Blood Pressure In Adolescents Research Articles

The Relationship of Circulating Homocysteine with Fibrinogen, Blood Pressure, and Other Cardiovascular Measures in African Adolescents

To evaluate the associations between homocysteine (Hcy) and cardiovascular health in South African adolescents. Circulating Hcy concentrations of 172 South African adolescents (105 girls, ages 13 to <18years) were measured. Anthropometric and cardiovascular factors were also included and cross-sectionally analyzed through general linear models. Hcy correlated positively with body weight (P=.03; after adjusting for multiple testing, it was not regarded as significant) and muscle mass (P=.01), but negatively with fibrinogen concentrations (P=.001). Across Hcy tertiles, blood pressure produced approximating U-shaped curves, with differences between the middle and upper tertiles (all P<.02). Forty percent of the adolescents had elevated blood pressure, of whom 37% fell in the lowest and 38% in the highest Hcy tertiles. Hcy differed between the sexes (with boys having higher Hcy), but not between subgroups based on puberty, weight, stunting, smoking, or alcohol consumption. Both high and low Hcy could be early contributing risk factors to cardiovascular health. The associations between Hcy and blood pressure suggest that dietary and lifestyle manipulation, to achieve the optimal range of Hcy, may be beneficial in preventing Hcy-related hypertension in adulthood. The inverse relationship between Hcy and fibrinogen remains to be clarified.

School-based surveillance on visit-to-visit blood pressure variability and high blood pressure in children and adolescents

BackgroundThe predictive importance of visit-to-visit blood pressure variability (VVV) for high blood pressure (HBP) in a pediatric population has been largely unsettled. We aimed to evaluate it based on Health Promotion Program for Children and Adolescents (HPPCA), a school-based surveillance conducted from 2012 to 2018 in Suzhou, China.MethodsA total of 330,618 participants had BP measurement in 2018 and ≥ 3 BP records during 2012–2017, were recruited from HPPCA. Absolute BP values (in mmHg) were converted into age-, sex- and height- normalized z-scores. VVV was expressed as standard deviation (SD), coefficient of variation (CV) or average real variability (ARV) of BP z-scores during 2012–2017. Logistic regression models were used to assess the associations between VVV and HBP in 2018.ResultsIn 2018, 42,554 (12.87%) subjects were defined as HBP. VVV, except for SBP-CV and DBP-CV, was significantly higher in the HBP group than normotensives group. After adjusting for covariates including mean BP values from 2012 to 2017, SBP-SD, SBP-ARV, DBP-SD and DBP-ARV, increased the risk of HBP by 5.70 [95% confidence interval (95% CI) 5.54–5.87], 4.10 (95% CI 4.01–4.20), 4.70 (95% CI 4.50–4.90) and 3.39 (95% CI 3.28–3.50) times, respectively. Notably, SBP-SD significantly improved risk discrimination of HBP based on other risk variables (c-statistics, net reclassification index and integrated discrimination improvement significantly increased).ConclusionsHigher SD or ARV of BP, was independently related with higher probability of HBP in Chinese pediatric population. SBP-SD could be potentially helpful for detecting HBP. Future researches investigating the predictive value of VVV are warrant.

European Network for blood pressure research in children and adolescents (COST Action CA 19115)

High blood pressure is a clearly established modifiable risk factor for cardiovascular and renal disease. Although most of its adverse effects develop in adulthood, it has become clear that high BP is a lifelong problem that can manifest early in life. While few would dispute the importance of taking effective steps to identify and manage this condition in middle-aged and elderly individuals, relatively little attention has been paid to the problem of high BP in children and adolescents.Therefore, the development of actions focused on early childhood, childhood and adolescence and the investigation of the underlying causes of this epidemic are of utmost importance. There is a pressing need for comprehensive pan-European action to increase the knowledge on the prevention, diagnosis and treatment of high blood pressure in children and adolescents, the current scarcity of which impedes the development of consensus across different research fields and hinders efforts to introduce changes in clinical practice. There are some aspects that demand urgent action: the definition of hypertension, the prevalence of high BP in Europe, accurate measurement for early identification, the assessment of hypertension-mediated organ damage and the development and implementation of prevention strategies. In order to provide answers to all of these unanswered questions and challenges, a multidisciplinary network was established, maintained and funded by the European Cooperation in Science and Technology (COST) Association. COST is a funding organization for the creation of research networks known as COST Actions. In this case, the network will promote coordinated and collaborative activities on personalized preventive measures for children and adolescents across Europe.

