Elevated Blood Pressure In Children Research Articles

Evaluation of Blood Pressure in Children Treated with Ceftriaxone: A Case-Control Study

Background: In children, high blood pressure can develop into hypertension and its consequences during puberty and adulthood. High blood pressure in children is often secondary to other causes, including renal diseases. Nephrolithiasis is one of the causes of secondary hypertension. The extensive use of cephalosporins in hospitals, particularly ceftriaxone, can result in nephrolithiasis. Therefore, the purpose of this study was to assess the relationship between ceftriaxone treatment and elevated blood pressure in children. Method: The research was conducted as a case-control study over an 18-month period from 2018 to 2019. In this study, blood pressure was measured in 111 children aged 3-13 years who were hospitalized at Amir Kabir Hospital in Arak and received ceftriaxone for at least 48 hours. As a control group, 111 children who did not receive ceftriaxone had their blood pressure measured. The blood pressure levels and percentiles of children in the two groups were then compared. Result: In the case and control groups, the mean age was 5.1±1.61 and 6.04±2.4 years, and the mean height was 109.17±10.71 and 114.86±12.95 cm, respectively. A slightly higher mean systolic blood pressure percentile was observed in the case group (65.59±18.17) than in the control group (65.28±14.51) (P=0.112), and the mean diastolic blood pressure percentile was also slightly higher in the case group (58.89±18.88) than in the control group (54.85±19.28) (P=0.317). The difference in diastolic blood pressure was greater than in systolic blood pressure. However, these detected differences were slight and not statistically significant. Conclusion: This study showed no association between blood pressure levels and ceftriaxone treatment in children older than three years who received the medicine for at least 48 hours. However, additional research is suggested, focusing on the effects of the medicine at higher doses and over a longer period of time following administration.

Captopril Polyvinyl Alcohol/Sodium Alginate/Gelatin-Based Oral Dispersible Films (ODFs) with Modified Release and Advanced Oral Bioavailability for the Treatment of Pediatric Hypertension.

Hypertension can begin in childhood; elevated blood pressure in children is known as pediatric hypertension. Contrary to adult hypertension, there is a scarcity of commercial medications suitable for the treatment of pediatric hypertension. The aim of this study was to develop orally dispersible films (ODFs) loaded with captopril for the treatment of hypertension in children. Captopril-loaded ODFs were composed of different blends of synthetic polymers, such as polyvinyl alcohol (PVA) and polyvinyl pyrrolidone, and natural polymers, such as sodium alginate (SA) and gelatin. The ODFs were characterized based on their mechanical and thermal properties, drug content, surface morphology, in vitro disintegration, in vitro release, and bioavailability. A novel HPLC method with precolumn derivatization was developed to precisely and selectively determine captopril levels in plasma. A low concentration of PVA and a high concentration of SA generated ODFs with faster hydration and disintegration rates. SA-based films exhibited fast disintegration properties (1-2 min). The optimized modified-release film (F2) showed significant (p < 0.05) enhancement in bioavailability (AUC = 1000 ng min/mL), with a value 1.43 times that of Capoten® tablets (701 ng min/mL). While the plasma concentration peaking was in favor of the immediate-release tablet, Tmax was significantly prolonged by 5.4 times for the optimized ODF (3.59 h) compared with that of the tablets (0.66 h). These findings indicate uniform and sustained plasma concentrations, as opposed to the pulsatile and rapid plasma peaking of captopril from the immediate-release tablets. These findings suggest that the modified release of oral films could offer more favorable plasma profiles and better control of hypertension than the conventional release tablets.

Blood Pressure in Children in the 21st Century: What Do We Know and Where Do We Go From Here?

The association between hypertension in adulthood and cardiovascular morbidity and mortality is well known. Based on that association, a diagnosis of elevated blood pressure in children has been clinically interpreted as early cardiovascular disease. The objective of this review is to discuss historical data and new research on the relationship between elevated blood pressure and early preclinical and later adult cardiovascular disease. After summarizing the evidence, we will address the gaps in knowledge around Pediatric hypertension in an effort to stimulate research into the important role that control of blood pressure in youth may play in preventing adult cardiovascular disease.

