Elevated Blood Pressure In Adolescents Research Articles

Association of consumption of sugar-sweetened beverages with elevated blood pressure among college students in Yunnan Province, China.

Although some studies have examined the association between eating behaviour and elevated blood pressure (EBP) in adolescents, current data on the association between sugar-sweetened beverages (SSB) and EBP in adolescents in Yunnan Province, China, are lacking. Cluster sampling was used to survey freshmen at a college in Kunming, Yunnan Province, from November to December. Data on SSB consumption were collected using an FFQ measuring height, weight and blood pressure. A logistic regression model was used to analyse the association between SSB consumption and EBP, encompassing prehypertension and hypertension with sex-specific analyses. The analysis included 4781 college students. Elevated systolic blood pressure (SBP) and diastolic blood pressure (DBP) were detected in 35·10 % (1678/4781) and 39·34 % (1881/4781) of patients, respectively. After adjusting for confounding variables, tea beverage consumption was associated with elevated SBP (OR = 1·24, 95 % CI: 1·03, 1·49, P = 0·024), and carbonated beverage (OR = 1·23, 95 % CI: 1·04, 1·45, P = 0·019) and milk beverage (OR = 0·81, 95 % CI: 0·69, 0·95, P = 0·010) consumption was associated with elevated DBP in college students. Moreover, fruit beverage (OR = 1·32, 95 % CI: 1·00, 1·75, P = 0·048) and milk beverage consumption (OR = 0·69, 95 % CI: 0·52, 0·93, P = 0·014) was associated with elevated DBP in males. Our findings indicated that fruit and milk beverage consumption was associated with elevated DBP in males, and no association was observed with EBP in females.

Prevalence of Elevated Blood Pressure and Its Relationship With Anthropometric Risk Factors in Students of a Pre-university Girls' College in Bangalore: A Cross-Sectional Study.

Background There is a growing concern regarding elevated blood pressure in adolescence. Children and adolescents with high blood pressure are at risk for adult hypertension. Being overweight and obese are important risk factors for hypertension. This study aimed to determinethe prevalence of elevated blood pressure and its association with anthropometric risk factors among students of a pre-university girls' college. Methodology A cross-sectional study was conducted among 337 students at a pre-university girls' college aged 15-19 years in urban Bangalore. A self-administered, semi-structured, pretested questionnaire collected the sociodemographic details, family history, and lifestyle. Height, weight, waist circumference (WC), and hip circumference were measured. Standard cut-off levels were used for body mass index (BMI), WC, waist-hip ratio (WHR), and waist-height ratio (WHtR). Resting blood pressure was determined using a digital blood pressure monitor. It was classified into normotensive, pre-hypertension (>90th to <95th percentile), and hypertension (>95th percentile). Data were analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA). Pre-hypertension and hypertension were considered as having elevated blood pressure. Results The prevalence of pre-hypertension and hypertension was 21.4% (n = 72, 95% confidence interval (CI) = 17.0-25.7) and 9.8% (n = 33, 95% CI = 6.6-13.0), respectively. The prevalence of overweight was 20.2% (n = 68, 95% CI = 15.9-24.5) and obesity was 12.2% (n = 41, 95% CI = 8.7-15.7). WC, WHR, and WHtR were abnormal in 34.7% (n = 117, 95% CI = 29.6-39.8), 47.5% (n = 160, 95% CI = 42.1-52.8), and 45.7% (n = 154, 95% CI = 50.4-51.0), respectively. There was a statistically significant correlation betweensystolic blood pressure and BMI (p < 0.001), WC (p < 0.001), and WHtR (p < 0.001), as well asdiastolic blood pressure and BMI (p < 0.001), WC (p = 0.008), and WHtR (p = 0.011). Statistically significant differences in mean BMI (p = 0.004), WC (p < 0.001), WHR (p = 0.007), and WHtR (p = 0.001) between normal, pre-hypertensive, and hypertensive students were also noted. Conclusions Pre-hypertension and hypertension are fundamental problems in pre-university girl students. With a similarly increased prevalence of obesity and other anthropometric risk factors, students must be aware of hypertension and its risk factors.

