National High Blood Pressure Education Program Research Articles

Prevalence and Factors Associated with Hypertension among Community-Dwelling Adolescents in a Rural Area of Haryana, India, Using AAP 2017 and NHBPEP Criteria.

To estimate the prevalence and determinants of hypertension among adolescents in a rural area in North India. This was a cross-sectional study conducted among community-dwelling adolescents (10-19 y) and defined blood pressure as per the National High Blood Pressure Education Program (NHBPEP) and American Academy of Pediatrics (AAP) 2017 criteria. A pretested, semistructured questionnaire was used to elicit sociodemographic details and risk factors of hypertension. Association of factors with hypertension, z scores of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were assessed by logistic and linear regression. In multivariable regression model, for both logistic and linear regression, variables with p value < 0.2 were included, excluding collinear variables. Eight hundred sixty-four adolescents participated with mean (SD) age, BMI of 14.0 ± 2.6 y, 18.3 ± 3.5kg/m2. Hypertension prevalence was 22.5% (95% CI: 19.7, 25.5) as per AAP and 15.2% (95% CI: 12.9, 17.8) as per NHBPEP criteria. Being hypertensive as per the AAP was associated with family history of noncommunicable disease (NCD) (adjusted odds ratio, AOR 1.80, 95% CI: 1.11, 2.86) and BMI (AOR = 1.09, 95% CI: 1.04, 1.14), and as per the NHBPEP, was only associated with BMI (AOR = 1.11, 95% CI: 1.05, 1.17). SBP z score was significantly associated with male sex (adjusted beta coefficient AC = 0.79, 95% CI: 0.69, 0.90), and weight z scores (AC = 2.00, 95% CI: 1.22, 3.28); DBP z score was significantly associated with z scores of height (AC = 0.70, 95% CI: 0.51, 0.96) and waist (AC = 1.15, 95% CI: 1.02, 1.30). The prevalence of hypertension among adolescents was high and was associated with BMI and family history of NCD.

Ambulatory blood pressure monitoring: A nurse practitioner run program.

Ambulatory blood pressure monitoring (ABPM) is a standard screening tool for the diagnosis of hypertension in children, adolescents, and adults. However, there is confusion and misunderstanding about which guidelines can provide the most accurate diagnostic values. At a large, free-standing pediatric hospital, ABPM testing was historically being conducted by both nephrology and cardiology departments. The nephrology service was using the American Heart Association (AHA) guidelines, published in 2014 for interpretation of results and for diagnosis of hypertension, whereas the cardiology service depended on the 2004 National High Blood Pressure Education Program (NHBEP) fourth report, which led to discrepancies in diagnosis of hypertension in this patient population. A nurse practitioner-led quality improvement project was designed and implemented to determine the best method of ABPM monitoring and test interpretation based on comparing results of patients using height, gender, and application of either the 2004 NHBEP fourth report or 2014 AHA guidelines. Using a retrospective chart review, ABPM monitoring results from both cardiology and nephrology services were reviewed and compared to identify the most accurate methods and to recommend changes to practice. Accuracy of interpretation for ABPM is best accomplished using the 2014 AHA guidelines. Using a single method of interpretation provides consistent diagnosis and treatment of hypertension in children. Nurse practitioners can apply this knowledge in other settings to manage hypertension and provide similar services in different settings, including primary care.

Cardiovascular health of 9-year-old IVF offspring: no association with ovarian hyperstimulation and the in vitro procedure.