Prevalence and Determinants of Elevated Blood Pressure among Children in Rural Kayonza District, Rwanda

Childhood elevated blood pressure (BP) has emerged as a concern for global public health. In Sub-Saharan African countries, where Rwanda is located, there is a scarcity of BP data for both children and adolescents. Elevated blood pressure (EBP) is a neglected issue in children, it can develop in young age and can last into adulthood. This community-based cross-sectional study in rural Kayonza, Rwanda investigated the prevalence and determinants of elevated blood pressure (EBP) in children aged 36 months. Measurements of blood pressure and height were converted to percentiles using World Health Organization standards. Data collection involved face-to-face interviews with a digital questionnaire. OMRON HBP-1320 blood pressure monitor and SECA 213 stadiometer were used. The mean systolic blood pressure was 90.60 mmHg and 58.75 mmHg and standard deviation of 7.60mHg for diastolic blood pressure. Most child's mothers (76%) were farmers, more than half (62.7%) of child mothers attended primary school, and 36.60% were between the ages of 31 and 35. (Mean age: 30.4 years, Stand. Dev.: 4.4, Minimum age: 21 years and Maximum age: 39 years), (53%) of children were males, 38 % were 36 months old (Mean age: 36.9 months, Stand. Dev.: 1.0, Minimum age: 35 months, and Maximum age: 39 months). Elevated BP for children is defined as being prehypertensive and hypertensive; all children with systolic or diastolic blood pressure percentiles of ≥90th to &lt;95th were prehypertensive, while those with systolic or diastolic blood pressure percentiles of ≥95th to 99th and above were hypertensive. The prevalence of elevated BP was 40.4% with 18.6% being prehypertension and 21.8% being hypertension among 3-year-old children in the rural Kayonza district. Of them 72 (97%) children who had elevated blood pressure, their family were using biomass fuel and 71(36.60%) of study children were below the 5th percentile of height which an indicator of short stature, 27(40.91%) among them had elevated blood pressure. Factors like difficulty getting food on daily basis (food insecurity) (AOR=3.75; 95% CI: [1.70-8.27]; p=0.001) and medium monthly family income (AOR= 2.38; 95% CI: [1.07-5.31]; p=0.033) were associated with increased prevalence of elevated BP. No statistically significant was found between elevated blood pressure and prenatal factors. Mobilization and increase community’s awareness on the procedure for measuring children’s BP during routine health visits from 3 years old should be done to prevent this increasingly common health condition which is ignored and in asymptomatic nature. Keywords: Elevated Blood Pressure, Prehypertension, Hypertension, Prenatal Factors, Environmental Factors, Behavioural Factors, Kayonza District, Rwanda.

Associations of parental reproductive age and elevated blood pressure in offspring: An observational study.

Increased parental reproductive age has been a social trend around the world, and elevated blood pressure in children leads to an approximately two-fold increased risk of hypertension in adulthood. Aim of this study is to assess the associations of parental reproductive age with the risk of elevated blood pressure in offspring, and to explore the influence of offspring lifestyle on the associations. Data was obtained from a national school program conducted in 7 Chinese provinces, and the final sample was 39,190 students aged 7-18 years. Anthropometric measurements and questionnaires were designed to collect data of children blood pressure and information respectively. In this study, 26.7% of children were defined as elevated blood pressure. A U-shaped pattern was observed in the relationship between maternal age and risk of elevated blood pressure, while risk of elevated blood pressure decreased continuously with paternal age increased. After adjustment, offspring of paternal age ≤27 & maternal age ≤26 years and those of paternal age >30 & maternal age >32 years were related to great risk of elevated blood pressure (OR = 1.18, 95% CI: 1.08-1.29, P < 0.001; OR = 1.18, 95% CI: 1.01-1.38, P < 0.05). When stratified by lifestyle status, significant associations between maternal/paternal age and risk of elevated blood pressure were only observed in those with worse lifestyle behaviors, but not in offspring with healthier lifestyle. Our findings demonstrate that risk of elevated blood pressure in children is independently related to parental reproductive age, and children maintaining a healthy lifestyle may mitigate the adverse effect.

