National High Blood Pressure Education Research Articles

The impact of updated clinical blood pressure guidelines on hypertension prevalence among children and adolescents.

To date, population estimates of hypertension prevalence among children and adolescents in Canada have been based on clinical guidelines in the National High Blood Pressure Education Program's 2004 Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (NHBPEP 2004). In 2017, the American Academy of Pediatrics published updated guidelines in Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents (AAP 2017), followed by Hypertension Canada in 2020 with its publication of Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children (HC 2020). This study compares national child and adolescent hypertension prevalence estimates based on NHBPEP 2004, AAP 2017 and HC 2020. Six cycles of data spanning 2007 to 2019 from the Canadian Health Measures Survey were used to compare blood pressure (BP) categories and the prevalence of hypertension by sex and age group under all sets of guidelines for children and adolescents aged 6 to 17. The impact of applying AAP 2017 across time and selected characteristics, the resulting reclassification into a higher BP category under AAP 2017, and differences in hypertension prevalence resulting from applying HC 2020 versus AAP 2017 were examined. Prevalence of Stage 1 hypertension was higher among children and adolescents aged 6 to 17 under AAP 2017 and HC 2020 than under NHBPEP 2004. Overall hypertension prevalence was also higher, and obesity was a major factor associated with being reclassified into a higher BP category under AAP 2017. Implementation of AAP 2017 and HC 2020 is associated with significant changes in the epidemiology of hypertension. Understanding the impact of applying updated clinical guidelines may help inform population surveillance efforts to track hypertension prevalence among Canada's children and adolescents.

S-43-6: HYPERTENSION FROM CHILDHOOD TO ADULTHOOD: THE BT20+ STUDY

Background: Hypertension is a major risk factor for cardiovascular diseases and its prevalence among the Sub-Saharan African population has risen extremely in the last decades. Moreover, there is growing evidence that suggest that hypertension has its roots in childhood and adolescence and persist into adulthood. However, the epidemiology of hypertension in the young in a Low to Middle Income Country (LMIC) setting is not fully understood due to paucity of longitudinal data. Thus, we sought to investigate prevalence and new cases of hypertension and to identify risk factors that predict the incidence of hypertension from early childhood in urban black South-African children. Methods: We used data from the Birth to Twenty (BT20+) cohort in Johannesburg, South Africa. This cohort comprised of children born in 1990 and who had their growth, development and blood pressure measured at six follow-up periods over the course of 13 years. Hypertension status was classified using the fourth report of the National High Blood Pressure Education Program. Hypertension incidence rate was calculated using staggered entry survival analysis. We identified risk factors for incident hypertension using multivariable cox proportional hazard regressions. Results: Over a follow-up period of 13 years, the overall point prevalence of hypertension ranged from 8.4 to 24.4 % and cumulative incidence of hypertension was 54.3% (95% CI: 51.8 to 56.8). The overall hypertension incidence rate was 57.0 cases per 1000 person-years (95% CI: 53.2 to 61.1). Furthermore, the risk for incident hypertension increased with a rapid relative weight gain in early childhood (aHR = 1.11, 95% CI: 1.00 to 1.22), in mid childhood (aHR = 1.13, 95% CI: 1.03 to 1.24) and in adolescence (aHR = 1.21, 95% CI: 0.99 to 1.47). An increase in maternal parity significantly increased the risk for incident hypertension (aHR = 1.08, 95% CI: 1.01 to 1.15). Conclusion: Rapid weight gain relative to height and higher parity are prominent risk factors for incident hypertension in urban black South African children and adolescents. In order to reduce the high incidence and the disease burden of hypertension, national health programs should focus on promoting healthy lifestyle in early stages of life to curb rapid weight gain. Further research is required to check whether incident hypertension in childhood predict clinical outcomes in adulthood.

Management of hypertension during pregnancy: A meta-analysis

Gestational hypertension, chronic hypertension, preeclampsia, and preeclampsia superimposed on pre-existing hypertension are the four categories into which the National High Blood Pressure Education Program of the NHLBI divides hypertensive disorders of pregnancy. Pregnant women with hypertension are at risk for death, renal failure, heart failure, hepatic rupture, cerebral edema, and cerebrovascular accidents. The foetuses of hypertension mothers are at risk for stillbirth, intrauterine growth restriction, and preterm birth difficulties after delivery due to maternal symptoms. When the diastolic pressure is greater than 90 to 110 mm Hg or the systolic pressure is greater than 140 to 170 mm Hg, most doctors start antihypertensive medication. A pre-pregnancy assessment for women with chronic hypertension should focus on end-organ damage, medication history, possible secondary causes of hypertension, and counselling on pregnancy's hazards. Women need to be monitored during their pregnancies, as well as during the intrapartum and postpartum periods.