Are the in vitro procedure, ovarian hyperstimulation or a combination of these two associated with blood pressure (BP) of 9-year-old IVF children born to subfertile couples? Our study demonstrates that ovarian hyperstimulation and the in vitro procedure are not associated with BP values in 9-year-old children born to subfertile couples. Possible long-term effects of IVF on child health and development have been studied relatively little. This is surprising, as it is known that environmental conditions may influence embryonic and foetal development which may result in health related problems in later life. Some studies suggested that IVF is associated with higher BP at pre-school age. Yet, it is unclear whether this may be also true for older children and if so, which component of IVF, i.e. the ovarian hyperstimulation, the embryo culture or a combination of these, attributes to this potentially less favourable BP. The Groningen Assisted Reproductive Technology cohort-study is a prospective assessor-blinded study of children followed from before birth onwards. In total, 170 children were assessed at the age of 9 years. The attrition rate up until the 9-year-old assessment was 21%. We evaluated cardiovascular health, focusing on BP (in mmHg and the internationally recognized percentiles of the US National High BP Education Program), heart rate and anthropometrics of 57 children born following controlled ovarian hyperstimulation-IVF/ICSI (COH-IVF/ICSI); 47 children born after modified natural cycle-IVF/ICSI (MNC-IVF/ICSI); and 66 children who were conceived naturally by subfertile couples (Sub-NC). Cardiovascular parameters were measured multiple times on one day. In addition, anthropometric data, including BMI and skinfold thickness, were collected. Systolic BP in mmHg did not differ between the COH-IVF/ICSI (mean 106.9, SD 6.7), MNC-IVF/ICSI (mean 104.8, SD 5.9) and Sub-NC (mean 106.3, SD 5.3) groups. In addition, systolic BP percentiles did not differ between the groups: COH-IVF/ICSI (mean 62.4, SD 20.2); MNC-IVF/ICSI (mean 56.3, SD 19.3); and Sub-NC (mean 62.3, SD17.8). Also, after adjustment for confounders BP in the three groups was similar. Heart rate and anthropometric values in the three groups did not differ. For instance, BMI values in the COH-IVF/ICSI-children were 16.3 (median value, range 13.0-24.7), in MNC-IVF/ICSI-children 16.1 (range 12.7-22.5) and in Sub-NC children 16.3 (range 12.7-24.0). The size of our study groups does not allow for pertinent conclusions on the effect of ovarian hyperstimulation and the in vitro procedure. The lack of a fertile control group may be regarded as another limitation. Our study suggests that ovarian hyperstimulation and in vitro procedures are not associated with cardiovascular health in 9-year-old. Yet, BP percentiles of the three groups were higher than the expected 50th percentile. This might indicate that children of subfertile couples have a higher BP than naturally conceived children. The study was financially supported by the University Medical Center Groningen (UMCG), the two graduate schools of the UMCG, BCN, SHARE and the Cornelia Stichting. The sponsors of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The authors have no conflicts of interest to declare.

Prevalence and predictors of pre hypertension and hypertension among school going adolescents (14–19 years) of Tripura, India

Abstract Background Uncontrolled hypertension during adolescence is an established risk factor for future development of cardiovascular disease (CVD). The study determined prevalence of pre hypertension and hypertension and the predictors of high blood pressure among adolescents. Methods The study included 530 Tripuri tribal and 363 Bengali adolescents from Tripura, India. Anthropometric measurements, adiposity status, systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the subject were evaluated. Subjects were classified as normotensive, pre hypertensive and hypertensive using National high blood pressure education program (NHBPEP) criteria. Multiple logistic regression was applied to study the strength of association between blood pressure and socieconomic correlates. Results Prevalence of normotension, pre-hypertension and hypertension was 89.47%, 7.73% and 2.80% respectively. Overweight or obese subjects were highly susceptible for pre-hypertension and hypertension. SBP showed significant positive correlation with body mass index (BMI), waist-hip ratio (WHR), waist circumference (WC) and waist-height ratio (WHtR). While DBP correlated significantly with BMI, WHR and body fat of subjects. Risk factors like age, parental literacy status, socioeconomic class, physical activity level, WHR, WC, WHtR; and percentage body fat showed significant association with hypertension. Conclusion Prevalence of pre hypertension and hypertension varies according to ethnicity, locality, adiposity and socioeconomic correlates of the subjects.

Blood pressure-to-height ratio for diagnosing hypertension in adolescents

Background Diagnosing hypertension in children and adolescents is not always straightforward. The blood pressure-to-height ratio (BPHR) has been reported as a screening tool for diagnosing hypertension.Objective To evaluate the diagnostic value of blood pressure-to-height ratio for evaluating hypertension in adolescents.Methods A cross-sectional study was conducted among 432 healthy adolescents aged 12-17 years in Singkuang, North Sumatera from April to May 2016. Blood pressure tables from the National High Blood Pressure Education Program (NHBPEP) Working Group on High Blood Pressure in Children and Adolescents were used as our standard of comparison. Sex-specific systolic and diastolic blood pressure-to-height ratios (SBPHR and DBPHR) were calculated. ROC curve analyses were performed to assess the accuracy of BPHR for discriminating between hypertensive and non-hypertensive adolescents. Optimal thresholds of BPHR were determined and validated using 2x2 table analyses.Results The accuracies of BPHR for diagnosing hypertension were &gt; 90% (P&lt;0.001), for both males and females. Optimal SBPHR and DBPHR thresholds for defining hypertension were 0.787 and 0.507 in boys, respectively, and 0.836 and 0.541 in girls, respectively. The sensitivities of SBPHR and DBPHR in both sexes were all &gt;93%, and specificities in both sexes were all &gt;81%. Positive predictive values for SBPHR and DBPHR were 38.7% and 45.2% in boys, respectively; and 55.9% and 42.4% in girls, respectively; negative predictive values in both sexes were all &gt;97%, positive likelihood ratios in both sexes were all &gt;5, and negative likelihood ratios in both sexes were all &lt;1.Conclusion Blood pressure-to-height ratio is a simple screening tool with high sensitivity and specificity for diagnosing hypertension in adolescents.

