Prehypertension In Children Research Articles

An Epigenomic Signature in Children Born Small for Gestational Age (SGA) With “Catch-up” Growth Is Present From Birth and Predicts Early Adulthood Pre-Hypertension

Abstract Background: Cardiometabolic conditions in adulthood are more common in children born SGA1. The relationship of the transcriptome (gene expression) and epigenome (DNA methylation) to birth size and the future development of cardiometabolic disease has not been characterized. Aims: To identify I) the relationship between epigenome at age 0, 7 and 17 years, transcriptome at age 9 years and birth size in a normal population; II) links between the transcriptome and epigenome in childhood and adult cardiometabolic risk. Study Design: Normal children (n=6487) from the Avon Longitudinal Study of Parents and Children were assigned to groups based on birth size using bodyweight (BW) and gestation and divided into groups using the population 10th centile. Adverse cardiometabolic risk at age 17 years was defined by the National Heart Lung and Blood Institute criteria of prehypertension using systolic and diastolic blood pressure as well as HDL and LDL2. Blood transcriptome at age 9 and blood epigenome at age 0, 7, and 17 years and were available from 980 and 947 children, respectively. Hypernetworks were used to integrate differentially expressed genes in the transcriptome (DEGs) and differentially methylated points (DMPs) in the epigenome, identifying functional links. Random Forest, a machine learning approach, was used to determine the predictive value of ‘omic data presented as the area under the curve (AUC) of the receiver operating characteristic. Results: Pre-hypertensive participants at age 17 years were distinguished from normotensive participants and this group was enriched for children born small who caught up by age 7 years (155/611 unhealthy/healthy SGA compared to 1979/12746 in all other BW groups; 1.6-fold, p<1x10-5). This group had a greater height velocity during their catch-up period than the normotensive participants (1.2-fold, p=0.027). Hypernetwork integration of ‘omic data identified a functional relationship between 55 DEGs at age 9 years and DMPs at age 7 years. Random forest analysis was able to accurately predict the presence of pre-hypertensive young adults from the age 9 transcriptome (AUC: 0.973). Using a gene-level contraction of DMPs which map to the 55 DEGs (i.e. cis-DMPs), we demonstrated accurate classification of pre-hypertensive young adults from their blood methylome at age 0 (AUC [95% CI]: 0.92 [0.89-0.95]), 7 (0.90 [0.87-0.93]), and 17 (0.91 [0.88-0.94]) years. Conclusions: Through the integration of transcriptome and epigenome, we have identified a set of genes with an epigenomic and transcriptomic signature which predict pre-hypertension in children born SGA who catch up. Specifically, we have shown that the associated epigenomic signature tracks from birth to early adulthood, indicating the possibility of early detection of risk and primordial prevention. 1 Barker etal. (1988) BMJ 297(6641):134-135. 2 Chobanian etal. (2003) JAMA 289(19):2560-2571.

The triglycerides and glucose index is associated with elevated blood pressure in apparently healthy children and adolescents.

Prevalence of elevated blood pressure in pediatric population has been increasing worldwide. Thus, the aim of this study was to examine whether the triglycerides and glucose (TyG) index is associated with the presence of prehypertension or hypertension in children and adolescents. Apparently healthy children aged 6 to 15years were enrolled in a population-based cross-sectional study. Participants were allocated into groups with normal blood pressure (NBP), prehypertension, and hypertension. Smoking, alcohol intake, pregnancy, previous diagnosis of diabetes, kidney, hepatic, or endocrine diseases were exclusion criteria. NBP was defined by systolic and/or diastolic blood pressure < 90th percentile, prehypertension by systolic and/or diastolic blood pressure ≥ 90th < 95th percentile, and hypertension by systolic and/or diastolic blood pressure ≥ 95th percentile, according to age, sex, and height percentiles. A total of 3589 children were enrolled, 1748 (49%) girls and 1841 (51%) boys, and allocated into groups with NBP (n = 2874), prehypertension (n = 271), and hypertension (n = 444). The multiple logistic regression analysis stratified by age and adjusted by the Z-score/SDS of body mass index and waist circumference showed that elevated TyG index was significantly associated with prehypertension (OR = 1.48; 95% CI: 1.08-2.05) and hypertension (OR = 1.63; 95% CI: 1.26-2.11).Conclusion: The results of the present study shows that the elevated TyG index is significantly associated with the presence of prehypertension and hypertension in children and adolescents. What is Known: • Prevalence of elevated blood pressure in children and adolescents has been increasing worldwide. • Insulin resistance plays a key role in the pathogenesis of hypertension. What is New: • The elevated TyG index is significantly associated with the presence of prehypertension in children aged 6-9years and adolescents aged 10-15years. • The elevated TyG index is significantly associated with the presence of hypertension in children aged 6-9years and adolescents aged 10-15years.