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.

Pregnancy per- and polyfluoroalkyl substances (PFAS) and hypertensive disorders of pregnancy in the Project Viva cohort

BACKGROUND AND AIM: Exposure to environmental chemicals may increase the risk of cardiovascular disease. However, data on associations between per- and polyfluoroalkyl substances (PFASs) and hypertensive disorders of pregnancy (HDP) are limited and inconsistent. We sought to determine the extent to which early-pregnancy PFAS concentrations are prospectively associated with HDP risk in a large cohort. METHODS: We studied 1,537 pregnant women from the Project Viva cohort in Boston, Massachusetts, USA. Using maternal plasma samples collected from 1999-2002 at a median of 9.7 gestational weeks, we quantified concentrations of eight PFAS [perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorohexane sulfonate (PFHxS), perfluorononanoate (PFNA), 2-(N-ethyl-perfluorooctane sulfonamide) acetate (EtFOSAA), 2-(N-methyl-perfluorooctane sulfonamide) acetate (MeFOSAA), perfluorodecanoate (PFDeA), perfluorooctane sulfonamide (FOSA)]. PFDeA and FOSA were detected in 50% of samples and were not included in further analyses. We assessed HDP using clinical data and defined preeclampsia and gestational hypertension according to the National High Blood Pressure Education Program recommendations. We used multinomial logistic regression to estimate associations of log2-transformed continuous PFAS concentrations with categories of HDP [gestational hypertension, preeclampsia, normotensive (ref)], adjusting for age, race/ethnicity, education, smoking, marital status, and parity. RESULTS:A total of 56 (4%) of women developed preeclampsia and 106 (7%) developed gestational hypertension. We observed higher risk of gestational hypertension per doubling of concentrations of PFOS (odds ratio [OR] 1.28, 95% confidence interval [CI]: 0.96, 1.70), PFOA (OR 1.36, 95% CI: 0.99, 1.86), and PFHxS (OR 1.22, 95% CI: 1.01, 1.48). Associations with other PFAS were consistent in direction but smaller in magnitude (e.g., EtFOSAA: OR 1.14, 95% CI: 0.95, 1.38). We did not observe associations between PFAS concentrations and preeclampsia. CONCLUSIONS:Our results support the hypothesis that PFAS exposure during pregnancy may increase the risk of gestational hypertension. However, we did not observe associations between PFAS exposure and preeclampsia. KEYWORDS: PFAS, hypertensive disorders of pregnancy, gestational hypertension, preeclampsia, pregnancy

Tailored intervention to implement the management of hypertensive and type 2 diabetes mellitus patients in community pharmacies – a pilot study

Abstract Introduction Uncontrolled blood pressure and poor glycaemic control may lead to increased morbidity and mortality (1). A systematic review of 40 studies reported beneficial effects of interventions conducted in community pharmacies in the management of diabetes and cardiovascular diseases (2). Aim To evaluate the impact of a tailored intervention on clinical outcomes in the management of hypertensive and/or type 2 diabetes mellitus (T2DM) patients in community pharmacies in a pilot implementation study. Methods The study (April to July 2019) utilized a mixed-method design. This included a cross-sectional survey among 133 consented community pharmacists and 390 T2DM and/or hypertensive patients at the pharmacies. Thirty-one item (pharmacists) and 29-item (patients) semi-structured questionnaires were used to gather information on their perception of pharmacists’ roles in the management of T2DM and/or hypertension. Barriers to implement identified roles by the pharmacists were documented. Thereafter, a prospective before- and after-intervention study was conducted in four consented pharmacies to address the barriers. Two pharmacists per pharmacy and 34 consented T2DM and/or hypertensive adult patients who had been on medications for ≥3 months participated. Pharmacists were provided with 2-hr one-on-one training on the management of T2DM and hypertension based on standard guidelines pre-intervention and at 4 weeks. Components of the pharmacist’s intervention included patient’s education, medication counselling , lifestyle modifications and self-care use of point of care devices. Systolic and diastolic blood pressure (SBP and DBP), fasting blood glucose (FBG) and body mass index (BMI) of all patients were measured at baseline, 4- and 8-week post-intervention. Weekly patient follow-up visits to the pharmacies were mandatory. Telephone calls and referral were incorporated, when necessary. Failure to show up for two consecutive visits disqualified patients from completing the study. Descriptive statistics (to summarise data), and paired t-test to compare mean differences in the measured parameters at α=0.05. Results Hypertensive and/or T2DM patients (374) and 71 pharmacists participated in the survey. The patients expected pharmacists to provide medication counselling (81;27.1%), education (47;12.6%), follow-up (18;4.8%), health outcomes monitoring (17;4.5%), and collaboration with physicians (12;3.2%). Sixty-nine (97.2%) pharmacists agreed that patients’ follow-up, patient counselling (71;100.0%), therapeutic plan design to achieve goals (67;94.4%) and collaboration with physicians (61;85.9%) were important. Barriers to providing adequate counsel to these patients were time constraints (23;32.4%), unconducive environment (7;9.9%) and patient’s impatience (33;46.5%). For the intervention component, 16 of the 34 patients enrolled were lost to follow-up (one hospitalized, seven failed two consecutive visits, and eight lost to referral). Effects of the tailored intervention on the parameters are in Table 1. Conclusion The patients’ and pharmacists’ perceived roles of the pharmacist in the management of hypertension and T2DM were in tandem. The 8-week tailored pharmacists’ intervention resulted in better control of blood pressure but increased FBG. This pilot study is limited by the small sample size of patients and pharmacists, as well as the lack of appropriate comparator. Future large-scale multi-site study with relevant comparator is required for a far-reaching conclusion on the impact of the tailored pharmacist intervention in the management of diabetes and hypertension.