Long term renal outcome and risk of elevated blood pressure in children undergoing complete primary repair of bladder exstrophy (CPRE)

Since the initiation of staged reconstruction for bladder exstrophy (BE), hypertension has been a known complication of the procedure. Hypertension is a well-established risk factor for chronic kidney disease (CKD) progression and associated with cardiovascular/cerebrovascular morbidity and mortality. Few studies exist evaluating the risk of developing hypertension among patients with bladder exstrophy who underwent CPRE. We hypothesized that long-term blood pressure levels may be elevated in males vs females, and may be correlated with presence of hydronephrosis, bladder neck reconstruction, or continence status. We sought to revisit our long-term experience with CPRE and determine factors associated with incidence of elevated blood pressures. We reviewed all BE patients undergoing CPRE at our institution from 1999 to 2019. Patients were considered eligible for inclusion if last renal ultrasound was obtained at least 5 years after repair. Upper tract outcomes based on imaging, history of pyelonephritis and renal function tests measured by serum creatinine and estimated glomerular filtration rate (eGFR, Schwartz formula) were reviewed. Systolic/diastolic blood pressures (SBP/DBP) from all encounters were captured. All blood pressure values were age adjusted by percentile. A total of 36 patients were considered eligible for review. Median follow-up of this cohort was 10.01 (5.16-21.47) years. The mean creatinine for the patients available was 0.58mg/dL (SD=0.20), at mean age of 8.90 years Neither SBP or DBP were significantly elevated in males vs females, but had lower odds of elevation >90th percentile for those with higher eGFR, lower renal length, and reimplantation. Pyelonephritis incidence was 38% (n = 14) with first episode at mean age of 8.8 years, and mean of 3.7 episodes per patient. At long term follow up, blood pressures following CPRE were not significantly elevated, despite the relatively frequent occurrence of CKD, and hydronephrosis. Male gender does appear to suggest higher risk for long-term deterioration in this regard. Higher eGFR, higher renal length, and presence of ureteral reimplantation were associated with lower likelihood of systolic/diastolic blood pressure elevation. Continence status and bladder neck reconstruction were not associated with likelihood of blood pressure elevation. Blood pressure and upper-tract outcomes for patients undergoing CPRE at birth are positive for the majority of patients. To avoid complications from hypertension, patients should be closely evaluated as the risks associated with elevated blood pressure are significant. Ultimately, larger-scale prospective and multi-institutional studies are further needed to characterize risks of hypertension in this complex patient population.

Prevalence trend of high normal blood pressure and elevated blood pressure in Chinese Han children and adolescents aged 7-17 years from 2010 to 2019

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

Role of Insulin Resistance as a Mediator of the Relationship between Body Weight, Waist Circumference, and Systolic Blood Pressure in a Pediatric Population.

Excess weight and high waist circumference (WC) are associated with increased blood pressure (BP), starting from the pediatric age. Insulin resistance is associated with elevated BP in childhood. The aim of the study was to assess the role of insulin resistance in mediating the relationship between body mass index (BMI), WC, and BP values in a pediatric population referred to a cardio-pediatric center for the presence of one or more cardiovascular risk factors. In 419 children (mean age 10.7 [standard deviation, SD 2.5] years), the following parameters were collected both in basal conditions and after 18.6 (SD 9.3) months of follow-up during which a treatment based on lifestyle and dietary modifications was given: systolic and diastolic BP (SBP and DBP), WC, plasma glucose, and insulin values. The HOMA (Homeostasis Model Assessment)-index was considered as an expression of insulin resistance. At baseline there was a significant correlation between HOMA-index and SBP z-score (β = 0.081, p = 0.003), and insulin resistance was a mediator of the relationship between BMI and SBP z-score (p = 0.015), and between waist circumference to height (WtHr) and SBP z-score (p = 0.008). The effect of BMI z-score modifications on SBP z-score changes from baseline to follow-up was totally mediated by HOMA-index changes (p = 0.008), while HOMA-index only partially mediated the effect of WtHr modifications on SBP z-score changes (p = 0.060). Our study strongly suggests that, in a pediatric population at cardiovascular risk, the HOMA-index is an important mediator of the relationship between BMI, WC and SBP.