Prevalence of hypertension and prehypertension in children and adolescents with intellectual disability in southeastern Poland.

There is insufficient information on the prevalence of hypertension (HPT) among children and adolescents with ID. The aim of this study was to determine the prevalence of HPT in children and adolescents with ID in comparison with the control group, which accounted for children and adolescents without ID. The study included 568 students with ID, aged from 7 to 18, attending special education institutions in southeastern Poland. The control group consisted of 568 students (matched to the study group for age and gender) without ID, attending randomly selected elementary and secondary schools located in the same area. Blood pressure was measured in compliance with the European Society of Hypertension recommendations. The overall prevalence of HPT and pre-HPT in children and adolescents with ID were 18.5 and 20.6% respectively. Prevalence of HPT and pre-HPT in children and adolescents without ID were 5.8 and 18.5% respectively. Children and adolescents with a higher level of ID were found to be at a greater risk of HPT. An excessive body mass and older age were predisposing factors to a significantly higher prevalence of HPT in children and adolescents with ID. The prevalence of HPT among students with ID was more than three times higher than in the general population. The level of ID, age, sex and body mass significantly correlated with HPT in the study group.

The prevalence of hypertension in children with renal scars.

Hypertension (HTN) is a late outcome of congenital or acquired renal scar. We used ambulatory blood pressure to assess the early blood pressure abnormalities in children with history of urinary tract infection with various degrees of renal scars. Between 2009 and 2011, 60 (45 females, 15 males) children aged 5-15 years and height equal or more than 120 cm with previous history of febrile urinary tract infection were entered into the study. All children went on 24-hour ambulatory blood pressure monitoring (24-H ABPM). Updated classification of 24-H ABPM was used to interpret the results. Masked hypertension was detected in 5% of cases, hypertension in 8.4%, and white coat hypertension in 11.7%. Pre-hypertension was seen in 23.3% of children. There was significant correlation between abnormal blood pressure and the severity of renal parenchymal scar (r=0.39, P value=0.004), vesicoureteral reflux (r= 0.34, P value=0.009), microalbuminuria (r= 0.39, P value=0.004), and carotid intima media thickness (r=0.41, P value=0.006). This study revealed the utility of 24-H ABPM in early detection of hypertension and pre-hypertension in children with severe renal scars and past history of urinary tract infection.

Prevalence of hypertension and pre-hypertension among adolescent school children in Thiruvananthapuram, Kerala, India

