory variables for systolic blood pressure in children included weight, pulse, and age; 46% of the variance was explained. Major variables for diastolic blood pressure in children included age, pulse, and Quetelet index; 25% of the variance was explained. After covariance adjusting for Quetelet index, blood pressures within race did not differ between the hyperlipidemic and the random recall groups. Quetelet index was the covariable that related positively to blood pressure and plasma triglycerides, and negatively to high density lipoprotein cholesterol. Although relative ponderosity does not appear to be an independent coronary heart disease risk factor variable, its inverse relationship to high density lipoprotein cholesterol and positive association with triglyceride and blood pressure in school children should provide a basis for prudent, early, therapeutic approaches to overweight children and those with persistently elevated blood pressure. (Arteriosclerosis 1981; 1:280-286).

Obesity is a growing problem in developed countries and is likely a major cause of the increased prevalence of high blood pressure in children. The aim of this review is to provide clinicians and clinical scientists with an overview of the current state of the literature describing the negative influence of obesity on blood pressure and it’s determinants in children. In short, we discuss the array of vascular abnormalities seen in overweight children and adolescents, including endothelial dysfunction, arterial stiffening and insulin resistance. We also discuss the potential role of an increased activation of the sympathetic nervous system in the development of high blood pressure and vascular dysfunction associated with obesity. As there is little consensus regarding the methods to prevent or treat high blood pressure in children, we also provide a summary of the evidence supporting relationship between physical activity and blood pressure in children and adolescents. After reviewing a number of physical activity intervention studies performed in children, it appears as though 40 minutes of moderate to vigorous aerobic-based physical activity 3–5 days/week is required to improve vascular function and reduce blood pressure in obese children. Future studies should focus on describing the influence of physical activity on blood pressure control in overweight children.