Relationship between fat distribution ratio and blood pressure in obese adolescents

Background The incidence of obesity in big cities increasessignificantly. The association between obesity and increased riskof cardiovascular disease and hypertension in adults has beenknown but less information is available in adolescents. Similarly,the relationship between body-fat distribution and cardiovasculardiseases in adolescents is less clear tha that in adults.Objective This study aimed to determine the association betweenbody fat distribution and increased blood pressure in obeseadolescents in Bandung.Methods This cross-sectional study was conducted from June toAugust 2006. Subjects were students aged 15-18 years at highschools in Bandung with body mass index (BMI) measured usingCDC chart 2000 (&gt; P95) and increased blood pressure (&gt; P90)depended on age and gender according to National High BloodPressure Education Program Working Group on High BloodPressure in Children and Adolescents 2004. Waist-to-hip ratio(central fat), and subscapula skinfold-to-triceps skinfold ratio(peripheral fat) were used to measure fat distribution. Correlationbetween body fat distribution and blood pressure was analyzedusing Pearson correlation statistical test.Results Out of 3170 adolescents examined, 34 obese adolescentgirls and 43 obese adolescent boys had increased blood pressure.Correlation between waist-to-hip ratio and systole blood pressurein boys showed by r=0.495; P=0.003 and girls showed r=0.494;P=O.OOl. Correlation between subscapula skinfold-to-tricepsskinfold ratio in boys showed r=0.289; P=0.097 and girls showedby r=0.248; P=0.109.Conclusion Central fat is moderately correlated with increasedblood pressure in obese adolescents.

Clinicians' Adherence to Guidelines on Evaluation of Hypertension in Children and Adolescents.

Hypertension is increasingly prevalent among children. We sought to review provider adherence to the National High Blood Pressure Education Program (NHBPEP) recommendations at a single academic medical center. We identified children 3-18 years of age with hypertension based on outpatient visit International Classification of Diseases, Ninth Edition, Clinical Modification codes from 2006 to 2012. We calculated the odds of individual tests administration for ten recommended tests, adjusting for demographic characteristics. We identified 3,588 (1.7%) of 216,855 children diagnosed with hypertension at a median age of 14 years (25th and 75th percentile 10 and 16, respectively). No child received all ten recommended tests. The median number of tests administered was 2 (1, 4) but varied significantly by race and age. Urine drug screen (<1%) and renin levels (1%) were the least common, whereas serum creatinine (49%) and echocardiogram (40%) were the most common tests. Male children were more likely to receive an echocardiogram (odds ratio 1.43; 95% confidence interval: 1.24-1.64), and black children and those ≥11 years old were less likely to have their serum creatinine checked. Adherence to the guidelines did not improve over time (P = .24). Children evaluated for hypertension in the outpatient setting infrequently receive the diagnostic tests recommended in the NHBPEP's report. Test administration frequency varies by patient demographics but has not improved significantly over time.

Blood pressure-to-height ratio for screening prehypertension and hypertension in Chinese children.

The diagnosis of hypertension in children is complicated because of the multiple age-, sex- and height-specific thresholds. To simplify the process of diagnosis, blood pressure-to-height ratio (BPHR) was employed in this study. Data were obtained from a Chinese national survey conducted in 2010, and 197 191 children aged 7-17 years were included. High normal and elevated blood pressure (BP) were defined according to the National High Blood Pressure Education Program (NHBPEP) Working Group definition. The optimal thresholds were selected by Youden's index. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and area under the curve (AUC) were assessed for the performance of these thresholds. The systolic and diastolic BPHR thresholds for identifying high normal BP were 0.84/0.55, 0.78/0.50 and 0.75/0.46 for children aged 7-8 years, 9-11 years and 12-17 years, respectively. The corresponding thresholds for identifying elevated BP were 0.87/0.57, 0.81/0.53 and 0.76/0.49, respectively. These proposed thresholds revealed high sensitivity and NPVs, all above 0.96, moderate to high specificity and AUCs, and low PPVs. Our finding suggested the proposed BPHR thresholds were accurate for identifying children without high normal or elevated BP, and could be employed to simplify the procedure of screening prehypertension and hypertension in children.