Abstract 15182: Evaluation of an Electronic Clinical Decision Support Tool for Incident Elevated Blood Pressure in Adolescents

Introduction: The PedsBP Clinical Decision Support (CDS) is an electronic health record-linked tool developed in an urban health system that aims to improve the quality of blood pressure (BP) measurement and recognition of hypertension in children. Aims: To describe the feasibility of implementing the PedsBP tool for use in a rural health system, and to describe repeat BP measurement among patients 6-17 years with an incident hypertensive BP at high-intensity clinics using the PedsBP CDS. Methods: This is a 3-arm, parallel group, cluster randomized controlled pragmatic trial in 40 community-based primary care clinics in a rural Midwestern health system (Essentia Health). Clinics were randomized 1:1:1 to usual care, low-intensity implementation (PedsBP CDS only), or high-intensity implementation (Peds BP CDS plus in-person training, monitoring CDS use, and feedback). The PedsBP CDS includes an alert to re-measure a hypertensive BP at that visit, an alert that a hypertensive BP should be repeated in 1-3 weeks, and patient-specific order sets. Study outcomes include repeat BP measurement at an index visit and diagnosis of hypertension within 6 months of meeting clinical criteria. Safety outcomes include stroke, transient ischemic attack, acute renal failure, uncontrolled hypertension within 6 months of index visit. Results: Among 22,238 (50.9% female, mean age 11.7 years, SD=3.5 years) patients with visits between 8/1/22-1/31/23 at participating clinics, 4008 (18.0%) had an incident hypertensive BP and 239 (1.1%) met clinical criteria for hypertension. Among those who met clinical criteria for hypertension, there were no cases of uncontrolled hypertension or other safety outcomes. Of 7974 patients with encounters at 13 high-intensity clinics and with a BP measured, the initial BP was elevated for 1307 (16.4%) and remeasured in 628 (48.1%). Among 1265 patients at high-intensity clinics with a BP elevated and with body mass index (BMI) information, 482 (38.1%) were obese (BMI percentile ≥95%), 209 (16.5%) were overweight (BMI percentile 85% to &lt;95%), and 574 (45.4%) were not overweight or obese (BMI percentile &lt;85%). Conclusions: The PedsBP CDS is feasible to implement in a new health system and has the potential to improve the quality of pediatric BP care.

0755 The Relationships Between Sleep Duration, Sleep Efficiency, and Blood Pressure During Late Adolescence

Abstract Introduction Elevated blood pressure (BP) is an important modifiable risk factor for cardiovascular disease (CVD), the leading cause of death in the world. Elevated BP in adolescence increases the risk for CVD in adulthood. Unfortunately, 1.3 million adolescents (ages 12 to 19) have extremely elevated blood pressure or hypertension (HTN). Evidence suggests that sleep duration is associated with HTN in adults, but less is known about these relationships during adolescence. Furthermore, there is limited research focused on specific developmental stages, particularly late adolescence, which is the last age group before adulthood. Also, there is a paucity of research on BP including other sleep variables like sleep efficiency. Therefore, the purpose of this secondary data analysis was to determine if sleep duration and sleep efficiency were associated with BP during late adolescence. Methods This secondary data analysis included older adolescents (16-18 years) who participated in the Cleveland Children’s Sleep and Health Study, a cohort study examining sleep disturbances and health outcomes. Height, weight, and BP (systolic (SBP) and diastolic (DBP)) were measured using standard clinical procedures. Objective sleep duration and sleep efficiency were measured by at least five days of actigraphy. Subjective sleep duration was averaged from daily self-report. The association was evaluated using Pearson correlations and multiple linear regressions. Results This sample included 259 adolescents (age 17.7±0.4, 63.3% White, 55.6% female). Pearson correlation analysis indicated a negative relationship between sleep efficiency and SBP (r = -0.210, p &amp;lt; 0.001) with a small-medium effect size (95% CI [-0.316, 0.098]). However, the negative correlation between sleep efficiency and SBP was no longer significant after controlling for assigned sex, race, and body mass index percentiles in a multiple linear regression model. Conclusion This secondary data analysis did not provide sufficient evidence on the associations between sleep duration and sleep efficiency with BP in older adolescents, possibly due to the homogenous sample with small variations in BP, sleep duration, and sleep efficiency. Therefore, there is a need for future studies including more heterogenous samples to evaluate the relationships between sleep and BP in this age group. Support (if any) 1st author - NHLBI T32HL105349 &amp; NICHD 5T32HD101397-03