Abstract 15869: Blood Pressure Trajectories Across the Life Course and Midlife Ventricular Systolic Function: The Bogalusa Heart Study

Introduction: Markers of adverse cardiac remodeling such as left ventricular (LV) hypertrophy and diastolic dysfunction have been associated with higher blood pressure (BP) during early and mid-life. Mid to late life hypertension is a well-known risk factor for left LV systolic dysfunction and progression to clinical heart failure (HF). We explore the association between BP in early to mid-life and LV systolic dysfunction measured by left ventricular ejection fraction (LVEF) in mid-life. Hypothesis: Higher BP in early to mid-life is associated with LV dysfunction as measured by LVEF. Methods: This complete-case analysis considered 1,140 participants of the Bogalusa Heart Study (57.5% female, 34.4% Black) with at least 3 traditional cardiometabolic risk factor (CMRF) observations since childhood (mean age 9.6±3.2 years) and transthoracic echocardiography-based LVEF estimations in midlife (48.9±5). Mean follow-up time was 38.6±3.8 years. A latent class trajectory modeling framework was employed to define trajectories of SBP. LVEF was divided into quartiles, and multivariable logistic regression models were utilized to estimate the association between life-course SBP trajectories and the lower quartile (Q1) of LVEF, controlling for traditional CMRF. Race, sex, and SBP trajectories interactions were tested to explore effect modification. Results: The prevalence of Q1 LVEF was higher among Black (32.1%, p&lt;0.01) and male (31.3%, p&lt;0.01) participants, compared to their counterparts. Four distinct trajectories were identified: stable-increasing (SI, 82.3%), moderate-increasing (MI, 5.2%), high-increasing (HI, 3.2%), and increasing-decreasing (D, 9.3%). Using SI as a reference, the following independent associations with the lower quartile of LEVF were identified: MI (OR: 1.4, 95%CI: 0.8 - 2.6, p=0.18), HI (OR: 0.72, 95%CI: 0.23-1.9, p=0.18), D (OR: 1.68, 95%CI: 1.1-2.6, p=0.02) Conclusion: Elevated systolic BP during early to mid-life (particularly 15-40 years of age) is associated with lower LEVF in midlife. These findings suggest the possibility of cardiac remodeling starting early in life. Increased awareness of elevated BP in childhood might be an avenue to prevent the progression to systolic dysfunction in late life.

Abstract 10153: Cord Blood Metabolite Signatures for Elevated Blood Pressure in Childhood and Adolescence

Background: Risk factors for high blood pressure (BP) in children start in utero . Cord blood metabolites reflect exposures of the developing fetus to the in utero environment. No studies have examined whether cord blood metabolites are associated with BP in children. Objectives: To examine prospective associations of cord blood metabolites with systolic BP (SBP), diastolic BP (DBP), and risk of elevated BP in childhood and adolescence. Methods: We used data from the Boston Birth Cohort. Metabolites were measured in cord blood plasma samples collected at birth. SBP and DBP were measured at clinic visits between 3 to 18 years. We calculated BP percentiles per the 2017 American Academy of Pediatrics Clinical Practice Guideline. We examined associations of cord metabolites with SBP and DBP percentiles using linear mixed models and with elevated BP using mixed-effects Poisson regression. We used the False Discovery Rate (FDR) method to adjust for multiple comparisons. Results: Our study included 902 mother-child dyads (60% Black, 23% Hispanic, 45% female). Children were followed for a median of 9.2 (IQR: 6.7-11.7) years, and the median number of BP observations per child was 7 (IQR: 4-11). After FDR adjustment, 3, 94, and 22 metabolites were respectively associated with SBP, DBP, and risk of elevated BP; 2 metabolites (1-methylnicotinamide, dimethylguanidino valeric acid) were associated with all three outcomes, and 22 metabolites were associated with both DBP and risk of elevated BP. After multivariable adjustment, 48 metabolites remained significantly associated with DBP. Metabolites that showed the strongest associations with SBP, DBP, and risk of elevated BP included nucleotides (e.g., xanthosine, hypoxanthine, xanthine) and acylcarnitines (e.g., C6 and C7 carnitines), which represent fatty acid oxidation and purine metabolism pathways. Conclusions: In this predominantly urban, low-income, minority cohort, cord blood metabolites were prospectively associated with BP and risk of elevated BP from childhood to adolescence. Acylcarnitines and purine metabolism may be involved in the early life origins of hypertension. Cord metabolites may explain the intergenerational effects of in utero environments on BP in childhood and adolescence.