PS1-52: Diagnosis of Pediatric Hypertension Depends on Clinical Practice Guideline Definitions

Background/Aims The National High Blood Pressure Education Program (NHBPEP) guidelines define hypertension (HT) in children and adolescents as blood pressure (BP) measures above the 95th percentile on three consecutive clinic visits. In contrast, the Expert Panel of Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (Expert Panel) clinical practice guidelines define HT as the average of three consecutive BP measures above the 95th percentile. Here we quantify the impact of these two different case definitions of HT on occurrence of HT in a defined population of children and adolescents.

Prevalência de hipertensão arterial e sua associação com sobrepeso e obesidade: estudo de base escolar

This study aimed to investigate the association of overweight and obesity with hypertension in adolescents from public schools in Curitiba, southern Brazil.The sample comprised 1,549 randomly selected adolescents aged 12 to 18 years (744 males). Body mass index (BMI) was calculated and classified according to Conde and Monteiro (2006). Blood pressure was measured by the auscultation method on two occasions (different days) and was classified according to the fourth report of the National High Blood Pressure Education Program (NHBPEP). Prevalence ratio was used as a measure of association. Overweight and obesity were observed in 23% and 5.8% of boys, respectively. Among girls, 18.8% were overweight and 5.6% were obese. After two measurements, 7% of boys had prehypertension and 10.5% had hypertension. Pre hypertension and hypertension were observed in 5.2% and 9.9% of girls, respectively. Obesity was significantly associated with high blood pressure among boys (PR = 1.19, 95% CI= 1.07-1.32). Overweight (PR = 1.11, 95% CI = 1.04-1.17) and obese (PR = 1.26,95% CI = 1.13-1.40) girls were more likely to have high blood pressure levelsin comparison to normal weight adolescents. These results showed alarming estimates of hypertension among young people and that the reduction of obesity during adolescence should be focused on public policies for hypertensionprevention in the population.

Epidemiology of hypertension

Abstract Hypertension is an epidemic affecting one billion people and is the commonest risk factor for death throughout the world. World health statistics 2012 has estimated the prevalence of hypertension to be 29.2% in males and 24.8% in females. Approximately 90 percent for men and women who are non hypertensive at 55 or 65 years will develop hypertension by the age of 80–85. Hypertension is not limited to rich population and affects countries across all income groups. Out of total 58.8 million deaths worldwide in year 2004, high blood pressure was responsible for 12.8% (7.5 million deaths). World over hypertension is responsible for 51% of cerebrovascular disease and 45% of ischemic heart disease deaths. Unlike the popular belief that hypertension is more important for high-income countries, people in low- and middle-income countries have more than double the risk of dying of hypertension. Understanding epidemiology of hypertension will significantly help in decreasing the burden of associated morbidity and mortality. In America, with the help of programs such as National High Blood Pressure Education Program (NHBPEP), the awareness about hypertension has improved from 51 percent in the period 1976–1980 to 70 percent in 1999–2000 and as a result hypertension related morbidity and mortality has substantially improved. Since 1972, age-adjusted death rates from stroke have decreased by about 60% and that by coronary heart disease has decreased by about 50 percent. Recent WHO initiative on non communicable diseases is expected to decrease hypertension related mortality and morbidity globally.

The treatment of hypertension: a remarkable success story.

One of the most successful public health programs in the past century provides an example of what can be accomplished when the government, the private sector, academia, and community organizations work together. The results of 4 decades of activities of the National High Blood Pressure Education Program (NHBPEP) can be measured in several ways. The publics' awareness, treatment, and control have increased remarkably. Hypertension is the primary reason adults visit physicians. Age-adjusted mortality for heart disease and stroke has declined by 70% and 80%, respectively, since the beginning of the program. The decline in heart and stroke deaths is seen in both sexes and blacks and whites, and is particularly evident in people who reside in the southeastern portion of the United States, which once had the highest mortality rates of stroke in the United States. This dramatic decrease in strokes and heart disease has occurred despite the substantial increase in obesity and diabetes in the United States.

