High Blood Pressure In Adolescents Research Articles

Association of meeting the 24-h movement guidelines with high blood pressure in adolescents: a cross-sectional study

The 24-h movement guidelines for children and adolescents comprise recommendations for adequate sleep, moderate to vigorous physical activity (MVPA) and sedentary behaviour (SB). However, whether adolescents who meet these 24-h movement guidelines may be less likely to have high blood pressure (HBP) has not been established. The present study assessed the association between meeting 24-h movement guidelines and HBP in a school-based sample of 996 adolescents between 10–17 years (13.2 ± 2.4 years, 55.4% of girls). Blood pressure was measured using a digital oscillometric device, while sleep, MVPA and SB were measured using the Baecke questionnaire. The association between the 24-h movement guidelines and HBP was performed using binary logistic regression adjusted for sex, age, socioeconomic status, and body mass index. It was observed that less than 1% of the sample meet the three 24-h movement guidelines. The prevalence of HBP was lower in adolescents who meet all three movement 24-h guidelines (11.1%) compared to those who did not meet any guidelines (27.2%). Individual 24-h movement guidelines analysis showed that adolescents with adequate sleep were 35% less likely to have HBP (OR = 0.65; 95% CI 0.46–0.91). Meeting sleep guidelines combined with meeting MVPA (OR = 0.69; 95% CI 0.50–0.95) or SB (OR = 0.67; 95% CI 0.48–0.94) was inversely associated with HBP. Adolescents who meet two or three 24-h movement guidelines were respectively 47% (OR = 0.53; 95% CI 0.29–0.98) and 34% (OR = 0.66; 95% CI 0.48–0.91) less likely to have HBP. In adolescents, meeting sleep and 24-h movement guidelines were inversely associated with HBP.

Lifestyle Determinants of Hypertension among Government School Adolescents: A Cross-sectional Study

Background: High blood pressure in adolescents is a growing concern around the world, and is caused by various lifestyle factors like an unhealthy diet, high in sodium and fats, lack of sleep, and physical inactivity. Unchecked hypertension during adolescence can lead to stroke, cardiovascular and kidney disease later in life. This study investigated any possible correlation between lifestyle variables and adolescent hypertension.Materials and Method: A cross-sectional analytic study was conducted with 600 school-going adolescents after obtaining permission from Ethical Committee, school administration, and parents. Data was collected for the student’s sociodemographic profile, personal/family history, lifestyle habits, BMI, and systolic/diastolic blood pressure. Qualitative data were presented as percentages or proportions; quantitative data was denoted by mean and standard deviation. ‘p-value’ less than 0.05 was considered significant.Results: Most of the adolescents (68%) were found to be underweight. Sleep duration had a negative correlation with blood pressure, which showed a statistically significant difference. Other lifestyle variables didn’t show any significant relationship with hypertension.Conclusion: 2/3rd of government school students studied were underweight, with a ratio of 1.2 normotensives for every hypertensive individual. Sleep duration exhibited a negative correlation with blood pressure, showing the importance of sleep.

PREVALENCE OF HYPERTENSION AND ASSOCIATED RISK PREDICTORS AMONG SCHOOL GOING ADOLESCENTS LIVING IN WEST BENGAL, INDIA

Background: Hypertension or high blood pressure (HBP) is a most common non-communicable disease. Childhood HBP is a major public health problem worldwide as it tracks to adulthood. HBP was associated with obesity. Objective: This study was undertaken to investigate the prevalence of high blood pressure in Indian adolescents and its association with various anthropometric obesity indices. Methods: The study was conducted among school students aged 11-17 years. Blood pressure was measured using digital oscillometric blood pressure monitor. Anthropometric parameters like height, weight, Neck circumference, Waist circumference and Hip circumference were assessed using standard methods. BMI, Neck height ratio and waist height ratio were calculated. Blood pressure status was evaluated on the basis of American Academy of Pediatrics guideline. SBP and/or DBP > 95th percentile in children below 13 years and 130/80 or above in adolescent 13 years or older was considered as high blood pressure. The association between BP and anthropometric parameters were examined. Results: A total 1272 students of class V-XII were participated in this study out of which 56.3% were female and 43.7% were male. 26.8% boys and 13.1% girls were under HBP category. Signicant positive correlation was observed between BP and body fat indices. Overweight and obesity were signicantly associated with risk of hypertension among boys and girls. Central obesity and upper body obesity were also associated with high blood pressure. Conclusion: Prevalence of high blood pressure in adolescent is alarming. Hypertension was signicantly associated with general obesity, abdominal obesity and upper body obesity. Thus screening of risk of high BP should be carried out in adolescents and initiate intervention to control the consequences of it.

