Risk Of Prehypertension Research Articles

Macronutrient Composition and Sodium Intake of Diet Are Associated with Risk of Metabolic Syndrome and Hypertension in Korean Women

Hypertension and hypertriglycemia are the most important contributors to metabolic syndrome (MetS) and cardiovascular disease risk in South Koreans with a relatively lean body mass. These major contributors differ from those identified in Western populations. This study aimed to identify the characteristics of the Korean diet associated with increased risk of MetS, whose prevalence has been steadily increasing in South Korea. On the basis of data collected from 5,320 subjects by the 2007–2008 Korean National Health and Nutrition Examination Survey, 3 dietary patterns were identified using factor analysis and their association with the risk of MetS and its components was examined. The balanced Korean diet, a typical Korean diet of rice and kimchi intake supplemented by a variety of foods had a desirable macronutrient composition and was associated with a lower risk of elevated blood pressure (OR=0.61, 95% CI=0.45–0.84) and hypertriglyceridemia (0.69, 0.49–0.88) in men and a lower risk of elevated blood pressure (0.59, 0.41–0.85) and MetS (0.67, 0.47–0.96) in women. The unbalanced Korean diet, characterized by a high intake of carbohydrates and sodium and little variety, was associated with a higher risk of MetS (1.44, 1.03–2.01) and elevated blood pressure (1.41, 1.00–1.98) in women. The semi-western diet, characterized by a relatively high intake of meat, poultry, and alcohol, was associated with a lower risk of low high-density lipoprotein cholesterol (0.70, 0.54–0.89) in women. Thus, macronutrient composition and sodium intake are associated with the risk of MetS and prehypertension in women. Maintaining a desirable macronutrient composition and avoiding excessive consumption of carbohydrates and sodium should be emphasized for prevention of MetS and hypertension in South Korean women.

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 …

A Question of Color

This study describes the relative influence of facial skin color, lifetime exposure to racial discrimination, chronic stress, and traditional prehypertension risk factors (family history of hypertension and age) on resting blood pressure and body mass index (BMI) among 196 southern African American (AA) female undergraduate students. Stepwise regression analyses indicated that skin color was the strongest predictor of systolic blood pressure (SBP), diastolic blood pressure (DBP), and BMI. Skin color, chronic stress, and family history of hypertension predicted 53% of the SBP variance. Skin color, chronic stress, and family history of hypertension predicted 30.2% of the DBP variance. Racism and age were not significant predictors of SBP or DBP. Of the variance in BMI, 33% was predicted by skin color, chronic stress, and racism. Age and family history of hypertension were not predictors of BMI. The current study provides evidence of the relationship of skin color and chronic stress to blood pressure among young southern AA women. The study identifies an important relationship between increased racial stress exposure and heavier BMIs, a predictor of prehypertensive risk.

PS3-29: Impact of BMI and Change in BMI on Progression from Normotension to Prehypertension or Hypertension in Patients Ages 3-17

Background/AimsOverweight and obesity among US children and adolescents is an important public health problem. Conditions associated with obesity, such as type 2 diabetes, hypertension, and hypercholesterolemia, are becoming more common in children. This study examined the relationship between changes in BMI percentile and incident prehypertension and hypertension in a cohort of children and adolescents.MethodsStudy subjects were 23,578 patients, ages 3–17, with three or more outpatient primary care visits between 2007 and 2010 at HealthPartners Medical Group, Kaiser Permanente Colorado, or Kaiser Permanente Northern California. Data were extracted from electronic health records (EHR). Change in BMI was defined as: increase, decrease, stayed obese, stayed overweight, and stayed healthy weight using established BMI percentile cut-points. Incident prehypertension and hypertension were defined using blood pressures and diagnosis codes from the EHR. We used time-dependent Cox proportional hazards models to estimate the hazard of change in BMI percentile with incident prehypertension and hypertension.ResultsOver a median 2.6 years follow-up, there were 7,232 cases of incident prehypertension, 148 diagnoses of incident hypertension, and 107 additional cases of incident hypertension based on blood pressure data from the EHR. Seventy-one prehypertensives went on to develop hypertension. Those who stayed obese, stayed overweight, and increased BMI had increased hazard of incident prehypertension (1.96, 1.39, and 1.49, respectively) and increased hazard of incident hypertension (3.61, 1.21, and 1.83, respectively) compared with those who stayed healthy weight.ConclusionsPersistently high BMI or increasing BMI over time was associated with pronounced increase in risk of both incident prehypertension and hypertension. Future research should examine factors associated with the development and recognition of hypertension.

