Blood Pressure In Children Research Articles

8137 Prevalence Of Overweight And Obesity In Dominican Children With Congenital Heart Disease

Abstract Disclosure: L.D. Rojas Rodríguez: None. M.J. Mateo Pérez: None. L.C. López Sención: None. V.T. San Martin: None. A. Grullón: None. Background: Overweight and obesity can be detrimental to the health of children with congenital heart disease, potentially leading to or contributing to other chronic medical conditions such as hypertension. This, in turn, may increase the cardiovascular demands of these patients whose lives are already affected by a defective heart anatomy. Objective: To determine the prevalence of overweight and obesity in Dominican children with congenital heart disease. Methods: An observational cross-sectional study was conducted to determine the prevalence of overweight and obesity in children with congenital heart disease attending the Pediatric Cardiology Department at Children's Hospital (Santo Domingo, Dominican Republic), from July to December 2022. The study population was classified into categories of underweight, normal weight, overweight or obesity using the CDC Body Mass Index-for-age growth chart (2022), based on their age, weight, height, and sex. The parents of the patients were interviewed to gather information about their children’s medical history, as well as their diet type and level of physical activity. Diet type was assessed through a questionnaire about daily meals; diets in which processed foods and simple carbohydrates were predominant were categorized as unhealthy, while those with a predominance of proteins and complex carbohydrates were categorized as healthy. Physical activity levels were measured using the Assessment of Physical Activity Level Questionnaire (APALQ). Additionally, blood pressure values were categorized as normal or elevated/high based on the American Academy of Pediatrics Clinical Practice Guidelines for Screening and Management of High Blood Pressure in Children and Adolescents (2017). Results: A total of 84 patients with congenital heart disease were analyzed, with 11.9% (10/84) categorized as having overweight and 23.8% (20/84) categorized as having obesity. Among patients with overweight or obesity, unhealthy eating habits predominated in 66.7% (20/30), while a sedentary level of physical activity was reported in 56.7% (17/30). Additionally, among patients with overweight or obesity, 36.7% (11/30) had elevated/high blood pressure. Conclusion: About one-third of Dominican patients with congenital heart disease were found to have overweight or obesity. Additionally, about one-third of those with excess weight were found to have elevated/high blood pressure. These findings stress the need for urgent implementation of personalized interventions and educational programs focused on fostering healthier lifestyles. The ultimate goal is to reduce cardiovascular risks and improve the overall well-being of children living with congenital heart disease. Presentation: 6/1/2024

Effectiveness, Acceptability, and Feasibility of a School-Based Program for Detecting High Blood Pressure in Children

Effectiveness, Acceptability, and Feasibility of a School-Based Program for Detecting High Blood Pressure in Children

Epigenetic Clock at Birth and Childhood Blood Pressure Trajectory: A Prospective Birth Cohort Study.

The impact of methylation gestational age (GAmAge; a biomarker of fetal maturity) at birth on childhood blood pressure (BP) trajectories is unknown. This cohort study included 500 boys and 440 girls with data on cord blood DNA methylation and BP at 3 to 15 years of age. Systolic BP (SBP) and diastolic BP percentiles were calculated based on clinical guidelines. Time-series K-means clustering identified 4 distinct SBP and diastolic BP percentile trajectories: high-steady, high-decrease, normal-increase, and normal-steady. GAmAge was estimated using an existing pediatric epigenetic clock. Extrinsic age acceleration was calculated as residuals of associations between GAmAge and chronological gestational age. Intrinsic age acceleration was calculated using the same method adjusting for cord blood cell compositions. Extrinsic age acceleration and intrinsic age acceleration were inversely associated with repeated measures of BP percentiles. Significant inverse associations were observed between extrinsic age acceleration and SBP percentiles in boys (β=-2.02; P=0.02) but not in girls (β=-0.49; P=0.58). Both extrinsic age acceleration and intrinsic age acceleration were inversely associated with SBP percentiles in girls born preterm (<37 weeks; βEAA=-2.95; βIAA=-3.00; P<0.05). Compared with the normal-steady SBP trajectory, significant inverse associations were observed between intrinsic age acceleration and high-steady, high-decrease, and normal-increase SBP trajectories in boys (odds ratio, 0.73-0.81; P<0.03), and significant positive associations were observed for high-decrease and normal-increase SBP trajectories in girls (odds ratio, 1.26-1.38; P<0.01). Significant sex differences were observed (Psex-interaction<2×10-16). GAmAge acceleration at birth was inversely associated with child BP, and such association was more pronounced in boys than in girls. Our findings may shed new light on the developmental origins of high BP and sex differences in cardiovascular risk.

