Protective Misperception? Prospective Study of Weight Self-Perception and Blood Pressure in Adolescents With Overweight and Obesity

Background The increasing prevalence of primary hypertension has motivated researchers to identify influencing factors, one of which is noise. There have been few studies on a relationships between noise exposure and blood pressure in children, and none have dealt exclusively with adolescents.Objective To assess for an association between noise exposure at school and blood pressure in adolescents. Methods To identify noisy and quiet schools, the mean noise levels of 192 senior high schools in Medan were measured using sound level meters. One noisy school and one quiet school were randomly selected for inclusion (mean noise levels of 68.2 and 53.8 dB, respectively). Students from both schools underwent blood pressure measurements by mercury sphygmomanometer. Their Body weights and heights were obtained for body mass index calculations. Subjects filled questionnaires and their parents were interviewed regarding history of illnesses.Results Of the 271 adolescents recruited, 136 (50.2%) were from the noisy school. Adolescents from the noisy school had higher mean systolic and diastolic blood pressures [121.6 (SD 13.87) mmHg and 71.1 (SD 8.15) mmHg, respectively], than those from the quiet school [111.8 (SD 12.61) mmHg and 63.8 (SD 8.05) mmHg, respectively]. After adjusting for other factors, noise had a significant, moderate, positive association with systolic and diastolic blood pressures [β = 0.452; B = 6.21 (95% CI 3.86-8.55) mmHg; and β = 0.473; B = 4.18 (95% CI 2.41 to 5.94) mmHg, respectively].Conclusion Adolescents from a noisy school have a greater risk of higher systolic and diastolic blood pressures than those from a quiet school.

In 2007 the International Diabetes Federation (IDF) proposed single blood pressure (BP) cutpoints (systolic: ≥130 mm Hg and diastolic: ≥85mm Hg) for the diagnosis of high blood pressure (HBP) in adolescents. Before this proposal, HBP had been defined as BP at or above the 95th percentile for age, sex, and height percentile (reference standard). In this study, we evaluated the risk for misclassification when using the IDF single-cutpoints criteria. We first applied the IDF criteria to a reconstructed population with the same age, sex, and height distribution as the population used to develop the reference standard. The proposed single cutpoints corresponded to percentiles from the 81.6th to 99.9th for systolic BP and from the 92.9th to 98.9th for diastolic BP in the reconstructed population. Using IDF criteria, there were high false-negative fractions for both systolic and diastolic BP (from 54% to 93%) in 10- to 12-year-olds and a false-positive fraction up to 35% in older subjects. We then applied the IDF criteria to 1,162 overweight/obese adolescents recruited during 1998-2000 from pediatric clinical centers in Milano, Varese, and Modena in Italy and in Zaragoza, Spain. Overall false-negative and false-positive fractions were 22% and 2%, respectively; negative predictive values were especially low for 10- to 12-year-old subjects. The use of IDF's single cutpoints carries a high risk of misclassification, mostly due to false negatives in younger subjects. The effort to simplify diagnosis could be overcome by the risk of undiagnosed HBP.

Gaining weight has been directly associated with an increased probability of developing high blood pressure (HBP) and metabolic abnormalities. We examined the independent and combined effects of overweight, obesity and abdominal obesity on blood pressure in adolescents. This cross-sectional school-based study evaluated 869 adolescents (53.4% girls) from 14 to 19 years of age, and the data were collected in 2013 in the city of Imperatriz, Maranhão, Brazil. The outcome was HBP. The independent variables were overweight and obesity classified by body mass index, abdominal obesity classified by the waist-to-height ratio and the combination of obesity and overweight and abdominal obesity. The potential confounding variables were age, the socio-economic status of the family, parental education, type of school and physical activity levels. The prevalence ratios of HBP were higher when male and female adolescents were overweight (1.61-3.11), generally obese (3.20-4.70), had abdominal obesity (2.18-3.02) and were both generally obese and had abdominal obesity (3.28-5.16) compared with normal weight adolescents. Obesity or abdominal obesity increased the risk of HBP in adolescents aged 14-19. However, adolescents who were both generally obese and had abdominal obesity showed an even higher risk of having HBP.