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

BackgroundEvidence on how different body composition indexes, such as body mass index (BMI), fat mass index (FMI) and fat free mass index (FFMI), influence blood pressure (BP) in Chinese children and adolescents is sparse. The aim of this study is to assess the effect of different body composition on BP in participants aged 7–18 in south China.MethodsA cross-sectional study was conducted in 2013. A total of 1,609 children and adolescents from urban and rural areas in Hainan Province, South China, were selected using multi-stage stratified cluster sampling method. Each participant underwent anthropometric and BP tests. BMI, FMI and FFMI were calculated and analyzed as body composition indexes.ResultsIn the population level stratified by sex, FFMI had the highest r-value (Partial Spearman correlations) of correlation with systolic BP in boys (rs=0.305, P<0.001) and girls (rs=0.237, P<0.001). FMI was found to have the highest r-value of correlation with DBP in boys (rs=0.154, P<0.001). The quantile regression model indicated that, within each age group, all body composition indexes was positively associated with systolic BP, and FFMI has the greatest value of regression coefficient (4.38, 95% CI: 3.81–4.95). But for diastolic BP, positive associations with BMI, FMI and FFMI were only observed in the 11–12 years group. Restrict cubic spline models showed that there were both linear and non-linear relations between BMI, FMI and BP, but for FFMI, there was only linear association with BP.ConclusionsThe relation between BP and FFMI was stronger than with BMI and FMI. Combined measurement of body composition should be considered to help health professionals interpret body mass data from children and adolescents with varied stature and age.

Secular Trends in Blood Pressure in Chinese Children and Adolescents Born 1981-2000: The Impact of Changing Growth Trajectories

Background: Globally, 80% of cardiovascular disease (CVD) deaths occur in low-/middle-income countries. High blood pressure (BP) is a major risk factor for CVD and has its origins in early-life. Childhood development of BP provides important information about the development of CVD risk. This study investigated how age trajectories of BP, from child to late adolescence, have changed in recent decades in China, and the mediating roles of physical growth. Methods: We used longitudinal data on 5,118 children with physical measurements between 7-18y from the China Health and Nutrition Survey 1991-2015. We applied fractional polynomial models with random effects to estimate mean trajectories of BP, BMI and height for cohorts born in 1981-85, 1986-90, 1991-95, and 1996-2000. Models for BP trajectories were also adjusted for BMI and/or height growth to assess their impact on BP trends. Results: BP trajectories (7-18y) shifted upwards with successive cohort. Compared to the earliest cohort, mean BP was higher in the latest cohort throughout childhood to late-adolescence. The increment in systolic BP was 3.8mmHg [95% CI: 2.5-5.1] in boys and 3.9mmHg [2.6-5.3] in girls at 9y, narrowed slightly during adolescence, remained at 2.8mmHg [0.7-4.9] and 2.3mmHg [0.3-4.3] respectively at 17y. Diastolic BP had similar increments to systolic BP in childhood and adolescence, but little increment in late-adolescence in girls. BMI and height trajectories also shifted upwards. The overall increment (in z-scores) was greater for height (0.55 [0.47-0.63]) than BMI (0.28 [0.20-0.35]). When adjusting for physical growth, the increment in systolic BP trajectories reduced but remained in childhood (p<0.05). The reduction was greater with adjustment for height than for BMI and the pattern was more evident in boys. Conclusions: The upward trends in BP trajectories over time among Chinese youths was largely (not entirely) explained by the increasing trends in physical growth, especially in height. The increment in BP remained in childhood after adjusting for growth, suggesting that other early-life factors might also contribute to the BP trends in Chinese children. How changes in BP within a short time frame will affect future CVD in the long term is unclear, particularly in the developing world. Funding Statement: This work was supported by the UCL Overseas Research Scholarship and China Scholarship Council to MG, https://www.csc.edu.cn/. Declaration of Interests: None declared. Ethics Approval Statement: The University of North Carolina and the Chinese Centre for Disease Control and Prevention reviewed and approved the data collection procedures.