The impact of air temperature and humidity on Children’s blood pressure mediated by Lipids: A prospective cohort study

ObjectivesFew studies illustrate the mechanism between air temperature and blood pressure (BP) in childhood. This study aims to investigate the associations between air temperature, humidity exposure, and BP trajectories in children and adolescents, and explore the potential mediating roles of lipid profiles in these relationships. MethodsThis prospective cohort study included 5,971 children with 10,800 person-times measurements at baseline from the Chongqing Health Cohort, with evaluations conducted in 2014–2015 (baseline) and follow-ups in 2016 (urban areas) and 2019 (urban and rural areas). Multilevel mixed-effects models were used to analyse the impacts of air temperature and humidity on BP levels and the incidence of elevated BP, while accounting for potential confounders. Mediation analyses were performed to evaluate the mediating effects of lipid profiles, including low-density lipoprotein (LDL), total cholesterol (TC), and specific lipid species. ResultsAfter adjusting for covariates, higher air temperature quartiles were associated with both decreased BP levels and elevated BP risk (RR: 0.83; 95 % CIs: 0.78, 0.89; P = 0.028). Conversely, higher humidity quartiles exhibited a U-shaped relationship with BP levels. Greater variability in air temperature was linked to increase BP levels. The cumulative effects of air temperature exposure on BP were significant from pregnancy to age 10, with females exhibiting larger effects (β:-3.291, 95 % CIs: −4.242,-2.340, P < 0.001). LDL and TC partially mediated the associations between air temperature and BP levels, particularly in males. Specific lipid species, including SM (d21:1), LPC (17:0), and PC (O-36:3), also exhibited significant mediating effects. ConclusionsThis study provides novel insights into the intricate interplay between air temperature, humidity, lipid metabolism, and blood pressure regulation in children. Lower average temperatures and extreme humidity levels were associated with increased risks of elevated BP, potentially mediated by lipid profiles. Early interventions targeting air temperature exposure and lipid metabolism could mitigate hypertension risk, promoting improved cardiovascular outcomes in children.

Cardiovascular Health Starts in the Womb.

Hypertension has largely been viewed as a disorder of adulthood. Historically, blood pressure (BP) was not routinely measured in children because hypertension was considered uncommon in childhood. It was not until the 1970s that it was apparent that in childhood BP levels were normally lower compared with those in adults, were related to age and growth, and that abnormal BP in children needed different definitions. Based on the distribution of BP levels in available child cohorts, the 95th percentile of BP levels became the definition of hypertension in children and adolescents-an epidemiological definition. Subsequent clinical and epidemiological research identified associated risk factors in childhood that linked abnormal BP in youth with hypertension in adulthood. In the 1980s, the Barker hypothesis, based on observations that low birth weight could be linked to cardiovascular disease in adulthood, promoted further research spanning epidemiological, clinical, and basic science on the childhood origins of hypertension. This review focuses on recent findings from both longitudinal maternal-child cohorts and experimental models that examine both maternal and offspring conditions associated with risks of subsequent cardiovascular disease.

Short-Half-Life Chemicals: Maternal Exposure and Offspring Health Consequences-The Case of Synthetic Phenols, Parabens, and Phthalates.