Prevalence of prehypertension, hypertension and cardiovascular risk factors in a Belarus urban population

Objective: To study the prevalence of prehypertension (preHT), hypertension (HT) and cardiovascular risk factors in a Belarusian Urban population. Design and methods: We conducted a cross-sectional analysis of 3399 individuals (1884 men and 1545 women) living in a district of Vitebsk in January 2007. PreHT and HT were evaluated according to the JNC-7 (2003). The survey included standard questionnaires for detection of cardiovascular risk factors, measurements of blood pressure, electrocardiography, serum C-reactively protein and cholesterol data. Results: Men and women were similar of mean age. During our study we received following data: preHT frequency was 34.3% (39.7% in men vs. 29.8% in women, P 0.05); overweight – 43.8% (43.2% in men vs. 44.3% in women, P>0.05); family history of premature cardiovascular diseases – 29.9% (28.6% in men vs. 31.% in women, P>0.05); smoking – 41.8% (80.6% in men vs. 13.6% in women; P 0.05). The preHT prevalence with adjustment age and sex was independently associated with following risk factors: body mass index (P<0.001), family history of premature cardiovascular disease (P<0.001), heart rate (P<0.001), alcohol abuse (P<0.05), smoking (P<0.1). The HT prevalence with adjustment age and sex was independently associated with following risk factors: level of education (P<0.01), body mass index (P<0.001), family history of premature cardiovascular disease (P<0.001), heart rate (P<0.001), alcohol abuse (P<0.001), smoking (P<0.001), low physical activity (P<0.001), total cholesterol (P<0.05), LDL cholesterol (P<0.05), triglycerides (P<0.05). Conclusions: The high prevalence of pereHT, HT and cardiovascular risk factors is noted as men and women in a Belarusian Urban population.

Childhood determinants of blood pressure and prehypertension in adolescents - results from the SAPALDIA youth study

Background: Hypertension has become the leading risk factor contributing to the global disability adjusted life years. Adolescent hypertension is increasing, possibly due to the obesity epidemic, and is known to track into adulthood. The SAPALDIA Youth Study, a nested study within the adult Swiss Air Pollution And Lung and Heart Disease In Adults cohort (SAPALDIA), aims to investigate early life factors and cardiovascular health in adolescents, with a special focus on active tobacco exposure. Methods: 288 SAPALDIA offspring (mean age 15 years, sd 3.5) underwent clinical examination and reported on early life, health and lifestyle, smoking habits and disease history. Parental determinants and disease status were taken from the SAPALDIA adult cohort data. The mean of two blood pressure measurements, following standard protocols, was calculated for analyses. Prehypertension in childhood was defined as average systolic (SBP) or diastolic blood pressure (DBP) levels ≥90th percentile but <95th percentile for gender, age, and height, respectively in adolescents ≥120/80 mmHg (2). Descriptive and multi-level regression analyses were performed to investigate the independent impact of early life determinants on blood pressure and prehypertension. Results: Prehypertensive values were found in 24%. We confirmed the impact of BMI on SBP (1 mmHg/10 percentile points, 95% CI 0.04,0.14, DBP 0.02 mmHg, 95%Ci -0.02; 0.06), and of high physical activity (≥60 min strenuous activity/day, SBP -3mmHg, 95% CI -6.0; 0.1, DBP -2.2 mmHg, -4.5; 0.1) and found a borderline significance for weekly smoking on SBP (SBP 3.6 mmHg; 95% CI -0.82; 8.0; DBP 2.3 mmHg, 95% CI -1.2; 5.7). Additional adjustment for parental education, smoking and cardiovascular risk strengthened the adverse association seen for weekly smoking. Associations with DBP proved less significant. Similar results were found in analyses with prehypertension. Conclusion: A high percentage of youth presented with prehypertension. Considering the impact of modifiable risk factors, and the high risk of prehypertension turning into clinical hypertension, screening for prehypertension and risk factors in youth should be given full attention to reduce the population risk by optimal metabolic control and lifestyle modification. Reference: 1. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics 2004