MỐI LIÊN QUAN GIỮA THỪA CÂN, BÉO PHÌ VÀ TIỀN CAO HUYẾT ÁP, CAO HUYẾT ÁP Ở HỌC SINH TRƯỜNG TRUNG HỌC PHỔ THÔNG ĐỒNG HÒA, THÀNH PHỐ HẢI PHÒNG

The increasing prevalence of high blood pressure in adolescents is an alarming global health problem, coupled with the rise in obesity and sedentary lifestyles. The aim of this study was to examine the associations between overweight, obesity, and pre-hypertension, and hypertension among adolescents aged 15 - 17 years in Hai Phong city. The case-control study was conducted on 1,000 students at Dong Hoa High School, Hai Phong city. The control group consisted of 730 students with normal systolic and diastolic blood pressure. The case group included 270 students with pre-hypertension and hypertension according to the diagnostic criteria of the American Academy of Pediatrics. The study results showed that the proportion of students with pre-hypertension and hypertension was quite high, 12.2% and 14.8%, respectively. The prevalence of pre-hypertension and hypertension in male students was significantly higher than in female students (P < 0.001). After adjusting for age and sex, overweight and obesity were statistically significantly associated with the risk of pre-hypertension, and hypertension with OR values of 2.2 (95%CI: 1.4-3.4) and 7.1 (95%CI: 3.0 - 16.5), respectively. Thus, overweight and obesity increases the risk of pre-hypertension and hypertension in adolescents aged 15 - 17 at Dong Hoa High School, Hai Phong city.

Blood pressure to height ratio for screening hypertension among Indonesian adolescents

Background Pediatric hypertension is an emerging health issue due to its increasing prevalence. Age-, gender-, and height-specific blood pressure percentiles have been widely used as a primary tool for detection of hypertension in the pediatric population. However, this method is too complicated to be used in general pediatric practice. The blood pressure to height ratio has been proposed as a practical tool to detect hypertension in children.
 Objective To evaluate the accuracy of blood pressure to height ratio to be used as a tool for screening high blood pressure in Indonesian adolescents.
 Methods This diagnostic test study using data from the 2013 Indonesia Basic Health Research (Riset Kesehatan Dasar/RISKESDAS) report included 39,057 adolescents aged 15-18 years with complete data on age, gender, weight, height, and blood pressure. Blood pressure values were classified using the 2017 American Academy of Pediatrics (AAP) hypertension clinical guidelines. Blood pressure to height ratio was calculated as mmHg/cm body height. A receiver-operator characteristics (ROC) curve analysis was performed to assess the accuracy of systolic blood pressure to height ratio (SBPHR) and diastolic blood pressure to height ratio (DBPHR) for screening high blood pressure in adolescents. The optimal cut-off points, sensitivity, and specificity of SBPHR and DBPHR were calculated.
 Results The optimal cut-off points for defining elevated blood pressure in male adolescents aged 13-18 years were SBPHR 0.69 for male adolescents (sensitivity 96%, specificity 80%) and DBPHR 0.46 (sensitivity 97%, specificity 84%). In female adolescents, the optimal cut-offs were SBPHR 0.72 (sensitivity 97%, specificity 82%) and DBPHR 0.48 (sensitivity 98% and specificity 79%).
 Conclusion Blood pressure to height ratio is a practical method with high sensitivity and specificity for detecting elevated blood pressure in Indonesian adolescents aged 15 to 18 years.