Phenols, parabens, and phthalates (PPPs) are suspected or known endocrine disruptors. They are used in consumer products that pregnant women and their progeny are exposed to daily through the placenta, which could affect offspring health. This review aims to compile data from cohort studies and in vitro and in vivo models to provide a summary regarding placental transfer, fetoplacental development, and the predisposition to adult diseases resulting from maternal exposure to PPPs during the gestational period. In humans, using the concentration of pollutants in maternal urine, and taking the offspring sex into account, positive or negative associations have been observed concerning placental or newborn weight, children's BMI, blood pressure, gonadal function, or age at puberty. In animal models, without taking sex into account, alterations of placental structure and gene expression linked to hormones or DNA methylation were related to phenol exposure. At the postnatal stage, pollutants affect the bodyweight, the carbohydrate metabolism, the cardiovascular system, gonadal development, the age of puberty, sex/thyroid hormones, and gamete quality, but these effects depend on the age and sex. Future challenges will be to explore the effects of pollutants in mixtures using models and to identify the early signatures of in utero exposure capable of predicting the health trajectory of the offspring.

Revealing the links between hair metal(loids) and alterations in blood pressure among children in e-waste recycling areas through urinary metabolomics

Hypertension is prevalent in e-waste recycling areas, and elevated blood pressure in children significantly increases the risk of hypertension in adulthood. However, the associations and toxic pathways between chronic exposure to metal(loids) and elevated blood pressure are rarely investigated. In this study, we measured the levels of 29 hair metal(loids) (chronic exposure biomarkers) and blood pressure in 667 susceptible children from an e-waste recycling area to explore their relationships. Paired urine metabolomics analysis was also performed to interpret potential mechanistic pathways. Results showed that the hypertension prevalence in our recruited children (13.0 %) exceeded the average rate (9.5 %) for Chinese children aged 6–17 years. The top five abundant metal(loids), including lead, strontium, barium, and zinc, demonstrated the most profound associations with elevated systolic blood pressure. Quantile g-computation, weighted quantile sum, and Bayesian kernel machine regression analysis jointly demonstrated a significant association between chronic exposure to metal(loids) mixture and systolic blood pressure. Interestingly, selenium showed significant antagonistic interactions with these four metals, suggesting that supplementing selenium may help children resist the elevated blood pressure induced by metal(loids) exposure. Increased metal(loids) and blood pressure levels were significantly linked to changes in urine metabolomics. Structural equation model indicated that androsterone glucuronide and N-Acetyl-1-aspartylglutamic acid were the significant mediators of the associations between metal(loids) and blood pressure, with mediation effects of 77.4 % and 29.0 %, respectively, suggesting that androsterone glucuronide and N-Acetyl-1-aspartylglutamic acid may be involved in the development of metal-induced blood pressure elevating effect. Girls were more vulnerable to metal(loids)-induced hormonal imbalance, especially androsterone glucuronide, than boys. Chronic exposure to metal(loids) at e-waste recycling sites may contribute to elevated blood pressure in children through disrupting various metabolism pathways, particularly hormonal balance. Our study provides new insights into potential mechanistic pathways of metal(loids)-induced changes in children's blood pressure.

Accuracy of the WatchBP Office Central as a Type 2 device for non-invasive estimation of central aortic blood pressure in children and adolescents.

High blood pressure (BP) in childhood is a recognised precursor of elevated cardiovascular risk in adulthood. Brachial BP is normally used for clinical decision making, but central BP may be a better marker of pressure load on the heart. There is a paucity of validated non-invasive, automated devices for estimating central BP in children and adolescents. In this study, we compared the WatchBP Office Central (a Type 2 central pressure estimation device) against a high-fidelity micromanometer in the ascending aorta of anaesthetised patients undergoing clinically-indicated catheterisation (n = 15, age 4-16 years). As a secondary aim, central systolic BP (cSBP) was also compared to two non-invasive estimation methods in 34 awake patients undergoing routine cardiac MRI (age 10-18 years). WatchBP substantially overestimated cSBP compared to the intra-arterial gold-standard reference (26.1 ± 7.4mmHg), and recruitment was terminated at n = 11 (included in the analysis) due to high statistical certainty that the device would not pass the validation criteria of 5±8 mmHg. WatchBP cSBP was also substantially higher than values obtained from a phase contrast MRI method (11.8 ± 7.9 mmHg) and the SphygmoCor XCEL (13.5 ± 8.9 mmHg) in the awake patient group, which translate to 21-23 mmHg on average after accounting for known/estimated biases in these non-invasive comparators. Compared with invasive central diastolic and systolic BPs, the brachial measures from WatchBP yielded errors of 0.1 ± 5.6 and 12.5 ± 6.0 mmHg respectively. We conclude that the WatchBP substantially overestimates cSBP in children and adolescents. These findings reinforce the need for central BP-measuring devices to be further developed and validated in this population.