Dietary pattern and blood pressure levels of adolescents in Sohag, Egypt

Poor eating patterns formed early in life may lead to health problems in later years. These poor dietary habits are carried over into adolescence in Upper Egypt. The study aimed to assess the relationship between dietary pattern and blood pressure levels of adolescents in Sohag as one of Upper Egypt Governorates. A comparative cross-sectional study was carried out on 300 school students of both sexes between 12 and 18 years of age in Sohag. Schools from one educational district were stratified into private or public and boys or girls sectors. From each stratum, about 35-40 students were selected from one class at random. Data on sociodemographic characteristics, medical history, lifestyle, and dietary habits and intake were collected from each student. Anthropometric measurements and both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were taken at the time of the interview. Hypertension was detected among 7.7% of the adolescents studied and prehypertension was detected among 34% of the adolescents. The entire studied sample consumed energy, protein, and sodium that exceeded their daily requirements, whereas their intake of potassium was less, with no statistically significant difference. The prehypertensive group consumed the highest daily intake of energy, macronutrients, sodium, and potassium. High BMI and low consumption of fruits and vegetables were associated with increased SBP and DBP. High consumption of chips was a predictor for increased SBP, whereas daily consumption of soft drinks was a predictor for increased DBP. The study revealed significant association between the unhealthy dietary pattern and the risk of hypertension and prehypertension among adolescents in Sohag. Changes in their eating habits and dietary intake are highly recommended. Implementing a comprehensive nutrition promotion program has the potential to decrease the risk of hypertension during adulthood.

Cardiovascular risk assessment in children

Aim of the study was to assess the role of family history, physical activity and parental smoking in the prediction of BMI, SBP and hypertension risk in children. In a paediatric primary care setting, a sample of 1310 children aged 5-14 years was systematically selected by 48 family paediatricians in northern Italy. BMI, waist circumference-to-height ratio (WtHr), SBP and DBP were measured and the information on the presence of small birth weight for gestational age (SGA) and early adiposity rebound (EAR) was collected. Data concerning exercise, video time, family history for cardiovascular diseases and parental smoking were derived from parental interview. Data were collected using an 'ad hoc designed' electronic sheet available online. Multiple linear regression showed that the presence of EAR, low exercise (<2 h/week), high video time (>2 h/day TV/videogames/computer) and parental smoking were associated to higher BMI (z-score; P < 0.005). Age, BMI (z-score), WtHr, presence of SGA, low exercise, high video time and family history of cardiovascular diseases were associated to SBP values (P < 0.03). Logistic regression analysis showed that factors related to risk of hypertension and prehypertension were BMI (z-score; odds ratio, OR 2.63; 95% confidence interval, CI 2.12-3.28), WtHr (OR 1.13; 95% CI 1.10-3.28) and low exercise (OR 1.58; 95% CI 1.12-2.24; P <0.01). Our study demonstrates that a simple tool like a cardiovascular multi-item sheet can provide useful information to paediatricians for child health. Physical exercise plays a pivotal role in obesity prevention and protection from hypertension risk.