Evaluation of endothelial function in obese children and adolescents

Evaluation of endothelial function in obese children and adolescents

Dietary Approaches to Stop Hypertension Dietary Intervention Improves Blood Pressure and Vascular Health in Youth With Elevated Blood Pressure.

This randomized control trial assessed the post-intervention and 18-month follow-up effects of a 6-month dietary approaches to stop hypertension (DASH)-focused behavioral nutrition intervention, initiated in clinic with subsequent telephone and mail contact, on blood pressure (BP) and endothelial function in adolescents with elevated BP. Adolescents (n=159) 11 to 18 years of age with newly diagnosed elevated BP or stage 1 hypertension treated at a hospital-based clinic were randomized. DASH participants received a take-home manual plus 2 face-to-face counseling sessions at baseline and 3 months with a dietitian regarding the DASH diet, 6 monthly mailings, and 8 weekly and then 7 biweekly telephone calls focused on behavioral strategies to promote DASH adherence. Routine care participants received nutrition counseling with a dietitian consistent with pediatric guidelines established by the National High Blood Pressure Education Program. Outcomes, measured pre- and post-intervention and at 18-months follow-up, included change in BP, change in brachial artery flow-mediated dilation, and change in DASH score based on 3-day diet recalls. Adolescents in DASH versus routine care had a greater improvement in systolic BP (-2.7 mm Hg, P= 0.03, -0.3 z-score, P=0.03), flow-mediated dilation (2.5%, P=0.05), and DASH score (13.3 points, P<0.0001) from baseline to post-treatment and a greater improvement in flow-mediated dilation (3.1%, P=0.03) and DASH score (7.4 points, P=0.01) to 18 months. The DASH intervention proved more effective than routine care in initial systolic BP improvement and longer term improvement in endothelial function and diet quality in adolescents with elevated BP and hypertension. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00585832.

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.

Relation of Endothelin-1 and Malondialdehyde with Pre-eclampsia in Pregnant Women

A case-control study was conducted in Kirkuk city in Kirkuk general hospital from first of March 2018 and to end of September 2018 to evaluate the role of endothelin-1 and malondialdehyde in pathogenesis of pre eclampsia in pregnant women. The study included 30 pregnant women with preeclampsia, patients were defined and divided according to the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. A control group of 30 healthy normotensive pregnant females was also included. All comparison groups were matched for mother’s age, parity, and gestational age at the time of enrollment and blood collection. Three ml of blood was collected by vein puncture, blood samples were placed into sterile test tubes and left for 30 minutes at 37 °C then were centrifuged at 3000 rpm for 15 minutes then the clot was removed and the obtained sera were then aspirated using automatic micropipette and transferred into clean test tubes and stored in deep freeze at -20°C for determination of endothelin-1 and malondialdehyde by usingELISA technique. The study showed that the highest mean level of endothelin-1 was found in pregnant women with pre-eclampsia(13.15±2.81 pg/ml) and the lowest mean was in the control group (0.41±0.31 pg/ml). The result was highly significant (P&lt;0.01). The study showed that the highest mean level of MDA was found in pregnant women with pre-eclampsia (6.75±2.94 nmol/ml) and the lowest mean was recorded in the control group (3.85±1.29 nmol/ml). The result was highly significant (P&lt;0.01). The current study showed that the mean age of patients enrolled in the study was 33.5 years, the highest mean of endothelin-1 in HD patients was recorded within the age group 20-29 year of pregnant women with pre-eclampsia. Although the results was non-significant. The study showed positive correlation between endothelin-1 and MDA levels pregnant women with pre-eclampsia. It was concluded that serum endothelin-1 and MDA levels were highly correlated with pregnant women with pre-eclampsia