O107 A LONGITUDINAL STUDY ON THE IMPACT OF CHILDHOOD ELEVATED BLOOD PRESSURE ON TARGET ORGAN HEALTH IN ADOLESCENCE: THE EXAMIN YOUTH SA STUDY

Background and objective: Primary hypertension in children is becoming a global threat for the growing economic burden of hypertension management in adulthood and sustainable healthcare. We determined the associations of adolescent blood pressure (BP) with target organ damage markers (carotid intima-media thickness (CIMT) and left ventricular mass index (ilVM)) over a four year period, stratified by childhood BP status at baseline. Methods: We included 421 Black and 307 White South African adolescents (mean age: 11.04 years) with complete follow-up data for BP, CIMT and iLVM. Standard anthropometric measures and basic demographic information were collected. Results: Children were stratified by baseline BP status, i.e., normotensive; n=454 (57.5% Black and 57.7% female) and elevated BP; n=274 (58.4% Black and 52.2% female), with comparable proportions of ethnicity (p=0.81) and sex (p=0.15). Systolic BP (by 6mmHg; p&lt;0.001), diastolic BP (by 3mmHg; p&lt;0.001) and perfusion pressure (by 4mmHg; p&lt;0.001) as well as sex-specific body mass index for age z-scores (BAZ; p&lt;0.001) were all higher in the elevated BP compared to normotensive group. Groups were comparable for age (p=0.78), CIMT (p=0.28) and iLVM (p=0.64). In partial regression analysis (adjusting for ethnicity, sex, follow-up age and BAZ), systolic BP correlated positively with CIMT (r=0.125; p=0.041) and iLVM (r=0.184; p=0.002) in the elevated BP group only. Backward multiple adjusted linear regression analysis (adjustment for perfusion pressure at baseline, age, sex, ethnicity and BAZ) showed adverse associations of systolic BP with CIMT (β=0.126; p=0.046) and iLVM (β=0.199; p=0.001), and diastolic BP with iLVM (β=0.130; p=0.002), only in children with elevated BP at baseline. Conclusion: Elevated BP in early childhood contributes to the long-term impact on target organ health during adolescence independent of sex and ethnicity, while the association of BP with iLVM seems to be moderated by excess adiposity.

Changes of oxidative stress in 3D film to be prepared for echocardiography: A randomized controlled study.

Echocardiography (ECHO) is a nonprocedure that causes acute stress in children. Fear, anxiety, and fluctuations in children's blood pressure and heart rate can potentially lead to alterations in echocardiographic measurements. The insufficient research on virtual reality pediatric preparation applications, particularly in the context of echocardiographic procedures, underscores the necessity for additional studies focusing on pediatric patients. This study sought to assess the impact of virtual reality applications tailored explicitly for ECHO on children's oxidative stress levels. This was a prospective, randomized, controlled experimental study. Forty-eight children (experimental/24, control/24) aged 7 to 12 years who had an ECHO appointment in the pediatric cardiology outpatient clinic in the 3 months from June to August 2019 participated in the study. Participants whose blood analyses showed hemolysis were eliminated, and the study was completed with 37 children in total: 16 children in the experiment and 21 children in the control. Post hoc power analysis was performed for sample adequacy, and the power of the study was found to be 0.99. A 3D film was prepared for the research and applied to the experimental group before the procedure. All children's oxidative stress levels (cortisol, malondialdehyde, nitric oxide) and glutathione levels were checked after ECHO. The stress hormone cortisol and malondialdehyde levels were lower in the 3D-applied experimental group than in the control group. As another crucial anti-stress antioxidant factor, glutathione level increased in the experimental group compared to the control group (P < .05). The research revealed that the 3D film used to prepare ECHO reduces the stress parameters associated with heart risk and may affect the ECHO measurements. At the same time, the study also proved the positive effect of 3D film preparation by increasing the anti-stress factor.