Analysis of Active and Passive Tobacco Exposures and Blood Pressure in US Children and Adolescents

Hypertension is a leading cause of cardiovascular disease in adults; preclinical associations between hypertension and cardiovascular disease are seen in childhood. Nicotine is a known toxin, but its association with pediatric hypertension is unclear. To test the hypothesis that tobacco exposure is associated with the presence of elevated blood pressure in US children and adolescents and that this association is dose dependent. This cross-sectional study used data from the 2007 to 2016 National Health and Nutrition Examination Survey (NHANES), a population-based nationally representative sample of US children and adolescents. Children were eligible if they were aged 8 to 19 years at the time of participation in the main NHANES study. Exclusion criteria included those of the main NHANES study, inability to complete testing, or missing questionnaires. Of the 10 143 participants in NHANES aged 8 to 19 during the study years, 8520 were included in the analysis. Analysis was conducted from October 12, 2019, to July 9, 2020. Tobacco exposure, defined as serum cotinine levels greater than 0.05 µg/L, or reporting living with a smoker or smoking themselves. Elevated blood pressure, classified as greater than 90% for a child's age, sex, and height according to the 2017 American Academy of Pediatrics Clinical Practice Guidelines. The a priori hypothesis that there is a positive association between tobacco exposure and elevated blood pressure in the study population was tested. Analysis included logistic regression with adjustment for possible confounders. Subgroup and sensitivity analyses were conducted. A total of 8520 children were included in the analysis, representing 41 million US children. The mean (SD) age of the participants was 13.1 (0.05) years, 51% (95% CI, 49%-52%) were male, and 58% (95% CI, 54%-62%) were non-Hispanic White individuals. Participants with any tobacco smoke exposure were more likely than those without exposure to be older (mean [SD] age, 13.3 [0.07] years vs 12.8 [0.06] years), male (53% [95% CI, 51%-55%] vs 49% [95% CI, 47%-50%]), and non-Hispanic Black individuals (19% [95% CI, 16%-22%] vs 10% [95% CI, 8%-12%]). The odds of having elevated blood pressure was 1.31 (95% CI, 1.06-1.61) for any tobacco exposure after adjustment; odds were similar across subgroups and remained significant in multiple sensitivity analyses. This study suggests that tobacco exposure is associated with elevated blood pressure in US children and adolescents. This modifiable risk factor represents a target for further research into reducing hypertension in children and adolescents.

Prevalence and associated factors of elevated blood pressure in adolescents in schools in Lubumbashi, Democratic Republic of Congo

Miguel Devronsky proposed in 1970’s a theory explaining mechanism of action of ingested pure protein; so-called protein-diet, as follows:

Association of dietary patterns with blood pressure and body adiposity in adolescents: a systematic review.

This paper aimed to systematically review the results of observational studies that investigated the association of dietary patterns with blood pressure and body adiposity markers in adolescents. Articles were searched in July 2020 in PubMed, Scopus, Web of Science, and Scientific Electronic Library Online (SciELO). Of the 3408 studies found, 24 fulfilled the inclusion criteria and were considered in this review. Almost all studies (n = 23) identified at least one unhealthy pattern, predominantly characterized as consumption of confectionery, refined grains, sweets, sweetened drinks, red meats, and processed meats. Fourteen of the twenty-four studies found a significant association between any dietary pattern and blood pressure and/or body adiposity markers. There was a positive association of dietary patterns - characterized by the consumption of foods rich in sodium, animal fat, refined carbohydrates, and low in fiber - with increased blood pressure and body adiposity. Our findings highlight the importance of studies with this scope, whose results can support the surveillance of adolescent's health. However, considering the limited number of studies that found a significant association and their limitations, the present results should be interpreted carefully. More prospective studies are needed to determine how adherence to dietary patterns could influence blood pressure and body adiposity markers in the long term.