In-utero exposure to air pollution and blood pressure in children from the Rhea birth cohort study, Greece

BACKGROUND AND AIM: High blood pressure (BP) in childhood has been linked with hypertension and impaired cardiovascular health within adulthood. Exposure to air pollution has been associated with elevated BP in children but only a few studies evaluated the persistence of these associations into early adolescence. We investigated the association between pregnancy exposure to air pollution and BP through childhood in the Rhea birth cohort in Greece. METHODS: Residential exposure to particulate matter &amp;#x3c;10 &amp;#x3bc;m (PM10) and &amp;#x3c;2.5 &amp;#x3bc;m (PM2.5) during pregnancy was estimated with temporally adjusted land-use regression models. We measured systolic (SBP) and diastolic (DBP) blood pressure at 4, 6, and 11 years. Hypertension was defined as DBP or SBP &amp;#x2265;95th sex-, age- and height-percentiles. Generalized estimating equation and multivariate regression models assessed the associations (per 5 µg/m³) with repeated and single time-point measures, respectively. We also tested effect modification by sex and maternal smoking. RESULTS: Median (IQR) levels of PM2.5 and PM10 during pregnancy were 14.4 (2.4) &amp;#x3bc;g/m3 and 35.6 (2.3) &amp;#x3bc;g/m3, respectively. PM10 was associated with higher SBP and DBP in boys but lower in girls (p-interaction= 0.025 and 0.036) at 4 years. We also observed higher risk for hypertension overall (1.62; 95% CI: 1.04, 2.53) and in boys (2.01; 95% CI: 1.07, 3.79), and in children born to non-smoking mothers during pregnancy (2.14; 95% CI: 1.25, 3.66). Higher PM2.5 was associated with lower SBP in boys at 6 (β= -3.75 mmHg; 95% CI: -7.14, -0.36) and 11 years (β= -4.49 mmHg; 95% CI: -9.09, 0.11; p-interaction= 0.068 and 0.072). Sex differences in BP trajectories were also observed. CONCLUSIONS: This study suggests that prenatal air pollution exposure may affect blood pressure during childhood. Further research is needed to understand sex differences and the role of co-exposure to maternal smoking. KEYWORDS: Blood pressure, childhood, air pollution, prenatal

Metabolome-Wide Association Study of Cord Blood Metabolites With Blood Pressure in Childhood and Adolescence.

No studies have examined whether the cord blood metabolome-a reflection of in utero metabolism-influences blood pressure (BP) in children. To examine prospective associations of cord blood metabolites with systolic BP (SBP), diastolic BP (DBP), and risk of elevated BP in childhood and adolescence. In the Boston Birth Cohort, we measured metabolites in cord blood plasma, and SBP and DBP at clinic visits between 3 and 18 years. We examined associations of cord metabolites with SBP and DBP percentiles using linear mixed models and with elevated BP using mixed-effects Poisson regression. Our study included 902 mother-child dyads (60% Black, 23% Hispanic, 45% female). Children were followed for a median of 9.2 (interquartile range, 6.7-11.7) years, and the median number of BP observations per child was 7 (interquartile range, 4-11). After false discovery rate correction, 3 metabolites were associated with SBP, 96 with DBP, and 24 with elevated BP; 2 metabolites (1-methylnicotinamide, dimethylguanidino valeric acid) were associated with all 3 outcomes, and 21 metabolites were associated with both DBP and elevated BP. After multivariable adjustment, 48 metabolites remained significantly associated with DBP. Metabolites that showed the strongest associations with SBP, DBP, and elevated BP included nucleotides (eg, xanthosine, hypoxanthine, xanthine) and acylcarnitines (eg, C6 and C7 carnitines), which represent fatty acid oxidation and purine metabolism pathways. In our urban and predominantly racial/ethnic minority cohort, we provide evidence that metabolomic alterations in utero, in particular, acylcarnitine- and purine-metabolism metabolites, may be involved in the early life origins of hypertension.