The association of blood pressure, body mass index and carotid intima-media thickness as childhood predictors of cardiovascular disease risk: A systematic review and meta-analysis.

Blood pressure, body mass index (BMI), and carotid intima-media thickness (CIMT) are well-known independent predictors of cardiovascular disease especially in adulthood. However, there is insufficient evidence regarding the statistical significance of the relationship between childhood CIMT, blood pressure and BMI. This systematic review and meta-analysis was therefore conducted to ascertain the relationship. This systematic review and meta-analysis was reported in accordance with the PRISMA statement. Three electronic databases were searched, namely EMBASE, MEDLINE and the Cochrane Library. Data were extracted independently by two review authors. Quantitative data were analyzed using Review Manager. The meta-analysis was conducted using a random effects model and standard mean difference. The results of the meta-analysis indicated a statistically significant difference in CIMT of 0.86 (95% CI: 0.41-1.31) between normotensive versus hypertensive children. Again, overweight and moderately obese children had higher CIMT values as compared to normal weight children with a pooled standard mean difference of 0.72 (95% CI: 0.24-1.20) and 2.75 (95% CI: 0.73-4.77) respectively. The pooled standard mean difference of systolic and diastolic blood pressures was found to be 2.44 (95% CI: 1.69-3.19) and 1.28 (95% CI: 0.65-1.92) respectively between normal weight and overweight/obese children. The meta-analysis found a significant difference in CIMT between normotensive and hypertensive children, with overweight and moderately obese children having higher CIMT values. Thus, conducting CIMT screening for obese or overweight children and children with increased blood pressure can provide valuable information about their cardiovascular disease risk.

Diet Quality at 3 Years of Age Relates to Lower Body Mass Index but Not Lower Blood Pressure at 10 Years of Age.

A healthy diet prevents overweight problems and hypertension. We investigated the associations of a healthy diet with the body mass index (BMI) and blood pressure (BP) in early childhood. In the GECKO birth cohort, height, weight, and BP were measured at 5 and 10 years of age. Diet was evaluated at 3 years using three diet scores: the Dietary Approaches to Stop Hypertension (DASH), the Mediterranean Diet Score (MDS), and the Lifelines Diet Score (LLDS). Linear and logistic regression models assessed the associations of diet scores with the BMI and BP. Of the 1077 children included, 10.8% were overweight or obese at 5 years. That number was 16.5% at 10 years. In addition, 34.5% had elevated BP at 5 years. That number was 23.9% at 10 years. Higher DASH, MDS, and LLDS, which indicate healthier diets, were all associated with lower BMI z-scores at 10 years of age. Higher DASH is related to lower overweight risk at 10 years. None of the diet scores were associated with BP or elevated BP at either 5 or 10 years. Also, in an overweight subset, diet was not related to BP. A healthy diet in early childhood is related to children being less overweight but not having lower BP at 10 years of age.

Associations of prenatal and concurrent exposure to phenols mixture with anthropometric measures and blood pressure during childhood: A time-varying mixture approach