Association of Birthweight with Overweight, Obesity, and Blood Pressure among Adolescents

We investigated the association of birthweight with overweight, obesity, and blood pressure (BP) among adolescents. This cross-sectional study included 857 participants aged 11-17 years from Liangshan, southwest China. Birthweight information was collected from the participants' parents. The participants' height, weight, and BP were measured. High birthweight was defined as a value greater than the sex-specific upper quartile. Participants were classified into four groups based on their weight change at birth and adolescence: normal weight at both time points, weight loss, weight gain, and high weight at both time points. High birthweight was positively associated with overweight and obesity in adolescence [odds ratio (95% confidence interval), OR (95% CI): 1.93 (1.33, 2.79)]. Compared with participants with normal weight at both time points, those with high weight at both time points were more likely to have elevated BP in adolescence (OR [95% CI]: 3.02 [1.65, 5.53]), while those with weight loss had similar odds of elevated BP. The sensitivity analysis results did not change significantly when high birthweight was defined alternatively as birthweight > 4 kg. This study showed that the association between high birthweight and elevated BP in adolescence is influenced by current weight.

Circadian Misalignment Impacts the Association of Visceral Adiposity With Elevated Blood Pressure in Adolescents.

Although insufficient sleep has been shown to contribute to obesity-related elevated blood pressure, the circadian timing of sleep has emerged as a novel risk factor. We hypothesized that deviations in sleep midpoint, a measure of circadian timing of sleep, modify the association between visceral adiposity and elevated blood pressure in adolescents. We studied 303 subjects from the Penn State Child Cohort (16.2±2.2 years; 47.5% female; 21.5% racial/ethnic minority). Actigraphy-measured sleep duration, midpoint, variability, and regularity were calculated across a 7-night period. Visceral adipose tissue (VAT) was measured with dual-energy X-ray absorptiometry. Systolic blood pressure (SBP) and diastolic blood pressure levels were measured in the seated position. Multivariable linear regression models tested sleep midpoint and its regularity as effect modifiers of VAT on SBP/diastolic blood pressure levels, while adjusting for demographic and sleep covariables. These associations were also examined as a function of being in-school or on-break. Significant interactions were found between VAT and sleep irregularity, but not sleep midpoint, on SBP (P interaction=0.007) and diastolic blood pressure (P interaction=0.022). Additionally, significant interactions were found between VAT and schooldays sleep midpoint on SBP (P interaction=0.026) and diastolic blood pressure (P interaction=0.043), whereas significant interactions were found between VAT and on-break weekdays sleep irregularity on SBP (P interaction=0.034). A delayed and an irregular sleep midpoint during school and during free-days, respectively, increase the impact of VAT on elevated blood pressure in adolescents. These data suggest that deviations in the circadian timing of sleep contribute to the increased cardiovascular sequelae associated with obesity and that its distinct metrics require measurement under different entrainment conditions in adolescents.