Lifestyle Interventions for Elevated Blood Pressure in Childhood-Approaches and Outcomes.

The purpose of this review is to provide an overview of existing and emerging lifestyle treatments in the clinical management of primary elevated blood pressure and hypertension in pediatric patients. The authors hope to expand the knowledge base surrounding pediatric hypertension and update clinicians on best practices to improve outcomes. Elevated blood pressure is traditionally addressed with broad lifestyle recommendations such as limiting salt consumption and losing weight. This approach is not well adapted for pediatric patients. Novel and often underutilized approaches to the treatment of hypertension in pediatrics include psychological counseling for behavior modification, circadian nutrition, consistent use of interdisciplinary teams, manipulation of macronutrients, stress management, technology-infused interventions, and systemic changes to the food environment. Elevated blood pressure is a pervasive condition affecting cardiovascular disease and mortality risk. Increasingly, pediatric patients are presenting with elevated blood pressure with etiologies known to be affected by lifestyle behaviors. Weight management, dietary modifications, and daily physical activity are well-researched methods for improving individual blood pressure measurements. These strategies can sometimes be as effective as pharmacological interventions at lowering blood pressure. However, compliance with these individual recommendations is not consistent and has led to unsatisfactory results. There are emerging treatment trends that may provide non-traditional and more effective non-pharmacologic routes to blood pressure management in pediatric patients.

Isolated diastolic hypertension in childhood and risk of adult subclinical target organ damage: a 30-year prospective cohort study.

Background:Data on the association of isolated diastolic hypertension (IDH) in childhood with adult cardiovascular risk are scarce. This study aimed to estimate the prevalence of IDH in adolescents and to explore the impact of IDH in childhood on adult subclinical target organ damage (STOD).Methods:This longitudinal study consisted of 1738 school children (55.4% boys) aged 6–15 years from rural areas of Hanzhong, Shaanxi, who were followed for 30 years. Their blood pressure was recorded to define the hypertension subtypes: normotension, IDH, isolated systolic hypertension (ISH) and mixed hypertension. Tracked STOD included arterial stiffness (n = 1738), albuminuria (n = 1652) and left ventricular hypertrophy (LVH) (n = 1429).Results:Overall, the prevalence of IDH, ISH and mixed hypertension was 5.4, 2.2 and 3%, respectively, and there was no gender difference. Over 30 years, 366 (21.1%) of participants developed arterial stiffness, 170 (10.3%) developed albuminuria and 68 (4.8%) developed LVH. Compared with normotensive participants, IDH in childhood had higher risk ratio (RR) of experiencing arterial stiffness (RR, 1.66; 95% CI, 1.01–2.76) and albuminuria (RR, 2.27; 95% CI, 1.35–4.16) in adults after being fully adjusted but not LVH. However, if the elevated blood pressure in children was used as the reference standard, IDH in childhood was associated with adult LVH (RR, 2.48; 95% CI, 1.28–4.84).Conclusion:IDH accounts for a higher proportion of adolescent hypertension subtypes and can increase the risk of adult STOD. These results highlight the necessity of improving the prevention, detection and treatment of IDH in adolescents.

Weight status related early changes in blood pressure, cardiac structure and function in 4-year-old children