Salt intake and blood pressure in Iranian children and adolescents: a population-based study

BackgroundPrevious studies have reported a high prevalence of hypertension in Iranian students, especially in rural areas. The aim of this study was to investigate the daily intake of salt in students and its association with high blood pressure.MethodsA random sub-sample was selected from the participants of the second phase of Shahroud schoolchildren eye cohort study and then a random urine sample was tested for sodium, potassium and creatinine. Urine electrolyte esexcretion and daily salt intake were calculated by Tanaka et al.’s formula.ResultsAmong 1455 participants (including 230 participants from rural area and 472 girls), the mean age was 12.9 ± 1.7 year and the mean daily salt intake was 9.7 ± 2.6 g (95% CI 9.5–9.8). The mean salt consumption in rural areas [10.8 (95% CI 10.4–11.2)] was higher than urban areas [9.4 (95% CI 9.3–9.6)], in people with hypertension [10.8 (95% CI 10.3–11.3)] was more than people with normal blood pressure [9.4 (95% CI 9.3–9.6)], and in boys [9.8 (95% CI 9.7–10.0)] was more than girls [9.3 (95% CI 9.1–9.6)]. Higher age, BMI z-score, male sex and rural life, were associated with increased daily salt intake. Increased salt intake was associated with increased systolic and diastolic blood pressure.ConclusionDaily salt intake in Iranian adolescents was about 2 times the recommended amount of the World Health Organization, was higher in rural areas and was associated with blood pressure. Reducing salt intake should be considered as an important intervention, especially in rural areas.

High blood pressure in children and adolescents: lights and shadows in the American Academy of Pediatrics clinical practice guidelines

High blood pressure in pediatric age is meeting a growing interest owing to the possible aftermaths in adult age in terms of public health. In fact, children and adolescents with high blood pressure values are likely to become hypertensive adults, thus developing cardiovascular diseases. Over the last decade, numerous studies have been conducted in this field. That is the reason why the American Academy of Pediatrics in 2017 published un update on the previous recommendations of the United States Fourth Working Group on pediatric blood pressure. This update includes a new classification of hypertension, the endorsement of the 24-hour ambulatory blood pressure monitoring and the reduction in the blood pressure target for both chronic kidney disease and non-chronic kidney disease hypertensive children. This review discusses strengths and weaknesses of the recent practical guidelines of the American Academy of Pediatrics.

The Association between Low Blood Pressure and Attention-Deficit Hyperactivity Disorder (ADHD) Observed in Children/Adolescents Does Not Persist into Young Adulthood. A Population-Based Ten-Year Follow-Up Study

Background: Attention-deficit hyperactivity disorder (ADHD) is one of the most common behavioral disorders in childhood and adolescence associated with relevant psychosocial impairments. The basic pathophysiology of ADHD may be related, at least partly, to a deficit in autonomic arousal processes, which not only influence core symptoms of the disorder, but may also lead to blood pressure (BP) deviations due to altered arousal regulation. Objectives: This study examined long-term changes in BP in children and adolescents with ADHD up to young adulthood. Methods: In children and adolescents aged between 7 and 17 years at baseline, we compared BP recordings in subjects with (n = 1219, 11.1%) and without (n = 9741, 88.9%) ADHD over a 10-year follow-up using data from the nationwide German Health Survey for Children and Adolescents (KiGGS). Propensity score matching was used to improve the comparability between children in the ADHD and control groups with now n = 1.190 in each group. Results: The results of these matched samples revealed that study participants with ADHD showed significantly lower systolic BP (107.6 ± 10.7 mmHg vs. 109.5 ± 10.9 mmHg, p < 0.001, Cohen’s d = 0.17) and diastolic BP (64.6 ± 7.5 mmHg vs. 65.8 ± 7.4 mmHg, p < 0.001, Cohen’s d = 0.16) at baseline. In a sensitivity analysis with a smaller (n = 272) and more stringently diagnosed ADHD group, the significant differences remained stable with somewhat higher Cohen’s d; i.e., 0.25 and 0.27, respectively. However, these differences did not persist after 10-year follow-up in a smaller matched longitudinal sub-group (ADHD n = 273; control n = 323), as subjects with and without ADHD had similar levels of systolic (123.4 ± 10.65 vs. 123.78 ± 11.1 mmHg, p = 0.675, Cohen’s d = 0.15) and diastolic BP (71.86 ± 6.84 vs. 71.85 ± 7.06 mmHg, p = 0.992, Cohen’s d = 0.16). Conclusions: At baseline, children and adolescents with ADHD had significantly lower BP (of small effect sizes) compared to the non-ADHD group, whereas this difference was no longer detectable at follow-up ten years later. These developmental alterations in BP from adolescence to early adulthood may reflect changes in the state of autonomic arousal, probably modulating the pathophysiology of ADHD.