Background: The foundations of hypertension in a person are laid in childhood and adolescence. The phenomenon of tracking of blood pressure is one where those children and adolescents who are in a high blood pressure category tend to fall in the same category when they become adults. Early diagnosis of hypertension and prehypertension in children and adolescents will help in reducing the prevalence of hypertension and its complications in the future adult population of any country. The objective of this study was to find out the prevalence of hypertension and pre-hypertension among school children 13-17 years in Thiruvananthapuram City Corporation, Kerala. Methods: A two stage sampling technique was applied; in the first stage the schools were stratified as government, aided and unaided schools using probability proportionate to size. In the second stage, from the selected schools one division or class from each standard was identified at random as a cluster and all the eligible children in the selected cluster were studied. A single BP measurement was taken using a standardized digital sphygmomanometer (OMRON IA1). Hypertension and prehypertension was defined as per national high blood pressure education program (USA), working group on hypertension control in children and adolescents blood pressure tables. The data was entered in MS excel and further analysis was done using SPSS 16.0 version software and proportions of outcomes were analyzed. Results: The total number of children studied were 2438, Boys 1274 (52.3%, 95% CI 50.28-54.32) and girls 1164 (47.7%, 95% CI 45.68-49.72). The prevalence of hypertension was found to be 21.4% (95% CI 19.64% - 22.96%). The overall prevalence of systolic hypertension is slightly high among the girls (19.4%) than the boys (18.2%), (P value>0.05). The prevalence of pre-hypertension among the study subjects was 21.3 % (19.65-22.95%). The prevalence of systolic pre-hypertension was found to be 21.4% (95% CI 19.74%- 23.06%) and diastolic pre-hypertension 5.3% (95% CI 4.4%-6.2%). Conclusions: The overall prevalence of pre-hypertension and hypertension was 42.6%. These facts show us that preventive interventions are urgent.

Childhood Obesity and Hypertension

The epidemic of obesity along with hypertension (HTN) and cardiovascular disease is a growing contributor to global disease burden. The prevalence of HTN and pre-hypertension in children has been rising steadily over the decades to nearly 4% and 10% respectively [1,2]. Paediatric hypertension is one of the strongest predictor of adult hypertension, which increases the cardiovascular mortality risk in adults [3]. Obesity in childhood is found to be associated with hypertension, dyslipidemia, impaired glucose metabolism and other metabolic and physical consequences like left ventricular hypertrophy, nonalcoholic steatohepatitis, obstructive sleep apnea, orthopedic problems, and psychosocial problems. A literature review found that the risk of adult obesity is at least twice as high for obese children as for non-obese children, as about a third of obese preschool children were obese as adults, and about half of obese school-age children were obese as adults [4]. Adults who have been obese as children may have an even greater prevalence of risk factors for CVD, including hypertension and dyslipidemia, compared with those who had normal weight as children. It has also been shown that childhood obesity and central adiposity increased the risk for the metabolic syndrome in adulthood [5].

Overweight, obesity and the risk of prehypertension in children

Background Epidemiological studies have shown that the prevalence of overweight and obesity has increased markedly among school-aged children. Overweight and obesity during childhood are associated with significant health problems, also increase the risk for developing of cardiovascular diseases. Prehypertension (Pre-HTN) has become very common in children in recent years. This study examined the associations between overweight and obesity and the risk of Pre-HTN in 12-13- year-old children. Methods The case-control study included 3145 children …

Explaining Socioeconomic Inequalities in Childhood Blood Pressure and Prehypertension

Much remains to be understood about the socioeconomic inequalities in hypertension that continue to exist. We investigated the association of socioeconomic status with blood pressure and prehypertension in childhood. In a prospective cohort, 3024 five- to six-year–old children had blood pressure measurements and available information on potential explanatory factors, namely birth weight, gestational age, smoking during pregnancy, pregnancy-induced hypertension, familial hypertension, maternal body mass index, breastfeeding duration, domestic tobacco exposure, and body mass index. The systolic and diastolic blood pressures of children from mid-educated women were 1.0-mm Hg higher (95% CI, 0.4–1.7) and 0.9-mm Hg higher (95% CI, 0.3–1.4), and the blood pressures of children with low-educated women were 2.2-mm Hg higher (95% CI, 1.4–3.0) and 1.7-mm Hg higher (95% CI, 1.1–2.4) compared with children with high-educated women. Children with mid- (odds ratio, 1.50; 95% CI, 1.18–1.92) or low-educated mothers (odds ratio, 1.80; 95% CI, 1.35–2.42) were more likely to have prehypertension compared with children with high-educated mothers. Using path analyses, birth weight, breastfeeding duration, and body mass index were determined as having a role in the association of maternal education with offspring blood pressure and prehypertension. The socioeconomic gradient in hypertension appears to emerge from childhood as the results show a higher blood pressure and more prehypertension in children from lower socioeconomic status families. Socioeconomic disparities could be reduced by improving 3 factors in particular, namely birth weight, breastfeeding duration, and body mass index, but other factors might also play a role.