Birthweight, postnatal growth and blood pressure in adolescents of low socioeconomic condition: a cohort study in Northeast Brazil

ObjectiveTo verify the influence of low birth weight and rapid postnatal weight gain and associated factors on blood pressure in adolescence in a population of low socioeconomic status, considering that injuries occur in the perinatal period can be predictors of future metabolic changes and are still poorly explored. MethodsA cohort study was carried out with 208 adolescents, 78 born with low weight and 130 born with appropriate weight. The infants were followed up during the first six postnatal months and reassessed at 8 and 18 years of age. The independent variables were birthweight and postnatal weight gain. Rapid postnatal weight gain was defined when above 0.67 z score. The co-variables were sex, maternal height and family income at birth, nutritional status at eight years old, socioeconomic conditions, nutritional status, fat mass index, and physical activity level at 18 years. The outcome variable was blood pressure at 18 years old. The bivariate and multivariable logistic regression analysis were realized and p < 0,05 was considered significant. ResultsThe proportion of adolescents with elevated blood pressure was 37.5%. The multivariable logistic regression analysis showed the variables independently associated with a higher chance of elevated blood pressure in adolescence were rapid postnatal weight gain (OR = 2.74; 95% CI 1.22–6.14; p = 0.014), male sex (OR = 4.15; 95% CI 1.66–10.38; p = 0.002) and being physically active (OR = 2.70; 95% CI 1.08–6.74; p = 0.034). ConclusionsThe rapid postnatal weight gain was a predictor for elevated blood pressure in adolescence, independently of other factors.

Percent body fat, but not body mass index, is associated with cardiometabolic risk factors in children and adolescents.

The epidemic of overweight and obesity has become a worldwide public health problem. Cardiometabolic diseases may originate in childhood. We investigated the association between percent body fat (PBF) measured by the bioelectrical impedance assay and cardiometabolic risk (CMR) in pediatrics. This cross-sectional study involved 3819 subjects (6-17 years old) in Shanghai. We assessed the association between PBF and body mass index (BMI) with multiple CMR factors. We examined the risk for cardiometabolic abnormalities attributable to overweight and obesity based on age- and sex-specific PBF Z-scores and BMI Z-scores, respectively. PBF, but not BMI, was positively associated with multiple CMR factors in males and females except for total cholesterol in females (all p < 0.05). Compared with the non-overweight group based on PBF, overweight and obesesubjects had increasingly higher odds ratio of dyslipidemia (2.90 (1.99-4.23), 4.59 (2.88-7.32) for males and 1.82 (1.20-2.75), 2.46 (1.47-4.11) for females) and elevated blood pressure (BP) (3.26 (2.35-4.51), 4.55 (2.92-7.09) for males and1.59 (1.07-2.34), 3.98 (2.27-6.17) for females). Obesity females showed a higher likelihood for hyperglycemia (2.19 (1.24-3.84)) than non-overweight females. In both sexes, the predictive effect of PBF on dyslipidemia and elevated BP in adolescents was better than that in children. For hyperglycemia, the predictive effect of PBF was better in male adolescents and female children. There was no risk difference for cardiometabolic abnormalities attributable to BMI-based obesity categories. PBF but not BMIwas associated with CMR. Overweight and obesity categories based on PBF had an increased risk for cardiometabolic abnormalities in children and adolescents.

0219 Interplay of School Days and Free Days with Sleep Midpoint on the Association of Visceral Adiposity with Blood Pressure in Adolescents