Whole-Blood Capillary Tube Clotting Time as a Possible Predictor of Hypertensive Disorders in Pregnancy

Background: Hypertensive disorders in pregnancy (HDP) are associated with coagulation abnormalities. However, results of standard coagulation tests in patients with HDP have been inconsistent. Aim: The aim of this study was to determine mean clotting time (CT) in subjects with HDP attending antenatal clinic at Murtala Muhammad specialist Hospital Kano, Nigeria and to assess CT as a possible predictor of HDP. Materials and Methods: Eighty-four HDP subjects and equal number of normotensive pregnant women were recruited for the study. Blood pressure was measured according to standard protocol. Urinalysis was performed using urine test strips (Medi-Test Combi 9®). Whole-blood CT was determined using capillary tube method. Hypertensive disorders in pregnancy were defined according to the report of National high blood pressure education program working group on high blood pressure in pregnancy. Data were analyzed using IBM SPSS version 23.0. Chi-square test of association and independent t test were used to determine association and difference between categorical and quantitative variables respectively. Pearson’s correlation was used to determine relationship between quantitative variables.

The challenge of simplifying blood pressure screening in children and adolescents.

Simplified methods of blood pressure screening could facilitate the clinical routine of the primary care physicians and may increase adherence to pediatric hypertension guidelines. Blood-pressure-to-height ratios are appealing for the simplicity of data needed to evaluate a child's blood pressure status, including only office blood pressure values and height. In several epidemiological studies around the world blood-pressure-to-height ratios showed good predictive power in identifying children with high blood pressure in terms of area under the curve and sensitivity compared to the gold standard National High Blood Pressure Education Program blood pressure tables, but low positive predictive values meaning a high rate of false-positive cases and possibly increased subsequent work load for primary physicians. Finally, blood-pressure-to height ratios seem to be dependent to age, sex, and weight status. In conclusion, blood-pressure-to-height ratios need to be further improved and validated in different pediatric populations before routine clinical use.

Pediatric Hypertension (HTN) Assessed by Various Methods: A Study among Pediatric Inpatients in University Hospital Gabriel Tour&amp;#233; (UH-GT)

Introduction: It is known for decades that a correlation among child blood pressure and adult pressure exist. There are few publications on Hypertension (HTN) in pediatric area. We therefore conducted this study to estimate the extension of HTN among children and looking for associated factors. Methods: Blood pressure was assessed using the references released by the National institutes of health in the United States, those of the French Society of Pediatric Nephrology and z-score. We used the auscultation method with appropriate cuff adapted to the child’s upper arm. We got for each arm 3 blood pressure measures taken children seated or lying on the back and mean blood pressure was calculated and used for the evaluation of the pressure level. The arm with the higher blood pressure was considered for the study. Socio-demographical and clinical data were collected anonymously on a formulary and then inserted in a Microsoft Access Database. Analysis was done using Statistical Package for the Social Sciences (SPSS) software using appropriate tests. Results: The study involved 154 patients (boys:girls = 56.5:43.5) aged 3 to 16 years. Patients of 11 years and older made 57.1% of the sample. Most patients suffered from severe malaria (35.1%, glomerular and heart diseases with respectively 16.2% and 9.1%. The global proportion of hypertensive patients was 27%, 39% and 5.2% respectively based on references of the French society of nephrology, those of the 4th report of the NHBPEP and standard deviation. Looking for associated factors with hypertension the logistic regression found no predictor for hypertension using pressure cut-offs values based on the French society of nephrology and those of the 4th report of the National High Blood Pressure Education Programm (NHBPEP). Conclusion: Children must be checked for hypertension to avoid organ damage and later cardiovascular complications. Blood pressure assessment should be preferably done on outpatients as the role of the stressful hospitalization environment can be attenuated.