The association between serum copper concentrations and elevated blood pressure in US children and adolescents: National Health and Nutrition Examination Survey 2011\u20132016

BackgroundCopper is an essential trace metal with potential interest for cardiovascular effects. Few studies have explored the association between copper and blood pressure in children and adolescents.MethodWe conducted a cross-sectional analysis of 1242 children and adolescents aged 8–17 years who participated in the 2011 to 2016 National Health and Nutrition Examination Survey. Using 2017 American Academy of Pediatrics guidelines, elevated blood pressure (EBP) was defined as a mean systolic and/or diastolic blood pressure (BP) ≥ 90th percentile for sex, age, and height for children aged 1–12 years and systolic BP ≥ 120 mmHg or diastolic BP ≥ 80 mmHg for adolescent age 13–17 years. Mean serum copper was 114.17 μg/dL.ResultsAfter multiple adjustments, dose–response analyses revealed that EBP was associated with progressively higher serum copper concentrations in a nonlinear trend. In comparison with the lowest quartile of serum copper concentrations, the adjusted odds of EBP for the highest quartile was 5.26 (95% confidence interval, 2.76–10.03).ConclusionOur results suggested that high serum copper concentrations were significantly associated with EBP in US children and adolescents.

Effect of Physical Activity and Nutrition Education on Body Mass Index, Blood Pressure and Biochemical Variables in Overweight and Obese Adolescents.

Background:The majority of obese children lives in developing countries. The ten-fold increase in obesity during the last four decades necessitates the implementation of interventions to mitigate the longterm effect of obesity into adulthood. The study aimed to determine the impact of physical activity and nutrition intervention on the body mass index (BMI), blood pressure and selected biochemical factors of overweight and obese children aged 13.0 to 16.1 years from eThekweni, South Africa.Methods:Participants (N = 41) with a BMI >85th percentile were included in the 10-week controlled trial of physical activity and nutrition education intervention. Baseline and end measurements included BMI, blood pressure, and fasting biochemical variables (glucose, cholesterol, insulin resistance and alanine aminotransferase). BMI was classified according to the WHO BMI z-scores. The 10-week intervention entailed combined aerobic and resistance exercises supervised twice a week together with a once a week nutrition intervention. Participants performed additional unsupervised aerobic exercises three times a week.Findings:Elevated systolic blood pressure (52%), low-density lipoprotein levels (29%), insulin (17%) and insulin resistance values (15%) were identified. The 10-week intervention programme significantly decreased BMI (30.8 ± 5.4 kg/m2 to 29.8 ± 5.7 kg/m2; p < 0.01), systolic blood pressure (125.9 ± 15.7 mmHg to 115.2 ± 12.4 mmHg; p < 0.05), and low-density lipoprotein cholesterol (2.63 mmol/L to 2.37 mmol/L; p < 0.05). Controlling for pre-testing variables as covariates, additional ANCOVA analysis highlighted significantly lower BMI (M = 28.33, F = 7.88, p < 0.05) and BMI z-scores (M = 2.08, F = 4.99, p < 0.05) in the intervention group post-testing.Conclusion:A 10-week physical activity and nutrition education intervention in overweight and obese adolescents significantly reduced BMI and showed trends of a decrease in blood pressure and low-density lipoprotein cholesterol.

Paediatric hypertension: The importance of prevention and early diagnosis

High Blood Pressure and Hypertension (HTN) in pediatrics are increasing as a result of sedentary lifestyle associated with overweight and obesity that are becoming more prevalent in this population. Despite being a silent disease, it is associated early on with end-organ injuries that increase cardiovascular risk in adults and therefore lead to serious and sometimes fatal events. In addition to prevention, the correct diagnosis and early therapeutics are of great importance. This article aims to alert about the risks of high blood pressure in childhood and adolescence, preventive measures and early interventions, especially in those with primary HTN.