Abstract Introduction The circadian timing of sleep, including its variability, has emerged as an important contributor to obesity and cardiovascular health, such as elevated blood pressure. Adolescence is a particularly vulnerable period for circadian misalignment, which may express differently if youth are in school or on free-days. We examined whether deviations in sleep midpoint increase the impact of visceral adiposity on elevated blood pressure in adolescents as a function of being entrained to school or not. Methods We analyzed cross-sectional data from the Penn State Child Cohort follow-up study, a random population-based sample of 303 adolescents (16.2 ± 2.2 y; 47.5% female; 21.5% minority). Actigraphy-measured sleep midpoint was calculated as the midpoint (zeroed to midnight) of the sleep period for weekdays (5-nights) and weekends (2-nights). Actigraphy-measured sleep regularity was calculated as the intra-individual standard deviation of the 5-night weekdays sleep midpoint. Visceral adipose tissue (VAT) was measured via dual-energy X-ray absorptiometry scan. Systolic (SBP) and diastolic (DBP) blood pressure was measured three times in the seated position. Multivariable linear regression models were stratified by “in school” and “on break” to test sleep midpoint and sleep regularity as effect modifiers of VAT on SBP/DBP levels. Analyses were adjusted for sex, race/ethnicity, age, actigraphy-measured sleep duration and polysomnography-measured apnea/hypopnea index. Results When participants were studied while “in school”, significant interactions were found between VAT and weekdays sleep midpoint on SBP (p-interaction=0.027) and DBP (p-interaction=0.046), so that the later the sleep midpoint on school days, the greater the association of VAT with SBP/DBP. When participants were studied while “on break”, a significant interaction was found between VAT and weekdays sleep regularity on SBP (p-interaction=0.039), so that the higher the sleep irregularity on weekdays, the greater the association of VAT with SBP. No other significant interactions were found. Conclusion A delayed and an irregular sleep midpoint during school days and during breaks, respectively, best identified those adolescents with greater cardiovascular risk associated with visceral obesity. These data suggest that not only the circadian timing of sleep contributes to adverse cardiovascular outcomes but its distinct biomarkers require measurement under different entrainment conditions in adolescents. Support (If Any) National Institutes of Health (R01HL136587, UL1TR000127)

Abstract MP56: Sleep Regularity Modifies The Association Of Visceral Adiposity With Elevated Blood Pressure In Adolescents

Introduction: Although obesity, insufficient sleep and sleep apnea are known risk factors for elevated blood pressure, the circadian timing of sleep is also involved in metabolic and blood pressure regulation. As a result, sleep irregularity, which is highly prevalent in adolescents, may be a potential risk factor for obesity-related adverse cardiovascular outcomes. Hypothesis: We hypothesize that greater sleep irregularity increases the impact of visceral adiposity on elevated blood pressure in adolescents. Methods: We analyzed cross-sectional data from the Penn State Child Cohort follow-up study, a random population-based sample of 303 adolescents (16.2 ± 2.2 year old; 47.5% female; 21.5% racial/ethnic minority) who had complete at-home 7-night (at least 5) actigraphy (ACT) data and in-lab dual-energy X-ray absorptiometry (DEXA) scan and polysomnography (PSG) data. ACT-measured sleep duration and sleep midpoint were calculated as the intra-individual mean of the 7-night total sleep time and the midpoint (zeroed to midnight) of the sleep period, respectively. ACT-measured sleep regularity was calculated as the intra-individual standard deviation of the 7-night sleep midpoint. DEXA-measured visceral adipose tissue (VAT) was the primary predictor. Systolic (SBP) and diastolic (DBP) blood pressure, measured three times in the seated position, were the primary outcomes. Multivariable linear regression models tested sleep midpoint and sleep regularity as effect modifiers of VAT on SBP/DBP levels, while simultaneously adjusting for sex, race/ethnicity, age, ACT-measured sleep duration and PSG-measured apnea/hypopnea index. Results: Significant interactions were found between sleep regularity and VAT on SBP (p-interaction=0.009) and DBP (p-interaction=0.039), while not between mean sleep midpoint and VAT (p-interactions=0.210 and 0.883). These findings remained valid even after further adjusting for body mass index percentile (p-interactions=0.006 and 0.034). Among adolescents with high sleep irregularity (≥ 45 minutes; n=124), each standard deviation increase in VAT was associated with a 5.55 (0.91) and 3.07 (0.70) mmHg increase in SBP and DBP, respectively (both p&lt;0.001). Among those with low sleep irregularity (&lt; 45 minutes; n=179) VAT was not significantly associated with SBP [0.69 (0.99), p=0.488] or DBP [0.04 (0.77), p=0.956]. Conclusions: An irregular circadian timing of sleep may increase the impact of visceral adiposity on elevated blood pressure in adolescents. These data support that sleep irregularity, independent of sleep apnea and insufficient sleep, may contribute to the development of cardiovascular sequelae associated with central obesity.