BackgroundEnvironmental phenols were recognized as endocrine disrupting chemicals (EDCs). However, their impact on childhood anthropometric measures and blood pressure (BP) is still inconclusive. Limited studies have simultaneously considered prenatal and childhood exposures in analyzing mixtures of phenols. ObjectiveWe investigated the relationships between combined prenatal and childhood exposures (two periodic exposures) to phenol mixtures and anthropometric measure and BP, to further identify the vulnerable periods of phenol exposure and to explore the important individual contribution of each phenol. MethodsWe analyzed 434 mother-child dyads from the Sheyang Mini Birth Cohort Study (SMBCS). The urinary concentrations of 11 phenolic compounds were measured using gas chromatography tandem mass spectrometry. Generalized linear regression models (GLMs) and hierarchical Bayesian Kernel Machine Regression (hBKMR) were used to examine the effects of individual phenolic compounds at each period and of two periodic exposures. ResultsIn the single-chemical analysis, prenatal or childhood exposure to specific phenols, especially Benzopheone-3 (BP3), 4-tert-Octylphenol (4-tOP), and Benzyl paraben (BePB) were associated with BMI z-scores (BAZ), Waist-to-height ratio (WHtR), and BP. In the hBKMR models, two periodic exposures to phenol mixtures had a U-shaped association with WHtR, primarily driven by childhood BePB exposure. Moreover, among the phenol mixtures analysis, childhood 4-tOP exposure was identified as the primary contributor to the positive association with diastolic BP. Concurrent exposure to phenol mixtures resulted in greater susceptibility. ConclusionsWe found that prenatal and childhood exposure to phenol mixtures might influence childhood obesity and elevate blood pressure levels. Concurrent exposure to 4-tOP may be the primary driver of the positive associations with BP.

Primary Hypertension in Children and Adolescents

The incidence of primary hypertension is on the rise in the pediatric population, with an approximate prevalence ranging from 3% to 5%. The most significant risk factors for the onset and development of primary hypertension are well-known, and some of them are preventable, including increased salt consumption and obesity. Connected with metabolic risk factors, elevated blood pressure in childhood is carried into adulthood. Primary hypertension is associated with attenuated vascular responses to various physiological stimuli in both peripheral microcirculation and systemic macrocirculation in adults and children. Endothelial dysfunction is one of the most important features of arterial hypertension, together with an increased level of oxidative stress – both determinants significantly contribute to all the pathophysiological changes observed in hypertension. Systemic arterial hypertension has emerged as a prevalent cardiovascular risk factor associated with substantial morbidity and mortality. Hence, the timely identification of individuals with elevated blood pressure and early-life blood pressure management could serve as a crucial strategy to mitigate the risk of cardiovascular disease and mortality in adulthood.

Defining childhood hypertension: is it too complicated? An evaluation of the potential impact of different approaches in an Australian paediatric population.

Current American Academy of Pediatrics (AAP) and European Society of Hypertension (ESH) thresholds defining hypertension in children use blood pressure (BP) normalised to age, sex and height. However, scare data exists regarding the relative importance of these variables to accurately model the 95th quantile of BP. We hypothesised that height alone may fit the population data equally well compared to more complex definitions. We also compare the potential impact of various thresholds for defining hypertension in an Australian population. Longitudinal data from the Raine Study were used, with 2248 participants contributing 7479 valid BP values across the 3/5/10/14/17-year study visits. BP was measured after 5 min rest, ≥3 times at each visit, using a Dinamap device. Quantile regression was used to predict the 95th percentile of BP, with nonlinear modelling of covariates through restricted cubic spline terms. At a single visit, 6-16% of young children exceeded the ESH threshold and 12-23% the AAP threshold. The transition to fixed thresholds (≥13 years AAP, ≥16 years ESH), increased the number of males (AAP only) and reduced the number of females considered hypertensive. A quantile regression model constructed with Raine Study data using height-only as the explanatory variable better predicted BP than the respective model using age-only (or a combination of the two). There may be large differences in the prevalence of hypertension according to AAP and ESH criteria, with a marked sex-discrepancy emerging from the point of fixed threshold application in adolescence. It may not be necessary to normalise BP by both age and height, the latter being a better predictor of childhood BP. Simpler methods may be preferable in clinical practice but require validation against clinical outcomes.

High Blood Pressure in Children Aged 3 to 12 Years Old With Overweight or Obesity.