502 Explaining the Relation of Socioeconomic Status to Childhood Blood Pressure. the Abcd-Study

ObjectiveWe investigated the association of socioeconomic status to blood pressure and prehypertension in childhood.MethodsIn a prospective cohort study (ABCD-study) we obtained blood pressure measurements and information on potential explaining factors,...

Ambulatory blood pressure in prehypertensive children and adolescents

Prehypertension is defined as blood pressure (BP) ≥ 90 th percentile, or ≥ 120/80 mmHg, but <95th percentile for age, sex, and height. Since the definition is made by conventional BP measurements and office BP can be quite variable, we studied whether prehypertension could be differentiated by ambulatory BP monitoring from normotension or hypertension (HTN) in children and adolescents. One hundred and fifty-eight children (84 boys and 74 girls, aged 6-17 years, median 12) were studied. According to the office BP values, they were divided into normotension (80), prehypertension (20), and HTN (58). Systolic BP index and systolic daytime ambulatory BP (ABP) were significantly higher in prehypertensive patients than in normotensives and lower than hypertensives. When daytime ABP was used to diagnose HTN, four normotensive (5.0%), four prehypertensive (20.0%), and 27 hypertensive (46.6%) patients had HTN. Thus, in patients with prehypertension, the prevalence of masked HTN is significantly higher than in those with normotension. On the other hand, the prevalence of daytime ambulatory HTN is significantly lower, i.e., white-coat effect is more frequent, compared with hypertensive patients. Prehypertension lies between normotension and HTN in ABP values as well and is a good candidate for identifying masked HTN. Our data emphasize the importance of identifying prehypertension in children and adolescents.

Atherogenic indices and prehypertension in obese and non-obese children

We evaluate the relationship between different lipoproteins and atherogenic indices with pre-hypertension in 297 obese and 942 non-obese children with Tanner stage 1 enrolled in a multicentre, community-based cross-sectional study. Height, weight, fasting glucose and insulin levels, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), non-HDL-c, LDL/HDL-c, triglycerides/cholesterol and total cholesterol/HDL-c ratios were measured. Mean age was 8.4 ± 1.2 years; pre-hypertension was identified in 104 (8.4%) participants, 46 (15.5%) obese and 58 (6.1%) non-obese children. The pre-hypertensive non-obese children show a high proportion of family history of hypertension (41.6 and 24.7%, p = 0.002) and elevation of insulin at a relatively low body mass index. The triglycerides:HDL-c ratio, but not other lipoproteins or atherogenic indices, was associated with pre-hypertension in obese (1.15, 95% confidence intervals 1.06-1.26) and non-obese children (1.38 95% confidence intervals 1.22-1.57). The triglycerides:HDL-c ratio is related to pre-hypertension in children; the family history of hypertension seems to be a risk factor in developing pre-hypertension.

Prehypertension in Children and Adolescents: Association with Body Weight and Neck Circumference

The present study was undertaken to investigate the role of neck circumference (NC) in predicting prehypertension in children and adolescents. We conducted a cross-sectional study including 6,802 children and adolescents (3,631 boys and 3,171 girls) aged 5-18 years. Main anthropometric data and related information were collected. The prevalence of prehypertension was 14.4%, 16.4% and 17.1% in normal weight, overweight and obese group respectively. Among the participants with normal body mass index (BMI), higher NC was significantly associated with increased odds of prehypertension (OR: 1.439; 95% CI: 1.118 to 1.853) after adjustment for age, gender, BMI and WC. Significant associations between NC and either systolic blood pressure (SBP) (β=0.581 mmHg) or diastolic blood pressure (DBP) (β=0.236 mmHg) were found in the linear regression. No significant ORs were observed either in overweight or in obese categories. We concluded that additional measure of NC might expand the ability of BMI for the identification of prehypertension in normal weight children and adolescents.