Prenatal Metal Mixtures and Child Blood Pressure in the Rhea Mother-Child Cohort

BACKGROUND AND AIM: Blood pressure (BP) in childhood is an important risk factor for cardiovascular disease in adulthood. {In utero} exposure to metals has been associated with higher BP in childhood. However, most studies have evaluated elements individually and measured BP at a single time point. The objective of the current study was to investigate the impact of a complex mixture of metals on child BP trajectories and elevated BP at age 11. METHODS: The current study included 176 mother-child pairs from the Rhea Study in Heraklion, Greece who had three BP measurements in childhood (at ages 4, 6, and 11). We focused on eight metals (antimony, arsenic, cadmium, cobalt, lead, magnesium, molybdenum, selenium), which were measured by inductively coupled plasma mass spectrometry in maternal urine samples collected during pregnancy (median gestational age at collection: 12 weeks). Covariate-adjusted Bayesian Varying Coefficient Kernel Machine Regression and Bayesian Kernel Machine Regression were used to simultaneously evaluate these eight metals in relation to the change in BP from age 4 to 11 and elevated BP at age 11, respectively. RESULTS:J-shaped associations were observed between molybdenum and both systolic and diastolic BP at age 4. Similar associations were identified for both molybdenum and lead in relation to elevated BP at age 11. Positive associations between molybdenum and BP at age 4 (for concentrations 40-80 μg/L) were stronger at high levels of lead. Lead was positively associated with BP measures at age 4, but only at high levels of molybdenum. CONCLUSIONS:Co-exposure to high levels of molybdenum and lead during the prenatal period may contribute to increased BP at age 4, which in turn may contribute to elevated BP in adolescence. KEYWORDS: Metals, mixtures, blood pressure, childhood, BKMR, BVCKMR

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:

Effect of blood pressure measurement on detection of elevated blood pressure in Tibetan adolescents

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.

How useful are anthropometric measurements as predictive markers for elevated blood pressure in adolescents in different gender?

Background Obesity and obesity-related diseases are one of the common health problems worldwide and have also been proposed to be important predictors of blood pressure and cardiovascular disease risk. The aim of our study is to determine the utility of different anthropometric measurements (body mass index [BMI], skinfold thickness [SFT], waist circumference [WC], mid-upper arm circumference [MUAC], arm circumference-height ratio [AHtR], and waist circumference-height ratio [WHtR]) as markers of hypertension (HT) risk in adolescents. Methods In this cross-sectional study, 544 participants aged between 12 and 13 years were included. Anthropometric measurements and blood pressure of participants were measured. The association of different anthropometric measurements with blood pressure was evaluated. Results The frequency of both elevated blood pressure and HT was 30.2%. Biceps, triceps, and suprailiac SFT have an impact on HT in girls but only suprailiac SFT in boys. WC measurements above the 85th percentile were strongly correlated with HT conditions, and this relationship was stronger in boys than in girls (3.3 vs. 2.6 fold). MUAC, WHtR, and AHtR measurements also have strong correlation with HT in boys but only WHtR has a poor relation in girls. In boys and girls with obesity, there was a positive association between obesity and blood pressures. Conclusions Not only age-related BMI z scores but also a number of other anthropometric measurements, such as WC, SFT, MUAC, WHtR, and AHtR, could have an influence on high blood pressure. The influence changes with gender during adolescence.

Validation of recommended definition in identifying elevated blood pressure in adolescents.

Recently, the American Academy of Pediatrics (AAP) recommended 120/80mmHg as thresholds for identifying elevated blood pressure (BP) in adolescents aged 13-17years. The authors aimed to compare the performance of the new definition in identifying elevated BP with traditional percentile-based definition. Data were obtained from the National Health and Nutrition Examination Survey 1999-2014, which included 7485 adolescents aged 13-17 years. Elevated BP was defined using the recommended (≥120/80mmHg) and traditional definition (≥90th percentile for sex, age, and height or 120/80mmHg) presented in AAP guideline. The prevalence of elevated BP was 15.7% and 17.2% using the recommended and traditional definition, respectively (P<.001). The recommended definition had high sensitivity (90.9%), perfect specificity (100.0%), perfect positive predictive value (100.0%), and very high negative predictive value (98.1%) compared with the traditional definition. The Kappa correlation coefficient between two definitions was 0.94 (P<.001). Similar results can be observed in subgroups across sex, age, and sex- and age-specific height percentile except for both sexes with young age and low height percentile. Generally, our results supported the use of the recommended definition for identifying elevated BP in adolescents.