Objective: To explore the association between weight status and early changes in blood pressure, cardiac structure and function in children at 4 years of age. Methods: A cross-sectional study of the relationship between weight status and cardiovascular parameters was performed on the platform of "Shanghai Birth Cohort" in Shanghai Xinhua Hospital between 2017 and 2020. Height, weight, blood pressure and echocardiography were measured in 1 477 children at 4 years of age. According to body mass index (BMI), participants were classified into five groups: underweight, lean, normal weight, overweight and obese. Blood pressure, cardiac structure and function indexes were compared among different groups using one-way ANOVA. The associations between blood pressure, cardiac structure and function and weight status in children were analyzed by linear regression models. Multivariate logistic regression models were used to analyze whether weight status was an independent risk factor for elevated blood pressure or left ventricular hypertrophy (LVH) in children. Results: A total of 1 477 children including 772 boys and 705 girls were included in this study. There were 115 overweight and obese boys (14.9%) and 68 overweight and obese girls (9.6%). The majority of children had normal weight (916 cases, 62.0%), followed by underweight (303 cases, 20.5%), overweight (130 cases, 8.8%), lean (75 cases, 5.1%), and obese (53 cases, 3.6%). With the increase of BMI, systolic blood pressure, diastolic blood pressure, left ventricular mass index (LVMI), left ventricular posterior wall thickness in systole, left ventricular posterior wall thickness in diastole, left ventricular diameter in end-systole, left ventricular diameter in end-diastole, interventricular septum thickness in systole and left ventricular ejection fraction showed significantly positive trend, and the differences among the groups were significant (F=31.73, 6.59, 14.22, 4.96, 3.01, 31.50, 39.79, 5.91, 3.09, all P<0.05). Multiple linear regression showed that overweight and obese were all positively associated with systolic blood pressure (β=5.2, 95%CI 3.6-6.8), LVMI (β=1.9, 95%CI 0.8-3.1), left ventricular diameter in end-systole (β=1.3, 95%CI 0.9-1.8), and left ventricular diameter in end-diastole (β=1.6, 95%CI 1.0-2.2). In the Logistic regression model, compared with normal weight children, overweight (OR=2.37, 95%CI 1.37-4.41) and obese children (OR=10.90, 95%CI 4.47-26.60) both had significantly increased risk of elevated blood pressure. However, the risk of LVH did not significantly increased. Conclusions: Overweight and obesity in 4-year-old children are associated with increased blood pressure, increased left ventricle diameter and LVMI. Overweight and obesity are independent risk factors for elevated blood pressure in children at 4 years of age.

Arterial hypertension in children and adolescents: a modern view at the problem (a literature review). Part 1

The analysis of modern national and foreign literature on the prevalence, causes, mechanisms, and criteria of hypertension in children and adolescents was carried out. The aim of the study was to provide modern data on the epidemiology, risk factors, mechanisms of development and diagnostic criteria for hypertension in children and adolescents, based on a review of scientific sources. Materials and methods. A search was conducted in the scientific-metric systems Google Scolar, PubMed, Cohrane Database from 2011 to 2021 using the following keywords: epidemiology, risk factors for systemic hypertension, mechanisms of development, coronavirus disease, adolescents, criteria for diagnostics of systemic arterial hypertension. Conclusions. Scientific sources of the last decade have identified the main risk factors and the most common mechanisms of hypertension, systematized approaches to classification as well as diagnostic criteria for the disease at a young age. This disease has recently become more common among children younger than 18 years varying from 2 % to 20 % of cases. It is worth noting that the coronavirus pandemic has brought about changes in the study of hypertension in children and adults, serving as a leading factor of severe course and mortality, but research on this matter is currently under way. The significance of certain pathogenetic factors in the genesis of different variants of arterial hypertension in children has not been fully identified up to date, and further study on their relationship with hemodynamic parameters in children and adolescents is needed. Generally, scientists around the world are focusing their attention on early diagnosis of elevated blood pressure in childhood, while the process is reversible, to prevent complications and a more severe course of the disease.

Association of waist circumference with blood pressure and familial dietary habits in preschool children: a cross-sectional study in northeastern China