THE RELATIONSHIP BETWEEN SODIUM CONSUMPTION AND BLOOD PRESSURE OF ADOLESCENT GIRLS IN TASIKMALAYA, WEST JAVA

The incidence of hypertension in adulthood begins with an increase in blood pressure since adolescence and high blood pressure in adolescents is also associated with an increased risk of Chronic Heart Disease (CHD) as an adult. Consumption of natrium may lead positively associated with an increase in blood pressure in adolescence. The novelty of this study is because it examines the relationship between sodium consumption and blood pressure in adolescent girls. This study aims to analyze the relationship between sodium consumption and blood pressure in adolescent girls in Tasikmalaya, West Java. This research is an observational study with a cross-sectional study design. The population in this study were all female adolescents aged 12-18 years. The independent variables in this study were total sodium consumption, sodium consumption in snacks, sodium consumption in the main menu and sodium contribution from snacks. The natrium intake was measured by non consecutive recall method. The dependent variable was blood pressure measured by sphygmomanometer Omron HEM8712. The data were analyze by Pearson product moment test. The average total sodium consumption is 506.6mg and blood pressure is 113mmH. There was a positive relationship between total daily sodium (p=0.00; r=0.240), sodium in snacks (p=0.002; 0.162), and sodium in daily menus (p=0.001; r-0.182) with blood pressure. The conclusion natrium intake was correlated with blood pressure in adolescent girls, therefore, they should aware with high sodium food.Keywords : Sodium; Blood pressure; Snacks; Adolescent girls.

Handgrip Strength Is Not Associated With High Blood Pressure and Does Not Have Good Discriminatory Power for High Blood Pressure in Adolescents

de Lima, TR and Silva, DAS. Handgrip strength is not associated with high blood pressure and does not have good discriminatory power for high blood pressure in adolescents. J Strength Cond Res 37(1): 46-54, 2023-Muscle strength measured by handgrip strength (HGS) was inversely and independently associated with high blood pressure (HBP). In addition, HGS has been used as a valuable indicator for monitoring pediatric health. This study aimed to investigate the association between HGS indexes and HBP, verify the discriminatory capacity of HGS to identify HBP in adolescents, and propose cut-points for HGS to be used in the early identification of HBP if good discriminatory power is identified between the variables. This was a cross-sectional study comprising 811 adolescents (male: 48.9%; age: 16.4 ± 1.3 years) from southern Brazil. Blood pressure was measured by the oscillometric method. Handgrip strength was assessed by a hand dynamometer and 3 different approaches were adopted: (a) HGS in kilogram-force, (b) normalized HGS (HGS/body mass), and (c) allometric HGS (HGS/body mass-0.67). Binary logistic regression was used to verify the association between HGS indexes and HBP, and the receiver operating characteristic (ROC) was used to determine the possible use of HGS as a diagnostic tool for HBP. Handgrip strength indexes were not associated with HBP (p > 0.05), and ROC analyses showed a nonsignificant discriminating accuracy for most of the HGS indexes analyzed (p > 0.05) in identifying HBP in boys and girls. The area under curve (AUC) values ranged from 0.499 (95% CI [0.403-0.596] for allometric HGS among overweight or obese boys) to 0.595 (95% CI [0.546-0.643] for HGS among boys). Handgrip strength was not associated with HBP, and its use in the screening of HBP in adolescents is not recommended.

Prevalence of and Factors Associated With High Blood Pressure Among Adolescents in India

High blood pressure (BP) in children and adolescents is becoming one of the most common health conditions worldwide and is much more widely prevalent than previously thought. To estimate the prevalence of high BP in adolescents in India and identify associated factors. This cross-sectional study is a secondary analysis of data from the Comprehensive National Nutrition Survey (CNNS, 2016-2018), which used a multistage, stratified, probability proportion to size cluster sampling design to enroll a nationally representative sample of households and individuals aged 10 to 19 years across all states and union territories of India. Adolescents with acute or chronic illness, physical deformity, mental illness, or cognitive disability were excluded from the survey. Because BP was measured only in children between 10 and 19 years of age, only data from children within this age group were included for secondary analyses. Data analysis was performed from March 2021 to April 2022. Anthropometry. On the basis of the 2017 American Academy of Pediatrics guidelines, high BP was defined as stage 1 and 2 hypertension, with BP above the 95th percentile in children younger than 13 years and greater than 130/80 mm Hg in children 13 years or older. The association of age, sex, region, socioeconomic status, body mass index, fasting blood glucose, hemoglobin A1c, and lipid profile with high BP were examined using log binomial regression. Among 16 182 eligible children aged 10 to 19 years (mean [SD] age, 14.2 [2.8] years; 7849 [48.5%] female and 8333 [51.5%] male), 11 718 had valid BP data with 3 repeated readings. the prevalence of high BP was 35.1% (95% CI, 31.5%-38.9%) in children aged 10 to 12 years and 25.1% (95% CI, 22.5%-28.0%) in children 13 years or older. Overweight and obesity were associated with a higher risk of high BP in both younger (prevalence ratio, 1.17; 95% CI, 1.04-1.34) and older children (prevalence ratio, 1.33; 95% CI, 1.18-1.49). The prevalence of high BP in younger children with stunting was high at 40.1% (95% CI, 31.9%-48.9%) and was 21.9% (95% CI, 18.2%-26.1%) among older children with stunting. In both age groups, high BP coexisted with other cardiovascular disease risk factors, such that adolescents with high fasting blood glucose, high hemoglobin A1c, high triglyceride, and high low-density lipoprotein cholesterol levels had a higher risk of high BP. In this cross-sectional study, the prevalence of high BP, along with cardiovascular risk factors, was substantial in Indian adolescents. There is a need to screen and identify adolescents who have high BP and initiate interventions to control the burden of hypertension and its consequences in India.