Development of a simple tool for diagnosis and initial approach to hypertension and pre-hypertension in children and youth

Background: Hypertension and pre-hypertension in children and adolescents are frequently missed despite current screening recommendations and the potential benefit for early diagnosis and intervention. Difficulty in interpretation of office blood pressure readings in children has been partially blamed for the significant under-diagnosis of childhood hypertension. The objective of our group was to develop and evaluate a simple tool designed to assist primary health care physicians to interpret office blood pressure readings in children and adolescents. Methods: A multi-disciplinary advisory group in our institution undertook the development of a diagnostic tool based on currently accepted gold standard parameters. Input from Family Physicians and Pediatricians was used in the design process. The tool was then distributed among Family Physicians in our catchment area and evaluated with a post-distribution survey. Results: A laminated one page summary of pediatric blood pressure parameters and initial approach to pediatric hypertension was created and distributed. Feedback from primary care physicians was mostly positive and supportive of this initiative. Conclusions: Innovating and simplifying the screening process for hypertension and pre-hypertension in childhood may promote early detection and intervention however the effect of such initiatives on the rate of diagnosis of pediatric hypertension will need to be tested prospectively by appropriately designed studies.

Hypertension in adolescents

In adults, hypertension has long been perceived as a public health problem. By contrast, its impact in childhood is far less appreciated. In fact, quite often, high blood pressure in children is not even diagnosed. Blood pressure is a vital sign that is routinely obtained during a physical examination of adults, but only very seldom in children. The diagnosis of hypertension in children is complicated because ‘normal’ blood pressure values vary with age, sex and height. As a consequence, almost 75% of the cases of arterial hypertension and 90% of the cases of prehypertension in children and adolescents are currently undiagnosed. Furthermore, adolescence hypertension is increasing in prevalence as the prevalence of pediatric obesity has increased. Ambulatory blood pressure monitoring is a useful method for risk evaluation in adolescents. In addition to being viewed as an important cardiovascular risk factor in adolescents, elevated blood pressure should prompt a thorough search for other modifiable risk factors that, if treated, might reduce teenagers’ risk of developing cardiovascular disease in adulthood. Thus, assessing blood pressure values in children represents one of the most important measurable markers of cardiovascular risk later in life and a major step in preventive medicine.

Left ventricular mass in normotensive, prehypertensive and hypertensive children and adolescents

The purpose of this study was to investigate differences in left ventricular mass index (LVMI) and the prevalence of left ventricular hypertrophy (LVH) in children and adolescents classified as normotensives, prehypertensives and hypertensives by ambulatory blood pressure (BP) levels. A total of 124 consecutive children and adolescents aged 5 to 18 years were analysed. Patients underwent 24 h ambulatory blood pressure monitoring (ABPM) and echocardiography. Hypertensive and prehypertensive subjects had significantly higher LVMI than normotensives (36.8 +/- 8.4 g/m(2.7) and 34.1 +/- 3.4 g/m(2.7) vs. 29.5 +/- 8.3 g/m(2.7), P < 0.01 and P < 0.05, respectively). In multivariate analysis predictors for LVMI were body mass index (BMI) z score and hypertension (R-squared = 0.31). LVMI values in hypertensive subjects were significantly higher than those of normotensives even after adjustment for age, sex and BMI z score. The prevalence of LVH was significantly higher in the prehypertensive compared to normotensive subjects, and was equal to that of the hypertensive subjects. Hypertension and prehypertension in children and adolescents were associated with pathologically elevated LVMI values. If confirmed in a larger group prehypertensive children may be at risk for target organ damage similar to the condition of established hypertension.