Objective: (1) To describe the prevalence of high blood pressure (BP) and the association with BMI in young children with overweight/obesity; (2) to evaluate the accuracy of a single high BP to diagnose sustained hypertension over three visits. Methods: We used pre-intervention data from the Improving Pediatric Obesity Practice Using Prompts (iPOP-UP) trial. We included children aged 3-12 years with BMI ≥85th percentile at well-visits in 2019-2021 at 84 primary care practices in 3 US health systems in the Northeast, Midwest, and South. BP percentiles were calculated from the first visit with BP recorded during the study period. Hypertensive-range BP was defined by the 2017 American Academy of Pediatrics guideline. We tested the association between BMI classification and hypertensive BP using multivariable logistic regression. Results: Of 78,280 children with BMI ≥85th percentile, 76,214 (97%) had BP recorded during the study period (mean 7.4 years, 48% female, 53% with overweight, and 13% with severe obesity). The prevalence of elevated or hypertensive BP was 31%, including 27% in children with overweight and 33%, 39%, and 49% with class I, II, and III obesity, respectively. Higher obesity severity was associated with higher odds of hypertensive BP in the multivariable model. Stage 2 hypertensive BP at the initial visit had specificity of 99.1% (95% confidence interval 98.9-99.3) for detecting sustained hypertension over ≥3 visits. Conclusions: High BP is common in 3- to 12-year-olds with overweight/obesity, with higher obesity severity associated with greater hypertension. Children with overweight/obesity and stage 2 BP are likely to have sustained hypertension and should be prioritized for evaluation. Trial Registration: ClinicalTrials.gov Identifier: NCT05627011.

FEASIBILITY OF SCHOOL-BASED SCREENING FOR HIGH BLOOD PRESSURE IN CHILDREN: THE HEALTHY HEARTS @ SCHOOL STUDY

Objective: High blood pressure (BP) in childhood is associated with end organ damage and cardiovascular events in mid-adulthood. Community-based BP screening may improve equitable access and awareness, but robust methodology is required. Accordingly, our aim was to assess the acceptability and feasibility of a two-stage school-based BP screening program incorporating targeted 24-hour ambulatory blood pressure monitoring (ABPM). Design and method: One-hundred-ninety-eight children (59% male, 7.6–12.7 years) in grades 3-6 were recruited from three primary schools in Melbourne, Australia. Following an education session for all children in these grades, BP was measured five times in students after parental consent, using the auscultatory method, alternating between arms and after five minutes of rest. Those with an average BP &gt;85th percentile (AAP thresholds) or a risk factor for high BP had these measurements repeated two weeks later, along with ABPM. Families and students also completed an optional questionnaire post-program. Results: At the first assessment, 11 (5.6%) and 10 (5.0%) had elevated or hypertensive BP respectively (14.6% combined if using just the first measure). Fifty-nine (29.8%) were selected for the second assessment (including 10 with obesity, 15 born premature, four with a history of congenital heart disease, and nine with BP &gt;85th percentile, but &lt;90th percentile), of which 52 attended. ABPM indicated that 11 (5.6%) and five (2.5%) had white coat hypertension based on assessment one and two respectively, three (1.5%) had sustained hypertension (based on either assessment stage), and two (1%) had masked hypertension. Three additional participants each had either high BPs during school assessment but did not undertake, or had inconclusive, ABPMs. Overall, 11 (5.6%) were referred to a doctor for medical follow-up. The majority of students (67%) reported that ABPM was tolerable (‘bothersome’ score &lt;8/10 for day and/or night). 96% of families approved of the program and 90% welcomed it as part of their child's schooling. Conclusions: These data indicate that a school-based BP screening program is acceptable and feasible, and that measuring BP on multiple occasions, and with targeted ABPM, is pivotal for minimising false positives and unnecessary referrals.