Accuracy of anthropometric indicators of obesity to identify high blood pressure in adolescents-systematic review.

BackgroundAnthropometric indicators of obesity have been associated with blood pressure in adolescents. However, the accuracy of anthropometric indicators of obesity for screening for high blood pressure (HBP) in adolescents is not known. Thus, the aim of the present study was to summarize the set of evidence regarding the predictive ability of anthropometric indicators of obesity to identify HBP in adolescents.MethodsSearches were performed in five databases: MEDLINE, Web of Knowledge, Scopus, Scientific Electronic online (SciELO) and SportDiscus. The inclusion criteria for studies were: adolescents aged 10–19 years or mean age included in this range, observational and intervention studies, studies that proposed cutoff points for anthropometric indicators of obesity, and studies in English, Portuguese and Spanish. The methodological quality of studies was assessed using the QUADAS-2 instrument.ResultsTen studies met the inclusion criteria and had their information summarized. Based on the information described in these studies, the anthropometric indicators body mass index (BMI), waist circumference (WC), waist-to-height-ratio (WHtR), triceps skinfold thickness, body adiposity index, C index, body mass, waist-to-arm span ratio, arm fat area, average arm perimeter, fat percentage and arm span were likely to be used in high blood pressure (HBP) screening among adolescents. However, only one study showed acceptable values (moderate to high precision) in relation to the accuracy measurements of described cutoffs.ConclusionCaution is suggested in the use of anthropometric indicators of obesity for HBP screening in adolescents, in which a greater number of studies with accurate diagnostic tools are necessary.

Prevalence and long-term trends of arterial hypertension in adolescents aged 14-18 years in Novosibirsk (1989-2019) according to the new international guidelines for management of high blood pressure in adolescence