Preventing High Blood Pressure and Promoting Longevity

The article focuses on current and historical public health efforts to address high blood pressure among Chinese Americans. A 1972 poster produced by the National High Blood Pressure Education Program (NHBPEP) coordinated by the National Heart, Lung, and Blood Institute of the National Institutes of Health is presented. Hypertension prevalence is discussed among Chinese Americans.

Number of blood pressure measurements needed for screening of hypertension in children and adolescents

Background Routine blood pressure assessment is recommended because childhood hypertension is significantly associated with increased risk of cardiovascular disease in adulthood. However, results of blood pressure measurements in children are highly variable, associated with the risk of under or over-diagnosing in hypertension.Objective To assess the optimal number of measurements to screen elevated blood pressures in children and adolescents.Methods This study used two sets of data, i.e. a dataset from 104 obese and non-obese, male and female primary school-children, and a dataset from 79 obese female adolescents. Blood pressure (BP) was measured using standard techniques described by the fourth report of the National High Blood Pressure Education Program (NHBPEP) Working Group on Children and Adolescents. Elevated BP was defined as systolic and diastolic BP at or above the 90th percentile for gender, age, and height.Results BP measurements taken on day-one were significantlyhigher than those taken on day-two and three. This led tohigher prevalence of elevated BP when only one measurementwas performed. Using the average of two measurements in twooccasions detected elevated blood pressure with specificity andpositive predictive value (PPV) ranged from 0. 74 to 1.0 and 0.58to 1.0, respectively.Conclusions It is necessary to measure blood pressure repeatedly to minimize the risk of over-diagnosing in hypertension in children and adolescents. Using the average of three measurements in three visits is recommended, but drawing conclusions based on two measurements in two occasions have yielded sufficiently high specificity.

Prevalence and Severity of Hypertensive Retinopathy in Children

The National High Blood Pressure Education Program (NHBPEP) report recommends a retinal exam seeking evidence of target organ damage in hypertensive children. This study aimed to determine the prevalence and severity of hypertensive retinopathy among hypertensive children, evaluated by pediatric ophthalmologists in the "real world" clinical setting using direct ophthalmoscopy. The authors retrospectively reviewed the medical records of the 83 children diagnosed with hypertension by a pediatric nephrologist between 1999 and 2006. Of the 35 children examined by an ophthalmologist within 12 months of the diagnosis of hypertension, only 3 (8.6%; 95% CI, 1.8%-23.1%) were diagnosed with hypertensive retinopathy. Despite the fact that those selected for retinal examination were likely at higher risk for retinopathy, the prevalence of retinopathy was low, and only mild abnormalities were detected. Given the lack of evidence linking mild retinal abnormalities with adverse outcomes, the NHBPEP recommendation for retinal examinations in hypertensive children should be reconsidered.

Poor Glycemic Control is Associated with Abnormal Changes in 24-hour Ambulatory Blood Pressure in Children and Adolescents with Type 1 Diabetes Mellitus

Twenty-four hour ambulatory blood pressure (ABPM) is emerging as a valuable tool to assess blood pressure (BP) changes in children with type 1 diabetes mellitus (DM1). Hypertension (HTN) is an important risk factor for, and may be an important indicator of diabetic nephropathy. Early accurate identification of HTN in DM1 may improve outcomes. To evaluate BP in adolescents with DM1 using 24-hour ABPM, and to identify risk factors associated with abnormal blood pressure. The ABPM of 105 children with DM1 was reviewed. Mean systolic BP (sBP) percentile was determined from the National High Blood Pressure Education Program (NHBPEP) tables. The patients with abnormal sBP were compared to those with normal sBP with respect to age, race, sex, body mass index (BMI) percentile, duration of DM1, average hemoglobin A1c (HbA1c) over the preceding year, and family history of hypertension. Mean sBP was normal in 71%, whereas 23% had pre-hypertension, and 6% had stage 1 hypertension. Those who had abnormal sBP (pre-hypertension and stage 1 hypertension) had higher HbA1c (p = 0.023) and were more likely to be male (p = 0.03) than those with normal sBP. Stage 1 hypertension is present in 6%, and pre-hypertension in 23% of adolescents with DM1. Poor diabetes control and male gender appear to be risk factors for abnormal sBP as measured by 24-hour ambulatory blood pressure monitoring.