Evaluation of the relationship of subclinical hypothyroidism with metabolic syndrome and its components in adolescents: a population-based study.

This study investigated the association of subclinical hypothyroidism (SCH) with metabolic syndrome (MetS) and its components in adolescents. The study population included 1006 adolescents (aged 10-18 years) from the Korea National Health and Nutrition Examination Surveys; SCH subjects were compared with euthyroid subjects. MetS was defined using the International Diabetes Federation criteria. The risks of MetS and its components in SCH and euthyroid subjects were calculated using binary logistic regression analyses. Study subjects had a mean age of 14.2 ± 2.5 years, and 53% were male. The prevalence of MetS was 2.5% in the overall study population (3.2% of males and 1.7% of females). Among the 1006 subjects, 143 (14.2%) had SCH. The risk of MetS was not higher in SCH subjects than in euthyroid subjects (odds ratio [OR], 1.50; 95% confidence interval [CI], 0.54-4.11); however, among the components of MetS, the risk of abdominal obesity was higher in SCH subjects than in euthyroid subjects (OR, 2.08; 95% CI, 1.04-4.15) after adjusting for age, sex, and body mass index (BMI). Although not statistically significant, a trend toward increased risk of elevated blood pressure (BP) was observed in SCH subjects relative to euthyroid subjects after further adjusting for age, sex, and BMI (OR, 2.01; 95% CI, 0.89-4.52). Furthermore, non-obese SCH subjects had higher systolic BP compared with non-obese euthyroid subjects after adjusting for age, sex, and BMI (P = 0.014). SCH was not associated with the presence of MetS. However, SCH may be associated with abdominal obesity and possibly elevated BP in adolescents.

Diagnostic Effect of the Single BP Cut-Offs for Identifying Elevated BP and Hypertension in Adolescents Aged 13-17Years.

In contrast to the percentile-based definitions of elevated blood pressure (BP) and hypertension for children and adolescents of all ages in the 2004 fourth report, the 2017 American Academy of Pediatrics (AAP) BP guideline recommends a change to single BP cut-offs for clinical diagnosis (120/< 80-129/< 80mmHg for elevated BP and ≥ 130/80mmHg for hypertension) in adolescents aged 13years and older, and it also recommends researchers using the percentile-based definitions for more precise BP classification. The aim of our study was to assess the diagnostic effect of the single BP cut-offs for identifying adolescent abnormal BP as compared to the 2017 AAP percentile table by sex, age, and height. Data were from 8287 adolescents aged 13-17years in NHANES 1999-2016 and 1659 adolescents aged 13-17years in NHANES III (1988-1994). Compared to the 2017 AAP percentile table, the single BP thresholds performed well for identifying elevated BP in adolescents in NHANES 1999-2016/NHANES III, with high values of area under the curve 0.93/0.95, sensitivity 86.7%/89.9%, specificity 100%/100%, positive predictive value (PPV) 100%/100%, negative predictive value (NPV) 98.2%/98.8%, and kappa coefficient 0.92/0.94. The results were similar for identifying hypertension in the two datasets, with especially high PPV 100%/100% and NPV 99.2%/99.2%. However, the sensitivity values of the simple method for identifying hypertension were not satisfactory among girls, younger adolescents, and Hispanic adolescents in both datasets. In conclusion, the single BP cut-offs in general performed similarly well for identifying abnormal BP as compared to 2017 AAP percentile table, but not well in some subgroups.