Sodium Intake and Hypertension Risk in Children

Yang Y, Zhang Z, et al. Sodium intake and blood pressure among US children and adolescents. Pediatrics. 2012; 130(4): 611-619; doi: 10.1542/peds.2011-3870Investigators from the Centers for Disease Control and Prevention utilized 2003 to 2008 data from the National Health and Nutrition Examination Survey (NHANES) to determine the association between dietary sodium intake and blood pressure in children aged 8 to 18 years. In addition, the investigators evaluated the joint effect of dietary sodium intake and weight on the risk for pre-hypertension (P-HTN) and hypertension (HTN). Dietary sodium intake was estimated from 24-hour dietary recalls that were adjusted to minimize measurement error. Patients were classified as having normal blood pressure, P-HTN or HTN based on the average of three blood pressure measurements. Overweight was defined as 85th to 95th BMI percentile and obese as >95th percentile. Other covariates accounted for were race and gender.A total of 6,235 children were included in the study, 49% of whom were female. The prevalence of overweight and obesity combined was 37% and the prevalence of P-HTN and HTN combined was 15%. Children consumed an average of 3,387 mg of sodium per day. Among all participants, the systolic blood pressure increased by approximately 1 mm Hg for every 1,000 mg per day of sodium intake (P = .037). Diastolic blood pressure was not associated with sodium intake. There was a nonsignificant trend for children in the highest quartile of sodium intake to be more likely to have P-HTN or HTN than children who were in the lowest quartile of sodium intake (adjusted odds ratio [aOR]=2.0; 95% CI, 0.95-4.10). Children in the highest quartile of sodium intake who were also overweight or obese were at higher risk (aOR=3.5; 95% CI, 1.34-9.20). The risk for P-HTN or HTN increased by 74% for every 1,000 mg/day increase in sodium among overweight or obese children but increased by only 6% among normal weight children.The authors conclude that sodium intake is associated with systolic blood pressure and risk of P-HTN or HTN in a nationally representative sample of US children. Furthermore, overweight and obese children with high sodium intake may have a higher risk for P-HTN/HTN compared to normal weight children.Elevated blood pressure in childhood is a risk factor for the development of HTN and cardiovascular disease in adulthood. The prevalence of HTN in children has increased in recent years due partly to obesity and other lifestyle factors such as physical inactivity and consumption of high-calorie and -sodium foods.1 In the current study, investigators were able to demonstrate that sodium intake was associated with systolic blood pressure and risk of P-HTN or HTN in children, which is consistent with previous studies in children and adults. A novel finding of the study is the joint synergy between sodium intake and weight, suggesting that high sodium intake in overweight/obese children may have a greater effect on risk for P-HTN or HTN than in normal weight children. The authors suggest that sodium sensitivity in obesity may be related to hyperinsulinemia, hyperaldosteronism, and activity of the sympathetic nervous system.The authors of this study also found that children in the United States consume roughly the same amount of sodium as the average adult, around 3400 mg/day. The 2010 Dietary Guidelines for Americans advise reducing daily sodium intake to less than 2,300 milligrams for most individuals aged 2 years and older, and cutting back to 1,500 milligrams for people aged ≥51 years and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease.2 In 2008, Congress asked the Institute of Medicine to suggest strategies to reduce sodium consumption to the recommended allowance. The Institute of Medicine released a brief report in 2010 that recommended a coordinated effort by government agencies, health industry, consumer agencies, and the food industry to support FDA-set mandatory national standards for sodium content in foods by gradually reducing excess sodium in processed foods and menu items.3 Further interventions to prevent HTN should be aimed at reducing sodium intake, increasing physical activity, and maintaining a healthy weight for all children and adolescents.As noted over 2 years ago in these pages, current levels of dietary salt intake impose a costly public health burden (see AAP Grand Rounds, June 2010;23[6]:664). Isn't it time for pediatricians to inform their patients that salt – as well as calories – counts?