Pediatric Hypertension: Recent Trends and Accomplishments, Future Challenges

Publication of the Fourth Report on high blood pressure (BP) in children and adolescents by the National High BP Education Program (NHBPEP) in 2004 has been followed by a remarkable increase in interest in pediatric hypertension. New data have emerged on the epidemiology of hypertension in the young, the influence of the childhood obesity epidemic on BP, how ambulatory BP monitoring (ABPM) can be used in evaluating elevated BP and the extent of hypertensive target-organ damage in the pediatric age group. Exciting new information on drug treatment of pediatric hypertension has been produced by industry-sponsored clinical trials of antihypertensive medications spurred by the FDA Modernization Act (FDAMA) and successor legislation. Despite these trends, recognition of elevated BP in children and adolescents by primary care providers remains problematic. This article will highlight these and other aspects of pediatric hypertension, hopefully providing a snapshot of where we are in early 2008, and pointing out areas where further work is needed in order to reduce the future burden of adult cardiovascular disease.

What Is the Significance of Increased Carotid Intima Media Thickness in Hypertensive Adolescents?

Fortunately, common cardiovascular sequelae of long-standing hypertension in adults, such as myocardial infarction and stroke, are not seen in hypertensive children and adolescents. However, it is well established that persistent blood pressure elevation in the young can produce other target-organ effects. Chief among these are left ventricular hypertrophy (LVH), which may be present in ≤30% of children at the time of diagnosis of hypertension,1 and abnormal left ventricular geometry, which is typically seen in those with more severe blood pressure elevation. LVH can be seen even in adolescents with even mild blood pressure elevation and is probably the most readily assessed target-organ effect of hypertension in the young because of the wide availability of echocardiography. Its importance as a cardiovascular risk factor was recently highlighted by the National High Blood Pressure Education Program (NHBPEP) Working Group on High Blood Pressure in Children and Adolescents, which recommended that echocardiograms be obtained as part of the initial evaluation of children and adolescents with confirmed hypertension.2 It was further recommended that if LVH is found, the antihypertensive therapy should be intensified. Other consequences of hypertension almost certainly develop in young hypertensive subjects but are more difficult to demonstrate. These include renal damage, hypertensive retinopathy, and cognitive impairment. Hypertensive renal damage probably first manifests as microalbuminuria and later progresses to end-stage renal disease; indeed, hypertension is one of the leading causes of chronic …

Diabetes Mellitus and Hypertension Associated With Shock Wave Lithotripsy of Renal and Proximal Ureteral Stones at 19 Years of Followup

SWL has revolutionized the management of nephrolithiasis and it is a preferred treatment for uncomplicated renal and proximal ureteral calculi. Since its introduction in 1982, conflicting reports of early adverse effects have been published. However, to our knowledge the long-term medical effects associated with SWL are unknown. We evaluated these adverse medical effects associated with SWL for renal and proximal ureteral stones. Chart review identified 630 patients treated with SWL at our institution in 1985. Questionnaires were sent to 578 patients who were alive in 2004. The response rate was 58.9%. Respondents were matched by age, sex and year of presentation to a cohort of patients with nephrolithiasis who were treated nonsurgically. At 19 years of followup hypertension was more prevalent in the SWL group (OR 1.47, 95% CI 1.03, 2.10, p = 0.034). The development of hypertension was related to bilateral treatment (p = 0.033). In the SWL group diabetes mellitus developed in 16.8% of patients. Patients treated with SWL were more likely to have diabetes mellitus than controls (OR 3.23, 95% CI 1.73 to 6.02, p <0.001). Multivariate analysis controlling for change in body mass index showed a persistent risk of diabetes mellitus in the SWL group (OR 3.75, 95% CI 1.56 to 9.02, p = 0.003). Diabetes mellitus was related to the number of administered shocks and treatment intensity (p = 0.005 and 0.007). At 19 years of followup SWL for renal and proximal ureteral stones was associated with the development of hypertension and diabetes mellitus. The incidence of these conditions was significantly higher than in a cohort of conservatively treated patients with nephrolithiasis.

New blood pressure guidelines call for early intervention

A new set of guidelines has been issued by the National High Blood Pressure Education Program (NHBPEP) that may have significant impact on the importance given to blood pressure measurement as an early indicator of future cardiovascular risk, even in young children. ![Figure][1] Dr. Flynn