The high prevalence of arterial hypertension (AH) among the adult population of many countries of the civilized world, incl. Russia (about 40% among people of working age) indicates the need for early detection and prevention of this disease. Assessment of blood pressure (BP) levels in adolescence presents certain methodological difficulties. To date, 3 guidelines based on the results of large population studies of children and adolescents have been developed in the world pediatric practice. However, the application of these guidelines is still not consistent, especially regarding the assessment of BP levels in adolescence.Objective. To study the prevalence and trends of elevated BP levels, including AH, among adolescents aged 14–18 years in Novosibirsk using the main international definitions.Design and methods. In one of the districts of Novosibirsk, cross-sectional population surveys of random representative samples of schoolchildren aged 14–18 years of both sexes were carried out with an interval of 5 years. Seven screenings were carried out from 1989 to 2019, 4579 adolescents were examined. The study program for adolescents was the same for all screenings and included standard questionnaire, measurement of BP by auscultatory method, anthropometry (height, body weight, chest circumference, waist and hips), the study of nutrition by the 24-h dietary recall method, collection of family history by postal parental interviews, biochemical blood tests. BP was measured twice with an interval of 2–3 minutes (before and after filling out the questionnaire), in a sitting position, on the right arm, with an aneroid sphygmomanometer. Systolic BP was recorded with the appearance of the first Korotkoff tone (I phase), diastolic BP — with the disappearance of the tones (V phase). The average of two measurements was included in the analysis. The prevalence of elevated BP levels was assessed using international criteria. To date, several guidelines have been proposed for the diagnosis of elevated BP and AH in adolescence, using both the percentile method (4th report of NHBPEP 2004) and the methods of fixed (AAP 2017) and mixed criteria (ESH 2016 / Russian recommendations 2020). Statistical analysis was performed using the SPSS package for Windows 13,5.Results. The frequency of prehypertension according to the criteria of the 4th report was 40,3% among boys and 26,4% among girls (P < 0,05), the frequency of elevated BP according to the AAP 2017 criteria was 20,4 % and 12,5% in boys and girls, respectively (P < 0,05), the prevalence of high normal BP was 24,6% and 13,5% (P < 0,05) according to the ESH 2016 criteria. The frequency of AH syndrome according to the AAP 2017 criteria was significantly higher when using 4th report definitions and ESH 2016. According to the criteria of 3 different guidelines, there were a fluctual trends of AH in adolescents in Novosibirsk over a 30-year period, without a pronounced trend to decrease or increase. The prevalence of AH according to the AAP 2017 criteria was 2–3 times higher than when using percentiles (4th report) or mixed (percentiles + fixed cut-off points) European criteria (ESH 2016) during all the period.Conclusions. Long-term population studies of adolescents aged 14–18 in Novosibirsk made it possible to study the frequency and trends of elevated levels of BP and AH syndrome in adolescence and to conduct a comparative study of a number of international and domestic criteria.

Proposition of Cutoff Points for Anthropometric Indicators to Identify High Blood Pressure in Adolescents.

AimTo propose cutoff points for anthropometric indicators for high blood pressure (HBP) screening in adolescents and to identify, among these indicators, those more accurately for boys and girls.MethodsThis cross-sectional study was carried out in the city of São José, SC, Brazil with 634 adolescents aged 14 to 19 years. Blood pressure levels were measured using a digital oscillometric sphygmomanometer and adolescents were classified as having HBP or not. Anthropometric indicators were calculated based on anthropometric measurements such as body mass (BM), height, waist circumference (WC), hip circumference (HC) and triceps, subscapularis, suprailiac, and midcalf skinfold thickness (SF). The Receiver Operating Characteristic Curve (ROC) was used to analyze the predictive capacity of anthropometric indicators in the identification of HBP.ResultsHigher values of Area Under the Curve (AUC) were for the anthropometric indicators BM (0.67; 95%CI: 0.62–0.72), body mass index (BMI) (0.67; 95%CI: 0.62–0.72), and WC (0.67; 95%CI: 0.62–0.71) for males. For females, no anthropometric indicator had discriminatory power for HBP screening. The cutoff points for the anthropometric indicators with discriminatory power for HBP screening in males were BM > 64.80 Kg, BMI > 21.76 Kg/m2, fat percentage (FP) > 15.75, waist height to ratio (WHtR) > 0.41, WC > 73.00 cm, and HC > 92.25 cm.ConclusionAnthropometric indicators of body adiposity had greater discriminatory power of HBP screening in males. For females, caution is suggested because the anthropometric indicators showed AUC values (95%CI) below 0.60.

Association Between Extraversion Personality With the Blood Pressure Level in Adolescents.

PurposeThe association between extraversion personality and high blood pressure (BP) has not been well-studied. This study aims to explore the association between extraversion personality and the BP level in a large sample of adolescents.MethodsAs an ongoing study, 5,246 children aged 6–9 years were recruited using a stratified cluster sampling method in 2014. The extraversion personality trait, assessed by the Eysenck personality questionnaire (EPQ, answered by adolescents) in 2019, was used in the main analysis. A total of 3,407 participants were eligible and included in this analysis.ResultsThe EPQ extraversion score was negatively associated with a systolic BP, a diastolic BP, and mean arterial pressure (MAP) in a univariate analysis. After adjusting for other covariates, high extraversion score was negatively associated with systolic BP (β = −0.026; 95% CI = −0.047, −0.004; p = 0.002). There was an interaction between regions and the extraversion score on systolic BP (Pinteraction = 0.037). The stratified analysis showed that, in rural areas, the extraversion score was negatively associated with systolic BP (β = −0.050; 95% CI = −0.081, −0.016; p = 0.004). However, we did find an association between the extraversion score and systolic BP in urban areas (β = 0.000; 95% CI = −0.028, 0.028; p = 0.996). Similar results were observed for the extraversion assessed by parents.ConclusionsWe observed that extraversion personality was negatively associated with high BP in adolescents, especially for those who were living in rural areas. Our results suggested that a comprehensive intervention should be implemented to promote psychological health in adolescents.