The relationship between body mass index and blood pressure: A study among school going children of Rajasthan, India

Objectives: Hypertension has become common in children and generally remains undiagnosed and untreated. The present study aims to find the prevalence of high blood pressure (BP) and examines the relationship between body mass index (BMI) and BP among school going children. Materials and Methods: A cross-sectional study was conducted among 240 school going children aged between 10 years and 17 years of Udaipur district of Rajasthan. Data were collected using interview schedules and somatometric measurements were taken based on standardized protocols established by the International Society for the Advancement of Kinanthropometry. Data were analyzed using Statistical Package for the Social Sciences software version 20. Hypertension is considered when BP (systolic BP [SBP] and/or diastolic BP [DBP]) level is ≥95th percentile for height, age, and sex according to the Fourth Report on the Diagnosis, Evaluation, and Treatment of High BP in Children and Adolescents (2004). Results: It was found that 49% children were underweight, 3% were overweight, and 2% were obese. Hypertension was seen in 39 (16.2%) children (5.4% systolic hypertension, 5.8% diastolic hypertension, and 5% both systolic and diastolic hypertension). Children who were overweight/obese were more likely to have hypertension than those who were normal or underweight. Conclusion: The findings of the present study indicate that BMI is a crucial factor affecting BP levels. Simple measurements of body weight and height to determine BMI as a routine assessment in schools would help in controlling BP levels in children that might cause adulthood morbidity and mortality due to hypertension.

EVIDENCE OF THE ASSOCIATION BETWEEN SLEEP DURATION AND BLOOD PRESSURE IN ADOLESCENTS: A SYSTEMATIC REVIEW.

ABSTRACTObjective: To review the epidemiological evidence of the association between sleep duration and blood pressure in adolescents.Data sources: We performed a systematic review of observational studies in Medline, Scopus, Lilacs, Web of Science, Science Direct databases and Virtual Libraries in English, Spanish and Portuguese published until September 2018. Studies were selected first by title and abstract, then by complete reading, according to the eligibility criteria. The reference list of selected articles was evaluated in order to retrieve relevant studies.Data synthesis: Initially, 1,455 articles were retrieved. After exclusion due to duplicity or not meeting the eligibility criteria, 13 articles were included in the review. Studies varied greatly in sample size (143 to 6,940 patients), methods of measuring blood pressure and sleep duration, cutoff points, categorization and adjustment of variables. The main evidence from the studies is that short sleep duration is associated with high blood pressure in adolescence, although the presence of association between high blood pressure and long sleep duration is possible, but not clear in the literature.Conclusions: Sleep duration, especially short duration, is associated with high blood pressure in adolescents. Such evidence draws attention to implications on cardiovascular health in this age group.

Hypertension among obese children and youth age 8-12:Project EDDY-Kids 2019

ABSTRACT Hypertension in children and adolescents has increased over the years and is considered as a major public health issue. The correlation between obesity and hypertension is well established; data show the persistence of elevated blood pressure in children and adolescence into adulthood, which leads to cardiovascular diseases. In the EDDY-Kids 2019 prevention programme, we measured the blood pressure of 123 school children (ages 8–12) over the period of 6 months, starting in January, additionally giving weekly nutrition lessons and sports activities to evaluate the influence of a nutrition-, sports-, and lifestyle intervention on the children’s body composition, weight, and blood pressure. At all stages of the project, the number of children with elevated pressure was lower in the normal and below-normal cohorts compared to the overweight and obese group. This demonstrates a positive correlation between obesity and hypertension. In both groups, blood pressure values dropped over the time period of the programme. This could be the result of the intervention programme or the children adapting to the unusual situation. A lot of children were nervous or haven’t even experienced a blood pressure measurement before. The results clearly underline the necessity of measuring children’s blood pressure on a regular basis (annually or semi-annually) to allow nurses and doctors to facilitate the earliest possible diagnosis of elevated blood pressure in children, thereby helping to prevent a persistence of hypertension into adult age.