BackgroundChildhood obesity increases the risk of elevated blood pressure (BP) in children. Body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) are traditional obesity indices, but the extent to which these indices are associated with elevated BP in childhood remains debatable. Moreover, the familial dietary environment plays an important role in obesity, so it is necessary to determine the most relevant dietary factors for childhood obesity to prevent elevated BP. Our study aimed to identify the obesity indices that are most closely associated with elevated BP and then to determine the independent familial dietary factors for those obesity indices.MethodA total of 605 children aged 2 to 6 years, as well as their parents, were involved in this study. The weight, height, WC and BP of the children were measured. Information on familial environments was obtained by questionnaires completed by the parents. BMI, WC and WHtR were standardized into z scores, and categorical variables of these three obesity indices were defined as BMI Category, WC Category and WHtR Category. Logistic regression was used to analyse the associations between all obesity indices and elevated BP. Multivariate linear regression and logistic regression were used to determine the independent factors for obesity indices.ResultsThe obesity indices that were most closely associated with elevated BP were WC and WC Category. Parental BMI, birth weight, eating wheat as a staple food, appetite, eating speed, snacking while watching TV, parental encouragement to eat a diverse assortment of foods and drinking milk were independently associated with WC in both males and females. The risk of abdominal obesity increased 1.375 times in males and 1.631 times in females if appetite increased one level. If eating speed increased one level, the risk of abdominal obesity increased 1.165 times in males and 0.905 times in females. Females who drank milk more than 6 times per week had a 0.546 times lower risk of abdominal obesity.ConclusionWC was an anthropometric parameter more closely associated with elevated BP. In addition to genetics, some familial dietary factors involving eating preference, eating habits and parental feeding practice were independently associated with WC and abdominal obesity in preschool children.

Long-term effects of PM2.5 components on blood pressure and hypertension in Chinese children and adolescents.

Growing evidence has linked fine particulate matter (PM2.5) exposure to elevated blood pressure, but the effects of PM2.5 components are unclear, particularly in children and adolescents. Based on a cross-sectional investigation in China, we analyzed the associations between long-term exposure to PM2.5 and its major components with elevated blood pressure in children and adolescents. A representative sample (N=37,610) of children and adolescents with age 7-18years was collected in seven Chinese provinces. Exposures to PM2.5 and five of its major components, including black carbon (BC), organic matter (OM), inorganic nitrate (NO3-), sulfate (SO42-), and soil particles (SOIL), were estimated using satellite-based spatiotemporal models. The associations between long-term exposures to PM2.5 and its components and diastolic blood pressure (DBP), systolic blood pressure (SBP), and hypertension were investigated using mixed-effects logistic and linear regression models. Within the populations, 11.5 % were classified as hypertension. After adjusting for a variety of covariates, per interquartile range (IQR) increment in PM2.5 mass and BC levels were significantly associated with a higher hypertension prevalence with odds ratios (ORs) of 1.56 (95% confidence interval (CI): 1.08, 2.25) for PM2.5 and 1.19 (95% CI: 1.04, 1.35) for BC. Long-term exposures to PM2.5 and BC have also been associated with elevated SBP and DBP. Additionally, OM and NO3- were significantly associated with increased SBP, while SOIL was significantly associated with increased DBP. In the subgroup analysis, the associations between long-term exposures to BC and blood pressure vary significantly by urbanicity of residential area and diet habits. Our study suggests that long-term exposure to PM2.5 mass and specific PM2.5 components, especially for BC, are significantly associated with elevated blood pressure and a higher hypertension prevalence in Chinese children and adolescents.

Review on concepts of hypertension treatment

The outcome of treatment in elderly hypertensives is examined in six major randomized controlled trials. Thiazide diuretics were first-or second-line drugs in each, and the development of a national database on normative blood pressure levels throughout childhood has contributed to the recognition of elevated blood pressure in children and adolescents. The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early.

Association between pubertal development and elevated blood pressure in children.

Blood pressure (BP) increased with age and height development, but little was known about the effect of pubertal development on blood pressure in children. A cross‐sectional study was performed among 4146 children aged 7–12 years old in China. Pubertal development was assessed based on breast stages and testicular volume. The associations of pubertal development with BP levels and the rate of elevated blood pressure (EBP) were quantified using multiple linear and logistic regressions. We found that pubertal developmental level was positively correlated with BP, and children who experienced puberty onset and early pubertal timing had higher BP levels and prevalence of EBP. After adjusting for covariates, children experienced puberty onset had 3.84 and 2.24 mmHg increase in systolic blood pressure and diastolic blood pressure, and 70%, 53%, and 62% increased odds of EBP, ESBP, and EDBP, respectively, compared with those without puberty onset. Similar results were observed for children who had early pubertal timing. The change of BP in puberty is greater and the association between pubertal development and BP is stronger in girls than boys. These findings suggested that pubertal development could be an important independent factor and one critical period for the EBP progress. Monitoring and management of pubertal development are necessary particularly among girls.