Elevated Blood Pressure in Adolescence Is Attributable to a Combination of Elevated Cardiac Output and Total Peripheral Resistance.

Unlike in older people, it has been suggested that elevated blood pressure (BP) in young people is because of high cardiac output accompanied by normal total peripheral resistance (TPR)-a hyperkinetic/hyperdynamic circulation. We investigated this in a large, United Kingdom-based birth cohort of adolescents. The study was conducted on 2091 17-year-old participants in the ALSPAC (Avon Longitudinal Study of Parents and Children)-a prospective population-based birth cohort study. BP measurement and echocardiography were performed, and heart rate (HR), stroke volume (SV), and TPR were calculated. Data are means (SD). Higher quintiles of systolic BP were associated with higher SV, higher HR, and higher TPR. The proportional contribution made by SV, HR, and TPR to mean arterial pressure differed little by systolic BP quintile (SV [32%-34%], HR [25%-29%], and TPR [39%-41%]). Higher BP is attributable to a combination of higher cardiac output (ie, SV×HR) and higher TPR in a population-based sample of adolescents. There is no evidence of a disproportionate contribution from elevated cardiac output at higher BP levels.

Association between active commuting and elevated blood pressure in adolescents.

ABSTRACTObjectiveTo analyze the association between active commuting and blood pressure in adolescents.MethodsThis is a cross-sectional study with high school students from public education network in the state of Pernambuco, Brazil. Data from 6039 students (14 to 19 years) were collected using a questionnaire. “Physically inactive” were considered those who reported not to walk or ride a bicycle to and from school on any day of the past week, and/or those who, regardless of the weekly frequency of practice this type of activity, reported the duration of commuting to school was less than 20 minutes (round trip). The high blood pressure was obtained by Omron HEM 742 equipment. Adolescents with high blood pressure were defined as those with higher blood pressure or equal to the 95th percentile for age, sex and height. Regression logistic analyses were used to assess the association between active commuting and high blood pressure, considering adjustments for the following confounders: sex, age, overweight, total physical activity, socioeconomic level, place of residence.ResultsThe prevalence of high blood pressure was 7.3%, and 79.3% were considered insufficiently active in commuting. There was an association between high blood pressure and active commuting only among those living in rural areas (OR = 6.498; 95% CI = 1.513-27.900), and the same was not observed among those living in urban areas (OR = 1.113; 95% CI = 0.812-1.526).ConclusionActive commuting can be considered a protective factor for high blood pressure in adolescents living in rural areas.

Tobacco Exposure, Weight Status, and Elevated Blood Pressure in Adolescents

The pathogenesis of hypertension begins in youth. An estimated 4% of US adolescents have diagnosed hypertension and 17% have elevated blood pressures, predisposing them to hypertension and cardiovascular disease (CVD) later in life. There is limited research on the clustering of CVD risk factors such as tobacco exposure and weight status that may be associated with high blood pressure in adolescents. The aim of this exploratory study was to determine the relationships between total smoke exposure (TSE; cigarette smoking and secondhand smoke), waist circumference, and blood pressure in a sample of rural adolescents, ages 15-18. A convenience sample of 148 adolescents ages 15-18 was recruited from two rural high schools (88 female and 60 male, all Caucasian). Adolescents were assessed for tobacco exposure (self-report, salivary cotinine), weight status (body mass index, waist circumference), and blood pressure. Self-report measures of tobacco exposure included the Uptake Continuum and Peer and Family Smoking measure. Age, gender, waist circumference and salivary cotinine contributed to 35% of the variance in systolic blood pressure and 18% in diastolic blood pressure. One-fourth (25%) of adolescent males and 11% of adolescent females had elevated systolic blood pressures. Approximately one-fifth of the sample (22%) had elevated salivary cotinine levels indicative of tobacco use and secondhand smoke exposure. TSE and waist circumference were predictors of elevated blood pressure in adolescents. Public health measures need to address clusters of risk factors including blood pressure, tobacco exposure, and weight status among adolescents in order to reduce CVD.