The Dose–Response Relationship Between Physical Activity and Cardiometabolic Health in Adolescents

This study examines the dose-response relationship between moderate-to-vigorous physical activity and cardiometabolic measures in adolescents. Cross-sectional spline analyses were performed using 2003-2016 National Health and Nutrition Examination Survey data among adolescents (aged 12-19 years, N=9,195) on objectively measured (2003-2006) and self-reported (2007-2016) weekly mean minutes of moderate-to-vigorous physical activity and cardiometabolic measures (systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein, BMI, and cardiorespiratory fitness). Inflection points were determined for nonlinear relationships. For objective moderate-to-vigorous physical activity, female adolescents had significant nonlinear associations with inflection points at 90 minutes/week for BMI percentile and systolic blood pressure. Male adolescents had inflection points at 150 weekly minutes of objective activity for BMI percentile and cardiorespiratory fitness. BMI percentile was about 7% lower for female and male adolescents at 150 weekly minutes of objectively measured moderate-to-vigorous physical activity than at 0 minutes. For self-reported moderate-to-vigorous physical activity, inflection points were at 375 minutes/week (diastolic blood pressure for female adolescents) and 500 minutes/week (systolic blood pressure for male adolescents). Among several significant dose-response relationships between physical activity and cardiometabolic health in adolescents, consistent and often nonlinear relationships were identified for BMI, with inflection points at 90-150 minutes of objective moderate-to-vigorous physical activity. Notable differences in associations and linearity were identified by sex and physical activity measure (objective or self-reported). These results support calls for any increase in physical activity among adolescents and suggest that recommendations closer to the adult guidelines of 150 weekly minutes of physical activity may be health promoting and more attainable for youth than the current recommendation of 420 weekly minutes.

Subjective Proximity to Green Spaces and Blood Pressure in Children and Adolescents: The CASPIAN-V Study.

Evidence favoring a beneficial association between greenness and blood pressure (BP) in adults is accumulating. However, children and adolescents have been understudied accordingly. Methodologically, the data on “exposure” to residential green spaces are commonly satellite-derived, including rare existing studies on the relationship between proximity to green spaces and BP in children. Despite perfectly obliterating subjective biases, remote sensing methods of greenness data collection fail to address pragmatic interaction with such settings. This study aimed to assess the relationship between subjective proximity to green spaces and average/elevated BP in children. Through our study, systolic and diastolic BPs of 12,340 schoolchildren living in CASPIAN-V study areas were examined and recorded. We performed surveys to obtain the data on their proximity to green spaces, defined as having access to such spaces within a 15-minute walk from their homes. Linear mixed-effects models with BP as the outcome variable and the measure of exposure to green spaces as fixed-effect predictor were applied. The analysis was adjusted for several covariates. We found that perceived residential proximity to green spaces was associated with −0.08 mmHg (95% confidence intervals (CIs): −0.58, 0.41; p value = 0.72) reduction in systolic BP and −0.09 (95% CIs: −0.49, 0.31; p value = 0.66) reduction in diastolic BP. We also observed statistically nonsignificant odds ratio of 1.03 (95% CIs: 0.76, 1.39), 0.96 (95% CIs: 0.80, 1.16), and 0.98 (95% CIs: 0.82, 1.16) for isolated systolic/diastolic hypertension and hypertension, respectively. Our observations remained consistent after adjustment for height, parental employment, low birth weight, parental obesity, single parent, and breastfeeding. In conclusion, subjective proximity to green spaces might not be associated with a lower mean BP in children. Well-designed studies applying both subjective and objective data should be performed to elaborate on the relationship further.

Elevated blood pressure in childhood or adolescence and early cardiovascular damage

With the increase of overweight and obesity, elevated blood pressure (BP) in children and adolescents has been an important public health issue globally. Many studies have assessed the association between elevated BP and early cardiovascular damage in children and adolescents. A majority of these studies have highlighted the effects of elevated BP on cardiovascular damage, but with partly inconsistent findings. The studies of biological mechanisms played important roles in illuminating the potential mechanisms of cardiovascular damage caused by elevated BP. In addition, studies on the interventions, including losing weight and lowing BP were beneficial to reduce the occurrence of or reverse early cardiovascular damage. In this review, we reviewed articles on the association between elevated BP and early cardiovascular damage (including structural and functional damage of cardiac and vessels) in children and adolescents, underlying biological mechanisms, and the effectiveness of interventions to provide a reference for the prevention and intervention of early cardiovascular damage caused by elevated BP in children and adolescents and then reduce the occurrence of cardiovascular disease in adulthood.