Prehypertension and cardiovascular risk factors in Kursk inhabitants

Objective. To assess the prevalence of prehypertension and its association with cardiovascular risk factors in Kursk citizens. Design and methods. Cross-sectional study was carried out in one of Kursk outpatient departments during 2010, and 170 patients were screened. All subjects were interviewed with special questionnaire about personal data, lifestyle factors, concomitant medical history and therapy. Blood pressure (BP) was measured 3 times at right hand and anthropometrical parameters were assessed. Serum lipids and glucose were measured by Hitachi-902 equipment (Roche reagents). Metabolic syndrome (MS) was diagnosed according to ATP III criteria (2001–2005), IDF 2005 and harmonized criteria JIS 2009. Results. Comparing subjects with optimal BP, prehypertension and arterial hypertension we found that higher BP levels were associated with the higher prevalence of triglyceridemia and higher values of waist circumference, subjects with higher BP were also older. The number of smokers was twice higher among prehypertensive males than in females. Comparing groups of participants with optimal BP, prehypertension and hypertension we found that MS prevalence was higher in subjects with higher BP levels independently of the criteria applied: NCEP-ATP III, IDF, or JIS. The highest MS prevalence was identified when JIS criteria were applied. Males with optimal BP did not have MS. Females had higher MS prevalence independently of MS criteria, and the higher parameters were found in the group of hypertension. The positive statistical correlations were found between following parameters: systolic BP with age and waist (p = 0,001), diastolic BP with waist (p = 0,001). BP level correlated with triglycerides level in males. Conclusions. Our study showed high prevalence of prehypertension and its association with metabolic disturbances. The early diagnosis of prehypertension and cardiovascular risk factors correction should be performed. The prevalence in our population group was similar with world data, the gender and age particularities were detected.

Risk of Methylphenidate‐Induced Prehypertension in Normotensive Adult Smokers With Attention Deficit Hyperactivity Disorder

The authors studied predictors of methylphenidate‐induced increases in blood pressure (BP). In this secondary analysis of a randomized, double‐blind, placebo‐controlled smoking cessation trial, nonhypertensive adult smokers with attention deficit hyperactivity disorder randomized to osmotic‐release oral system methylphenidate (OROS‐MPH) (n=115) were matched one‐to‐one on baseline systolic BP (SBP) (±5 mm Hg) with participants randomized to placebo (n=115) and followed for 10 weeks. In adjusted mixed linear models of SBP and diastolic BP (DBP), baseline normal SBP (P&lt;.0001) and DBP (P&lt;.0001) were associated with significant OROS‐MPH–induced increases compared with placebo, whereas significant increases were not observed in participants with baseline prehypertensive SBP (P=.27) and DBP (P=.79). Participants randomized to OROS‐MPH with baseline normal BP had increased odds of developing either systolic (odds ratio [OR], 3.32; 95% confidence interval [CI], 1.41–8.37; P=.006) or diastolic prehypertension (OR, 4.32; 95% CI, 1.56–14.0; P=.004) compared with placebo using simple logistic regression. The authors demonstrated an augmented OROS‐MPH–induced BP elevation and risk of prehypertension in adults with baseline normal BP. Significantly increased BP was not observed in adults with baseline prehypertension. J Clin Hypertens (Greenwich). 2012; 00:00–00. ©2012 Wiley Periodicals, Inc.

Gender-specific prevalence and associated risk factors of prehypertension among rural children and adolescents in Northeast China: a cross-sectional study

Little is known about the prevalence and risk profile of prehypertension among Chinese children and adolescents. The aim of the present study was to investigate the prehypertensive status and its associated risk factors among rural Chinese children and adolescents. We conducted a cross-sectional study including 5,245 children and adolescents (2,732 boys and 2,513 girls) aged 5-18years in Northeast China. Main anthropometric data and related information were collected. The overall prevalence of prehypertension and hypertension was 15% and 20.2%, respectively. The prevalence of prehypertension among boys was 15.7%, compared to that of 14.2% among girls (P = 0.256). After adjusting for age, race, weight status, waist circumference, triceps skinfold, family income, smoking and drinking status, boys aged 12-14 and 15-18years had a 2.86- and 5.97-fold risk of prehypertension, respectively, compared to those aged 5-8years. Overweight and obese boys had an increased risk of prehypertension in comparison to those with normal weight (overweight: odds ratio [OR] = 1.837, 95% confidence interval [CI] 1.321-2.556; obese: OR = 2.941, 95% CI 1.783-4.851). A larger triceps skinfold (≥90th percentile) was significantly related to increased odds of prehypertension (OR = 2.32; 95% CI, 1.516-3.55) among boys. For girls, only older age was found to be a risk factor for prehypertension. Pediatric prehypertension is highly prevalent in rural Northeast China. The risk factors for prehypertension differed among boys and girls. A more comprehensive risk profile of prehypertension among children and adolescents needs to be established for early prevention.