Maternal Gestational Diabetes Is Associated With Offspring's Hypertension.

Several studies assessed maternal gestational diabetes mellitus (GDM) with the risk of childhood high blood pressure, and the results were inconsistent. We investigated the association between maternal GDM and hypertension risk in offspring during early childhood. We performed a large study in 1,156 mother-child pairs (578 GDM and 578 non-GDM matched by their offspring's age and sex). Maternal GDM was diagnosed according to the World Health Organization criteria. Childhood height, weight, and blood pressure were measured using standardized methods. Age-, sex-, and height-specific blood pressure Z score, childhood hypertension, and high blood pressure were evaluated according to the reference range of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. After adjustment for maternal and children's characteristics, children born to mothers with GDM during pregnancy had higher mean values of systolic blood pressure Z score (0.09 vs. -0.17), and higher prevalence of hypertension (6.4% vs. 3.5%) and high blood pressure (15.6% vs. 9.3%) in comparison with their counterparts born to mothers without GDM during pregnancy (all P values <0.05). Multivariable-adjusted odds ratios among children of mothers with GDM compared with children of mothers without GDM were 2.32 (95% confidence intervals [CI] 1.16-4.62) for hypertension and 1.89 (95% CI 1.24-2.86) for high blood pressure, respectively. Maternal GDM was associated with an increased risk of hypertension in the offspring. Controlling maternal GDM may be important for preventing childhood hypertension in the affected offspring.

Prevalence of overweight, obesity and hypertension among school going children in District Kanpur, Uttar Pradesh, India: a longitudinal study

Background: India is undergoing a rapid epidemiological transition with increased urbanization and socio-economic development which has resulted in a dramatic change in lifestyle, consisting of physical inactivity, diet rich in fat, sugar and salt coupled with a high level of mental stress. Obesity is one of the most common diseases worldwide and the prevalence in school aged children appears to be increasing. Thus, the present study was planned to establish an association between body mass index (BMI) with hypertension among 10-16 years children.Methods: Present longitudinal study was conducted on 350 children in private schools of District Kanpur and children 12-16yrs of age have included in the study. BMI for age charts was used to assess the obesity and blood pressure was measured by sphygmomanometer and Blood pressure values were compared to the values given by the update of 1987 task force report of the National high blood pressure Education Programme Co-ordinating Committee and children who were found prehypertensive or hypertensive were followed up after 4 weeks duration.Results: In present study the prevalence of overweight and obesity was found 4%,2% respectively. Prevalence of Pre-hypertension and hypertension was found 1.14%, 2.57% respectively and pre-hypertension and hypertension were found more in overweight and obese participants.Conclusions: Prevalence of pre-hypertension and hypertension is more among overweight and obese children. Overweight and obesity are not only risk factor for hypertension but also other diseases, so health education should regularly give about the obesity and its deleterious effects in later part of life.

Growth achieved and correlation with blood pressure levels in schoolchildren.

The prevalence of systemic arterial hypertension in childhood has increased progressively. To analyze blood pressure and height reached by children in public schools in the South of Brazil. This is a sectional study of a randomized sample of 1,082 students of six to seven and nine to ten years old used to evaluate blood pressure and height. Blood pressure levels were classified by percentile for gender, age and stature according to the North American reference of National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. Schoolchildren presented adequate growth, which was, on average, higher than the WHO reference values. Blood pressure levels were altered in 13.8% of children, with a higher frequency in the nine and ten year olds (17.6%). The isolated analysis of systolic and diastolic Blood pressure revealed a similar trend, with blood pressure levels higher than the greater the value of the Z-score for stature. The schoolchildren in the study evidenced adequate growth and an elevated prevalence of pre-hypertension and arterial hypertension, which tended to be higher in older children and/or those that achieved a greater stature growth.

5. Hypertensive disorders of pregnancy and trombophilia association

Introduction Hypertensive disorders during pregnancy are classified into 4 categories, as recommended by the national high blood pressure education program working group on high blood pressure in pregnancy: 1) chronic hypertension, 2) preeclampsia-eclampsia, 3) preeclampsia superimposed on chronic hypertension and 4) gestational hypertension (transient hypertension of pregnancy or chronic hypertension identified in the latter half of pregnancy). The role of thrombophilia in the pathogenesis of preeclampsia is controversial, and it’s possible the thrombophilia increases the risk of preeclampsia or interferes with its clinical course. Methods We study 79 pregnancy patients with a poor obstetrics results. All those patients were submitted to trombofilia research (Leiden V factor, mutation of prothrombin, SAAF, MTHFR, S protein, C protein, antithrombin ) and mutation of PAI (4G/5G). Results We identificated 38% of pacients with preeclampsia, and there was association between SAAF and preeclampsia (p Conclusions SAAF and PAI 4G/5G mutation are important trombophilia for the adverse outcome of pregnancy.