Blood pressure load, proteinuria and renal function in pre-hypertensive children

It is as yet unclear whether blood pressure load (BPL) can affect renal function in pre-hypertensive children. We have studied 250 children, with a mean age of 9.12 +/- 3.28 years, with the aim of assessing if pre-hypertension in children can indeed affect renal function. The study cohort consisted of 146 children with pre-hypertension (group P) and a control group of 104 children with normal blood pressure (group C). All children were tested for orthostatic proteinuria, an exclusion criterion, glomerular filtration rate (GFR), and proteinuria, and ambulatory blood pressure monitoring was performed. Based on the BPL, group P was further subdivided into group P1 (BPL <or= 40%, low BPL) and group P2 (BPL > 40%, high BPL). We found that GFR was reduced in pre-hypertensive children (90.74 +/- 48.69 vs. 110.32 +/- 20.30 ml/min per 1.73 m(2), p < 0.0001) and that proteinuria was increased (145.36 +/- 110.91 vs. 66.84 +/- 42.94 mg/m(2) per 24 h; p < 0.0001). However, mean values were still within normal limits. A comparison of the group with high BPL and that with low BPL revealed that the former had relatively reduced GFR (79.15 +/- 42.04 vs. 96.78 +/- 51.20 ml/min per 1.73 m(2); p < 0.006) and increased proteinuria (198.29 +/- 142.17 vs. 118.31 +/- 80.07 mg/m(2) per 24 h; p < 0.036). In comparison to the reference values of the normal population, the GFR was reduced and proteinuria was increased in the group with high BPL. Based on our results, pre-hypertension in children with high BPL seems to be associated with reduced GFR and increased proteinuria. A reasonable doubt remains that the patients with higher proteinuria and larger reduction of GFR may harbor an as yet unknown subclinical renal condition responsible for the onset of pre-hypertension. Therefore, children with even mildly elevated BP are at risk of developing renal damage and should change their lifestyle to prevent further increases in BP.

14 Retrospective Screening for Hypertension/Pre-Hypertension in a Pediatric Sub-Specialty Clinic.

The 2004 NHBPEP report provided updated normative data for systolic and diastolic blood pressure (SBP/DBP) in children. These data now define pre-hypertension (Pre-HTN) as well as HTN for gender, age, & height. Pediatric Endocrinologists see many diagnoses that may impact BP. Purpose: To retrospectively review and screen BP measurements, using 2004 NHBPEP data, for patients (pts) attending an out-pt, University-based, Pediatric Endocrinology Clinic. Methods: Chart review of visits (7/1/04–12/31/04) by the MD or NP for pts between 1–20 years of age. BP typically was obtained from the right arm manually or using a Critikon Dinamap™ 8100T monitor. Recorded gender/age/height/weight values subsequently were entered onto a PDA with the Stat Growth-BP™ program where pts' BPs then were noted as NL, Pre-HTN, or HTN. Pre-HTN = SBP +/or DBP between 90–95%; HTN = SBP +/or DBP ≤95%. Results: (Table 1). *30 pts had NL BP on another visit; 17 pts were diagnosed previously with HTN; 5 pts were noted as agitated or upset during BP measurement. Summary: Initial review of retrospectively collected data found 164 [(181–17) of 642; 25.5%] previously undiagnosed pts who screened positive for HTN onG 1 occasion; 80 of 642 pts (12.5%) fulfilled new criteria for Pre-HTN. Discussion: The origins of adult cardiovascular disease often lay in childhood; pts frequently seen in an Endocrinology clinic (e.g. For diabetes mellitus, obesity, dysmetabolic syndrome, sexual precocity, adrenal & thyroid disorders) may be especially at risk. By definition, HTN is confirmed withG 3 elevated SBP +/or DBP readings. Conclusions/Speculations: In a single University-based Pediatric Endocrine clinic, many patients with borderline or elevated BP are under-appreciated. A general pediatric clinic may be much busier. Clinicians must employ an efficient method to correctly identify HTN & Pre-HTN in children, relative to gender, age, and height.