Prevalence and Covariates of Undiagnosed Hypertension in the Adult Population of Puducherry, South India

Background Globally the prevalence of both hypertension and pre-hypertension are increasing and pre-hypertension has been associated with higher cardiovascular risk. The objective of this study was to find out the prevalence of undiagnosed hypertension and pre-hypertension and associated covariates among adults of rural and urban area of Puducherry. Material and Methods A population based cross-sectional study was carried out in the field practices area of Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute without intervention. Results Among 856 participants, 27.6 percent were hypertensive and 57 percent pre-hypertensive; the magnitude of both stage 1 and stage 2 hypertension increased with the age. Of the hypertensives, 26.3 and 28.7 percent were from rural and urban area respectively, whereas in pre-hypertension the corresponding figures were 61 and 53.4 percent. Significantly increased risk of hypertension was noted among adults with increasing age, having less than six members in the family, suffering from obesity (general and abdominal obesity) and living sedentary life. On the other hand, the probability of having increased risk of pre-hypertension was significantly higher among adults living in the rural areas, having non-vegetarian dietary habit, suffering from obesity (general and abdominal obesity), living sedentary life and having family history of hypertension. Multivariate logistic regression however showed significant correlation of hypertension with increasing age, sedentary lifestyle, tobacco addiction and obesity (general and central). Significant correlates of pre-hypertensive were rural residence, sedentary living habits, family history of hypertension, tobacco addiction and obesity (general and central). Conclusion The present findings show high prevalence of hypertension and pre-hypertension among population of Puducherry in South India.DOI: http://dx.doi.org/10.3126/nje.v2i2.6576 Nepal Journal of Epidemiology 2012;2(2):191-199

Association of blood cadmium with hypertension in the Korean general population: Analysis of the 2008–2010 Korean national health and nutrition examination survey data

We present data from the Korean National Health and Nutrition Examination Survey 2008-2010 regarding the association between blood cadmium levels and blood pressure in a representative sample of the adult South Korean population. We restricted the analysis to participants ≥20 years of age who completed the health examination survey, including blood cadmium measurements (n = 5,919). We performed multivariate linear regression analyses to estimate adjusted mean differences in diastolic and systolic blood pressure associated with doubling of, or quartiles of, cadmium levels after covariate adjustment. We calculated odds ratios (ORs) for hypertension and prehypertension for log-transformed blood cadmium levels and quartiles thereof after covariate adjustment. We observed a twofold increase in blood cadmium associated with 0.755 and 1.007 mmHg increases in diastolic pressure in women and men, respectively. We observed 2.243 and 1.975 mmHg increases in diastolic pressure in women and men, respectively, in the highest compared with the lowest quartile of blood cadmium. Systolic pressure showed results similar to those of diastolic pressure. Based on ORs, a doubling of blood cadmium resulted in 18.6% and 31.5% increases in the risk of hypertension in women and men, respectively. Doubling of blood cadmium resulted in a 23.5% and 22.9% increase in the risk of prehypertension in women and men, respectively. We found a significant association between blood cadmium levels and elevated blood pressure regardless of the type of variable (continuous or categorical) in women and men with a lower blood cadmium level compared to previous Korean studies. This study also showed that blood cadmium levels were robust risk factors for prehypertension in both women and men.