High blood pressure among adolescents in Africa: A systematic review and meta-analysis protocol.

IntroductionAs high blood pressure (HBP) is often considered an adult disease in Africa, studies on and services for HBP focus on adults to the near-exclusion of adolescents. The dearth of information about the burden of HBP does not favour much attention being paid to it. We, therefore, prepared this protocol to estimate the prevalence and awareness of HBP in adolescents in Africa through a systematic review and meta-analysis.MethodsWe will search several major databases for published and unpublished articles on population-based studies on adolescents living in Africa, aged 10–19 years produced from the year 2000 to date. The included articles will be those that define HBP according to international guidelines using the blood pressure cut-offs of the 95th percentile for age, sex and height or of 130/90 mmHg, depending on the age of the subjects. The study selection as well as the evaluation of the quality of the included articles will be done independently by two reviewers, in line with best practices. We will pool together the prevalence across studies using random effects analysis and assess heterogeneity using meta-regression analysis and sub-group analysis. Sensitivity analysis using a leave-one-out analysis and an evaluation of reporting bias will also be performed. Reporting of our findings will conform to the recommended reporting guidelines.ConclusionThe findings from our comprehensive systematic review and meta-analysis will provide an up-to-date information on the prevalence of HBP and its awareness among adolescents in Africa and its sub-regions. They could be used to advocate for increased priority to life course approach to the prevention of cardiovascular diseases.Systematic review registrationPROSPERO CRD42020197946.

Association between excess peripheral, central and general adiposity with high blood pressure in adolescents in southern Brazil.

Introduction: excess adiposity is one of the main risk factors for cardiovascular diseases, including high blood pressure. Children and adolescents with obesity and hypertension are at greater risk of morbidity and mortality in adulthood. Objective: to analyze the association between excess peripheral, central and general adiposity with high blood pressure in adolescents in southern Brazil. Methods: this is a cross-sectional study with 1,132 adolescents (16.50 ± 1.14 years) of both sexes. Measurements were performed with the oscillometric method using digital sphygmomanometer, considering high systolic and diastolic blood pressure, values above the 95th percentile for sex and age. Peripheral adiposity (triceps skinfold) and central adiposity (subscapular skinfold) were classified as high from the 90th percentile of the Centers for Disease Control and Prevention reference distribution. For excess general adiposity, triceps and subscapular skinfold above the 90th percentile were simultaneously considered. Logistic regression was used with 5% significance level. Results: male adolescents with high peripheral, central and general adiposity were, respectively, 2.43 (95% CI: 1.14; 5.19), 3.50 (95% CI: 1.66; 7.41) and 2.47 (95% CI: 1.01; 6.18) times more likely of having high SBP. Male adolescents with excess general adiposity were more likely of developing high diastolic blood pressure (OR: 3.31; 95% CI: 1.41; 7.70). Female adolescents with excess central and general adiposity were 4.15 (95% CI: 1.97; 8.77) and 3.30 (95% CI: 1.41; 7.77) times more likely of developing high diastolic blood pressure, respectively. Conclusion: male adolescents with excess peripheral, central and general adiposity were more likely of having high systolic blood pressure and high diastolic blood pressure when presenting high general adiposity. In addition, female adolescents with high excess central and general adiposity were more likely of having high diastolic blood pressure.