Associations between maternal exposure to multiple metals and metalloids and blood pressure in preschool children: A mixture-based approach

BackgroundExposure to metals during pregnancy can potentially influence blood pressure (BP) in children, but few studies have examined the mixed effects of prenatal metal exposure on childhood BP. We aimed to assess the individual and combined effects of prenatal metal and metalloid exposure on BP in preschool children. MethodsA total of 217 mother–child pairs were selected from the Zhuang Birth Cohort in Guangxi, China. The maternal plasma concentrations of 20 metals [e.g. lead (Pb), rubidium (Rb), cesium (Cs), and zinc (Zn)] in early pregnancy were measured by inductively coupled plasmamass spectrometry. Childhood BP was measured in August 2021. The effects of prenatal metal exposure on childhood BP were explored by generalized linear models, restricted cubic spline and Bayesian kernel machine regression (BKMR) models. ResultsIn total children, each unit increase in the log10-transformed maternal Rb concentration was associated with a 10.82-mmHg decrease (95% CI: −19.40, −2.24) in childhood diastolic BP (DBP), and each unit increase in the log10-transformed maternal Cs and Zn concentrations was associated with a 9.67-mmHg (95% CI: −16.72, −2.61) and 4.37-mmHg (95% CI: −8.68, −0.062) decrease in childhood pulse pressure (PP), respectively. The log10-transformed Rb and Cs concentrations were linearly related to DBP (P nonlinear=0.603) and PP (P nonlinear=0.962), respectively. Furthermore, an inverse association was observed between the log10-transformed Cs concentration and PP (β =-12.18; 95% CI: −22.82, −1.54) in girls, and between the log10-transformed Rb concentration and DBP (β =-12.54; 95% CI: −23.87, −1.21) in boys, while there was an increasing association between the log10-transformed Pb concentration and DBP there was an increasing in boys (β =6.06; 95% CI: 0.36, 11.77). Additionally, a U-shaped relationship was observed between the log10-transformed Pb concentration and SBP (P nonlinear=0.015) and DBP (P nonlinear=0.041) in boys. Although there was no statistically signiffcant difference, there was an inverse trend in the combined effect of maternal metal mixture exposure on childhood BP among both the total children and girls in BKMR. ConclusionsPrenatal exposure to both individual and mixtures of metals and metalloids influences BP in preschool children, potentially leading to nonlinear and sex-specific effects.

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

BackgroundThe World Health Organization recommends calcium supplementation (1500–2000 mg/d) during pregnancy for women with a low-calcium intake. ObjectivesThe 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). MethodsFollow-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. ResultsFive 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. ConclusionsThis 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.

IJCM_139A: Prevalence of Hypertension among the Urban Adolescents: A Prospective Robust Survey

Background: Childhood Blood pressure (BP) is a strong indicator of adult blood pressure (BP), hence, early detection and intervention is important in adolescents. Studies from China and United States have shown BP in adolescents to be variable and has indeed outlined the need to obtain three separate readings before diagnosing hypertension. There is a dearth of this documentation of blood pressure readings at different occasions in adolescents from the Indian settings. Objective: To determine the prevalence of elevated blood pressure and hypertension among 10-18 years school going adolescents. Methodology: This was a prospective longitudinal study conducted across the five urban schools of Bhopal amongst 10-18 years adolescents. Multistage cluster sampling was adopted to cover an estimated sample size of 780 over a one-year period. Those adolescents who were present during the time of survey following their parent’s consent were included. Those who were absent at two occasions during the follow up visit and those who were diagnosed with secondary hypertension were excluded. Those who satisfied the study criteria were given a self-administered WHO STEPS questionnaire initially. The height and weight were obtained followed by measurement of three auscultatory BP readings at an interval of one week apart (American Academy of paediatrics (Updated guidelines 2017) in each student. The R shiny app calculator was used for classifying hypertension in adolescents. The study was funded by AIIMS Bhopal and ethical clearance was obtained from the institute. Results: The overall prevalence of elevated BP/hypertension in adolescents was 1.4% (N=795). There was a positive correlation between BMI and (SBP &amp; DBP). The generalised linear mixed model showed age, BMI and boys to have higher predisposition to elevated BP/HTN. There was a significant difference in the SBP and DBP between the 3 visits stratified by sex. Also, the change in SBP and DBP between the readings were significant by ANOVA. Conclusion: The prevalence of elevated BP/HTN was 1.4% with girls being protective for girls. The study cannot be generalised as it is limited to the Government schools with relatively small sample size.