ASSOCIATIONS BETWEEN HOUSEHOLD AND NEIGHBOURHOOD SOCIOECONOMIC STATUS AND SYSTOLIC BLOOD PRESSURE AMONG URBAN SOUTH AFRICAN ADOLESCENTS

Factors resulting in high risk for cardiovascular disease have been well studied in high income countries, but have been less well researched in low/middle income countries. This is despite robust theoretical evidence of environmental transitions in such countries which could result in biological adaptations that lead to increased hypertension and cardiovascular disease risk. Data from the South African Birth to Twenty cohort, Bone Health sub-sample (n = 358, 47% female), were used to model associations between household socioeconomic status (SES) in infancy, household/neighbourhood SES at age 16 years, and systolic blood pressure (multivariate linear regression) and risk for systolic pre-hypertension (binary logistic regression). Bivariate analyses revealed household/neighbourhood SES measures that were significantly associated with increased systolic blood pressure. These significant associations included improved household sanitation in infancy/16 years, caregiver owning the house in infancy and being in a higher tertile (higher SES) of indices measuring school problems/environment or neighbourhood services/problems/crime at 16 years of age. Multivariate analyses adjusted for sex, maternal age, birth weight, parity, smoking, term birth, height/body mass index at 16 years. In adjusted analyses, only one SES variable remained significant for females: those in the middle tertile of the crime prevention index had higher systolic blood pressure (β = 3.52, SE = 1.61) compared with the highest tertile (i.e. those with the highest crime prevention). In adjusted analyses, no SES variables were significantly associated with the systolic blood pressure of boys, or with the risk of systolic pre-hypertension in either sex. The lack of association between SES and systolic blood pressure/systolic pre-hypertension at age 16 years is consistent with other studies showing an equalization of adolescent health inequalities. Further testing of the association between SES and systolic blood pressure would be recommended in adulthood to see whether the lack of association persists.

Insulin resistance, prehypertension, hypertension and blood pressure values in paediatric age

The aim of the present study was to evaluate whether insulin resistance [as measured by Homeostasis Model Assessment (HOMA) index] has an effect on prehypertension and hypertension risk in children after acknowledging the role of BMI and waist-to-height ratio. We studied a sample of 377 children 10.5 ± 2.3 years old who had a first diagnosis of hypertension or family history of cardiovascular disease. In this sample all weight classes were represented. The HOMA index was standardized by a linear regression model including BMI, waist-to-height ratio and pubertal status. The role of BMI and waist-to-height ratio on the risk of prehypertension and hypertension was confirmed by univariate logistic regression models, odds ratio of 1.59 [95% confidence interval (CI) = 1.27-2.00] for BMI, and 1.56 (95% CI = 1.06-2.31) for waist-to-height ratio (>50 vs. ≤50%). When standardized HOMA index was added to BMI or waist-to-height ratio in a multivariate model, it gave a significant independent contribution to explain the risk of prehypertension and hypertension. Odds ratio was 1.23 (95% CI = 1.01-1.51) in the model with BMI, and 1.23 (95% CI = 1.01-1.50) in the model with waist-to-height ratio. The role of HOMA index was confirmed when continuous values of systolic and diastolic blood pressure (standardized by age, sex and height) were analysed, instead of hypertension category. These results strongly support the hypothesis that in children, insulin resistance plays a role on hypertension independently from obesity, fat distribution and puberty across weight classes.

Blood pressure and heart rate over 10 years in the multimodal treatment study of children with ADHD.