Abstract MP64: Higher Visit-to-Visit Blood Pressure Variability In Early And Middle Childhood Is Associated With Higher Blood Pressure In Adolescence

Background: In young adults, higher blood pressure (BP) and visit-to-visit BP variability are independent risk factors for incident cardiovascular disease. No studies have examined if BP and visit-to-visit BP variability during early and middle childhood are independently associated with elevated BP during adolescence. Addressing this question can provide targets for primordial prevention of high BP. Hypotheses: Higher BP and BP variability in early and middle childhood are independently associated with higher BP in adolescence. Methods: We studied 476 children in the Boston Birth Cohort (enrolled 1998-2016) who had BP measured in early (1 to <6 y) or middle childhood (6 to <13y) and in adolescence (13 to <18 y). We modelled visit-to-visit BP variability using variability independent of the mean (VIM). We used linear regression models to examine the associations of mean BP and BP VIM in early and middle childhood (exposures) with mean BP in adolescence (outcome) and adjusted for potential confounders (see Table footnote). Results: After multivariable adjustment, a 1-SD higher level of systolic BP (SBP) in early and middle childhood was associated with a 1.89 (95% CI: 1.03, 2.75) and a 4.31 (95% CI: 3.58, 5.03) mmHg higher SBP in adolescence, respectively. A 1-SD higher level of SBP VIM in early and middle childhood was associated with a 1.46 (95% CI: 0.54, 2.38) and a 0.89 (95% CI: 0.05, 1.73) mmHg higher SBP in adolescence, respectively. Higher diastolic BP (DBP) in early and middle childhood was also associated with higher adolescence DBP, but the magnitude was smaller in comparison with SBP results ( Table ). Childhood DBP VIM was not associated with DBP in adolescence. Conclusion: In this prospective US predominantly minority birth cohort, both BP levels and variability during early and middle childhood are associated with higher BP in adolescence. Our findings underscore the need for health professionals to collect early-life BP data to facilitate opportunities for the primordial prevention of high BP in adolescence and beyond.

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

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

Waist-to-height ratio and skipping breakfast are predictive factors for high blood pressure in adolescents

The purpose of this study was to estimate the prevalence of high blood pressure (HBP) in adolescents of the Valencian Autonomous Community (VC) in Spain. Besides, its association with other risk factors related to cardiovascular disease (CVD) or arterial hypertension (AHT) in order to increase our knowledge of public health and to provide advice about healthy diets. We conducted a multicentre, observational, cross-sectional, epidemiological study in a sample of 4402 adolescents from 15 schools during the 2015–2016 school year. The participants were aged between 11 and 18 years, and any individuals already diagnosed with AHT were excluded. In addition to the Physical Activity Questionnaire for Adolescents (PAQ-A), Evaluation of the Mediterranean Diet Quality Index (KIDMED), a lifestyle habits survey, the waist-to-height ratio (WtHR), and body mass index (BMI) were calculated for each participant. Informed Consent was obtained from Parents of the adolescents involved in the current study. The study received approval from the University ethics committee and all procedures were conducted in accordance with the tenets of the Declaration of Helsinki. Chi-squared, Student t-tests, and ANOVA statistical analyses showed that 653 (14.8%) adolescents had previously undiagnosed HBP and that was significantly associated with male sex (p < 0.001), age over 15 years (p < 0.05), and height, weight, waist circumference, WtHR, BMI, and skipping breakfast. Based on the data we obtained in this study, the modifiable factors that influence HBP in adolescents were WtHR, BMI, and skipping breakfast.

2017 American Academy of Pediatrics Clinical Practice Guideline: Impact on Prevalence of Arterial Hypertension in Children and Adolescents With Type 1 Diabetes.

In 2017, the American Academy of Pediatrics introduced a new guideline (2017 Clinical Practice Guideline of the American Academy of Pediatrics [AAP 2017]) to diagnose arterial hypertension (HTN) in children that included revised, lower normative blood pressure (BP) values and cut points for diagnosing high BP in adolescents. We studied the impact of the new AAP 2017 on prevalence of HTN in children with type 1 diabetes mellitus (T1DM). Up to September 2018, 1.4 million office BP measurements in 79,849 children and adolescents (aged 5-20 years) with T1DM were documented in the DPV (Diabetes Prospective Follow-up) registry. BP values of the most recent year were aggregated, and BP values of 74,677 patients without antihypertensive medication were analyzed (median age 16 years and diabetes duration 5.3 years, 52.8% boys). BP values were classified according to AAP 2017 and the references of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) (2011) and the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (fourth report) (2004). Of the patients, 44.1%, 29.5%, and 26.5% were hypertensive according to AAP 2017, KiGGS, and fourth report, respectively. Differences in prevalence of HTN were strongly age dependent: <10 years, AAP 2017 31.4%, KiGGS 30.7%, fourth report 19.6%; 10 to <15 years, AAP 2017 30.9%, KiGGS 31.2%, fourth report 22.4%; and ≥15 years, AAP 2017 53.2%, KiGGS 28.4%, fourth report 30.0%. Among teenagers ≥15 years, 59.1% of boys and only 46.3% of girls were classified as hypertensive by AAP 2017 but only 21.1%/26% of boys and 36.7%/34.4% of girls by KiGGS/fourth report, respectively. Classification of BP as hypertension depends strongly on the normative data used. Use of AAP 2017 results in a significant increase in HTN in teenagers ≥15 years with T1DM, particularly in boys. AAP 2017 enhances the awareness of elevated BP in children, particularly in patients with increased risk for cardiovascular disease.