Blood pressure pattern and the relationship with body mass index among apparently healthy secondaryschool students in Sokoto metropolis, Nigeria

Background. Childhood obesity may result in the premature onset of cardiovascular risk factors, particularly hypertension, hence the need for proper screening. However, blood pressure (BP) is measured only once in most studies in Nigeria, probably because of difficulties in returning to the study areas for repeat measurement. Objective. To determine the BP pattern and assess its relationship with body mass index (BMI) in apparently healthy secondary-school students aged 10 - 18 years in Sokoto metropolis, Nigeria. Methods. This study was descriptive and cross-sectional, and carried out between 13 October 2014 and 30 January 2015. In total, 800 students from 6 schools were selected through multistage sampling. BP was measured on three separate days according to the National High Blood Pressure Education Program charts. BMI was categorised according to the Centers for Disease Control charts. The relationship of BP level with BMI was determined. Results. There were 424 (53.0%) males and 376 (47.0%) females, with a ratio of approximately 1:1. BP increased with age. The mean systolic and diastolic BP was significantly higher in females than males (systolic 113.1 mmHg v. 110.5 mmHg, and diastolic 69.0 mmHg v. 66.5 mmHg, respectively; p =0.01). Females had a higher mean BMI than males (18.7 kg/m 2 v. 17.9 kg/m 2 , respectively; p <0.01). BP increased as the BMI percentile increased (p < 0.001). The prevalence rates of hypertension were 6.1%, 3.5% and 3.1% at the first, second and third screenings, respectively, while the corresponding prevalence rates of prehypertension were 14.3%, 8.4% and 7.1%. The prevalence of obesity and overweight was 0.3% and 5.9%, respectively. Conclusion. The prevalence rate of prehypertension and hypertension reduced with subsequent measurements, and the prevalence rates of overweight and obesity were low. However, higher BP levels were associated with higher BMI, supporting its predictive significance for elevated BP.

Role of Renin-Angiotensin System Components in Hypertension During Pregnancy

The National High Blood Pressure Education Program of the NHLBI classifies hypertensive disorders of pregnancy into following categories: chronic hypertension, gestational hypertension, preeclampsia, preeclampsia superimposed on preexisting hypertension [1]. Hypertension in pregnancy is defined as 140/90mmHg or greater. Depending on the population studied, the incidence during pregnancy ranges from 0.5% to 3.0% [2]. Although the potential harmful effects of elevated blood pressure on both mother and fetus has been concerned, relatively little is known about its pathogenesis and prevention.

The Relationship Between Blood Pressure and Sleep Duration in Turkish Children: A Cross-Sectional Study.

Objective:As in adults, hypertension is also an important risk factor for cardiovascular disease in children. We aimed to evaluate the effect of sleep duration on blood pressure in normal weight Turkish children aged between 11-17 years.Methods:This cross-sectional study was conducted in the primary and secondary schools of the two central and ten outlying districts of Kayseri, Turkey. Subjects were 2860 children and adolescents (1385 boys, 1475 girls). Systolic and diastolic blood pressures were measured according to the recommendations of the Fourth Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. Sleep duration was classified as follows: ≤8 hours, 8.1-8.9 hours, 9.0-9.9 hours or ≥10 hours.Results:For short sleeper boys and girls (participants with a sleep duration ≤8 h) the prevalence of prehypertension and hypertension was 35.0% and 30.8%, respectively. In univariate binary logistic regression analyses (age-adjusted), each unit increment in sleep duration (hours) in boys and girls, decreased the prehypertension and hypertension risk by 0.89 [odds ratio (OR)] [confidance interval (CI); 0.82-0.98] and 0.88 (OR) (CI; 0.81-0.97), respectively (p<0.05). In multiple binary logistic regression analyses [age- and body mass index (BMI)-adjusted] the location of the school and sleep duration categories were shown to be the most important factors for prehypertension and hypertension in both genders, while household income was the most important factor, only in boys.Conclusions:A sleep duration ≤8 h is an independent risk factor for prehypertension and hypertension in Turkish children aged 11-17 years.