It is unknown whether prolonged childhood exposure to stimulant medication for the treatment of attention deficit hyperactivity disorder (ADHD) increases the risk for developing abnormalities in blood pressure or heart rate. The authors examined the association between stimulant medication and blood pressure and heart rate over 10 years. A total of 579 children, ages 7–9, were randomly assigned to 14 months of medication treatment, behavioral therapy, the combination of the two, or usual community treatment. The controlled trial was followed by naturalistic treatment with periodic assessments. Blood pressure and heart rate data were first analyzed with linear regression models based on an intent-to-treat approach, using raw data and the blood pressure categories of prehypertension and hypertension. Currently medicated patients were then compared with never or previously medicated patients. Associations between cumulative stimulant exposure and blood pressure or heart rate were assessed. No treatment effect on either systolic or diastolic blood pressure could be detected. Children who were treated with stimulants had a higher heart rate (mean=84.2 bpm [SD=12.4] on medication alone and mean=84.6 bpm [SD=12.2] on medication plus behavioral therapy) than those who were treated with behavioral therapy alone (mean=79.1 bpm [SD=12.0]) or those who received usual community treatment (mean=78.9 bpm [SD=12.9]) at the end of the 14-month controlled trial, but not thereafter. Stimulant medication did not increase the risk for tachycardia, but greater cumulative stimulant exposure was associated with a higher heart rate at years 3 and 8. Stimulant treatment did not increase the risk for prehypertension or hypertension over the 10-year period of observation. However, stimulants had a persistent adrenergic effect on heart rate during treatment.

A Predictive Model for Risk of Prehypertension and Hypertension and Expected Benefit After Population-Based Life-Style Modification (KCIS No. 24)

Few reports have identified and quantified significant risk factors responsible for multistate natural course of progression to hypertension and also regression of prehypertension to normal, which provides baseline risks to estimate the size of expected benefit derived from population-based life-style modification. Data used for estimating clinical parameters governing temporal natural course of hypertension are derived from 42,027 participants attending screening annually between 1999 and 2002. Information on transition history between normal, prehypertension, stage 1 and stage 2 hypertension between screens was therefore collected to compute multistep composite risk scores without intervention program. The expected benefits of risk reduction in prehypertension and hypertension under different intervention programs by modifying the related risk factors from abnormal to normal ranges were estimated. The majority of risk factors play a more remarkable role in prehypertension and stage 1 hypertension but less in stage 2 hypertension. The greater the number of risk factors included in the intervention programs becomes, the lower the mean risk score is expected to achieve. The 5-year predicted cumulative risk for stage 2 hypertension decreased from 23.6% in the absence of intervention program to 14% with the provision of "six-component intervention" in men. The results were similar for women. Multiple risk factors responsible for multistep transitions between prehypertension and hypertension were identified by using population-based screening data to derive multistep composite risk scores, which are useful for the expected benefit of reducing risk of hypertension by providing population-based life-style modification.

ADHD Pharmacotherapy: Rates of Stimulant Use and Cardiovascular Risk

ADHD Pharmacotherapy: Rates of Stimulant Use and Cardiovascular Risk

Prevalence of prehypertension and its relationship to risk factors for cardiovascular disease in community of Chengdu

Objective: In this paper we estimate the prevalence of prehypertension in community of Chengdu and evaluate the relationship between prehypertension and other risk factors for CVD and multiple metabolic disorders. Methods: The study used data from participants of three communities in Chengdu. A sample of 3524 persons, aged 18 years and over, completed an interviewer administered questionnaire and blood pressure measurements, physical examination and blood samples were obtained and analyzed for all individuals. Results: (1) The prevalence of prehypertension in Chengdu was 34.07% and increased with age up to 30–39 (39.93%) and then declined in the older age groups. Prehypertension was more common in males than females (41.16% vs 23.89%, P<0.05). (2) Prevalence of some cardiovascular risk factors in prehypertensives was significantly higher than that in normotensives (P<0.05). (3) Odds of hyperglycemia, increased fasting blood glucose, hyperuricemia and obesity, overweight, and increased waist circumference were significantly higher among prehypertensive participants when compared to normotensive participants. Conclusions: Prehypertension occurs in 34.07% of Chengdu and is associated with increased prevalence of other CVD risk factors. Health-care providers should recognize the increased CVD risk of prehypertension and should seek to identify and treat modifiable risk factors in these persons.