Intensity and frequency of physical activity and high blood pressure in adolescents: A longitudinal study

Despite limited evidence on the association between physical activity (PA) and blood pressure (BP) in youth, experts recommend that adolescents engage regularly in moderate-to-vigorous PA. We examined the relationships between PA intensity and frequency and the likelihood of having high BP in a population-based cohort of adolescents from Montréal, Canada. PA was self-reported every 3months from grade 7 to 11, and BP was measured at ages 12.8, 15.2, and 17.0years on average. We analyzed data from 993 participants (mean [SD] age=16.0 [1.0], 51.6% female) with BP data at ages 15.2 and/or 17.0years, using pooled ordinal logistic regression. BP (normal/elevated/hypertensive range) was the outcome, and past-year PA intensity and frequency were potential predictors. Eight percent of participants had elevated BP (120-129/<80), and 3.2% had BP in the hypertensive range (≥130/≥80). Participants engaged in a median (interquartile range) of 7.0 (4.5, 9.3) and 5.5 (2, 10.8) moderate and vigorous PA sessions/week, respectively. After adjusting for age, sex, mother's education, use of alcohol and cigarette consumption, engaging in PA more intense than light during the previous year was associated with a lower odds of having BP in the hypertensive range (ORs [95% CIs]=0.93 [0.88, 0.97] to 0.97 [0.94, 0.99]). The relationships were not altered by adjusting for BMI. Our findings support recommendations that adolescents engage in at least moderate PA on a regular basis to prevent development of BP in the hypertensive range.

ANTHROPOMETRIC MEASUREMENTS, DIETARY HABITS, SERUM LIPID AND GLUCOSE LEVELS IN RELATION TO HIGH BLOOD PRESSURE AMONG ADOLESCENT BOYS AND GIRLS IN CROATIA.

SUMMARYThe aim was to determine differences in anthropometric measurements, dietary habits, serum lipid and glucose levels in relation to high blood pressure (BP) among adolescent boys and girls in Croatia. The specific aim was to determine the effect of dietary habits and lifestyle on high BP in adolescents according to sex. The study included 260 (68.2%) adolescent girls and 121 (31.8%) boys with anthropometric data obtained (without missing values) from 246 girls and 111 boys. Participants answered questions from the questionnaire and anthropometric BP and blood test values were obtained. Non-parametric tests were used in analyses of reference intervals of systolic and diastolic BP in adolescent boys and girls according to age. High BP was defined as ≥90th percentile for adolescent girls and boys, with a value of ≥135/87.5 mm Hg. Mann-Whitney U test was used to analyze differences in anthropometric and laboratory values between the groups of girls and boys with high (≤90th percentile) and normal BP. Increase in systolic and diastolic BP was noted in the adolescents. In girls, BP values showed a decreasing systolic and increasing diastolic BP trend with age. Girls with high BP had a significantly higher body mass index (BMI) (p=0.020), waist circumference (WC) (p=0.002), waist-to-height ratio (WHtR) (p=0.016), waist-to-hip ratio (WHR) (p=0.043), hip circumference (HC) (p=0.015), triglyceride (TG) levels (p=0.021), higher prevalence of unhealthy diet at school breakfast (p=0.008) and lower prevalence of eating fish (p=0.02). Boys with high BP had a significantly higher BMI (p=0.045), WC (p=0.004), WHtR (p=0.017), WHR (p=0.022) and higher prevalence of eating meat products (p=0.015). Effective health interventions are needed to reduce the risk of developing cardiovascular diseases and preventing age-related illness.