BackgroundHigh resting heart rate is considered an important factor for increasing mortality chance in adults. However, it remains unclear whether the observed associations would remain after adjustment for confounders in adolescents.ObjectivesTo analyze the relationship between resting heart rate, blood pressure and pulse pressure in adolescents of both sexes.MethodsA cross-sectional study with 1231 adolescents (716 girls and 515 boys) aged 14-17 years. Heart rate, blood pressure and pulse pressure were evaluated using an oscillometric blood pressure device, validated for this population. Weight and height were measured with an electronic scale and a stadiometer, respectively, and waist circumference with a non-elastic tape. Multivariate analysis using linear regression investigated the relationship between resting heart rate and blood pressure and pulse pressure in boys and girls, controlling for general and abdominal obesity.ResultsHigher resting heart rate values were observed in girls (80.1 ± 11.0 beats/min) compared to boys (75.9 ± 12.7 beats/min) (p ≤ 0.001). Resting heart rate was associated with systolic blood pressure in boys (Beta = 0.15 [0.04; 0.26]) and girls (Beta = 0.24 [0.16; 0.33]), with diastolic blood pressure in boys (Beta = 0.50 [0.37; 0.64]) and girls (Beta = 0.41 [0.30; 0.53]), and with pulse pressure in boys (Beta = -0.16 [-0.27; -0.04]).ConclusionsThis study demonstrated a relationship between elevated resting heart rate and increased systolic and diastolic blood pressure in both sexes and pulse pressure in boys even after controlling for potential confounders, such as general and abdominal obesity.

Objective: This study was conducted to examine the effect of the body mass index and waist-hip ratio on blood pressure in adolescents. Material and Methods: This study, of descriptive and correlational research design, randomly selected the sampling group in the 3 general high schools of Beşiktaş District. The research population included 2769 students in the 9th, 10th, 11th and 12th grades of high school, and the sample included 711 students. Data were obtained using a research question form that was developed in line with the literature as well as body mass index percentile, waist-hip ratio measurement and a blood pressure (BP) percentile. Results The average waist-hip ratio was 72 (0.04) in female adolescents and 79 (0.04) in males adolescents. A total of 60.9% of the sampling had normal weight, and 87.3% had normal blood pressure. Both body mass index and waist-hip ratio had an effect on blood pressure (p<0.00), but body mass index in particular had a greater effect. Conclusion: To determine chronic health problems at an early age, it is necessary to follow up with adolescents at health centres and train them at school about healthy lifestyles. Nursing is one of the professional groups that should assume this responsibility.

Dietary long-chain n-3 PUFA (n-3 LCPUFA) in infancy may have long-term effects on lifestyle disease risk. The present follow-up study investigated whether maternal fish oil (FO) supplementation during lactation affected growth and blood pressure in adolescents and whether the effects differed between boys and girls. Mother-infant pairs (n 103) completed a randomised controlled trial with FO (1·5 g/d n-3 LCPUFA) or olive oil (OO) supplements during the first 4 months of lactation; forty-seven mother-infant pairs with high fish intake were followed-up for 4 months as the reference group. We also followed-up 100 children with assessment of growth, blood pressure, diet by FFQ and physical activity by 7-d accelerometry at 13·5 (sd 0·4) years of age. Dried whole-blood fatty acid composition was analysed in a subgroup (n 49). At 13 years of age, whole-blood n-3 LCPUFA, diet, physical activity and body composition did not differ between the three groups. The children from the FO group were 3·4 (95 % CI 0·2, 6·6) cm shorter (P=0·035) than those from the OO group, and tended to have less advanced puberty (P=0·068), which explained the difference in height. There was a sex-specific effect on diastolic blood pressure (P sex×group=0·020), which was driven by a 3·9 (95 % CI 0·2, 7·5) mmHg higher diastolic blood pressure in the FO compared with the OO group among boys only (P=0·041). Our results indicate that early n-3 LCPUFA intake may reduce height in early adolescence due to a delay in pubertal maturation and increase blood pressure specifically in boys, thereby tending to counteract existing sex differences.

The relationship between the renal renin-angiotensin aldosterone system (RAAS) and cardiorenal pathophysiology is unclear. Our aims were to assess 1) levels of urinary RAAS components and 2) the association between RAAS components and HbA1c, the urine albumin/creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and blood pressure (BP) in otherwise healthy adolescents with type 1 diabetes mellitus (TID) vs. healthy controls (HC). Urinary angiotensinogen and angtionsin-converting enzyme (ACE) 2 levels, activity of ACE and ACE2, BP, HbA1c, ACR, and eGFR were measured in 65 HC and 194 T1D from the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT). Urinary levels of all RAAS components were higher in T1D vs. HC (P < 0.0001). Higher HbA1c was associated with higher urinary angiotensinogen, ACE2, and higher activity of ACE and ACE2 (P < 0.0001, P = 0.0003, P = 0.003, and P = 0.007 respectively) in T1D. Higher ACR (within the normal range) was associated with higher urinary angiotensinogen (P < 0.0001) and ACE activity (P = 0.007), but not with urinary ACE2 activity or ACE2 levels. These observations were absent in HC. Urinary RAAS components were not associated with BP or eGFR in T1D or HC. Otherwise healthy adolescents with T1D exhibit higher levels of urinary RAAS components compared with HC. While levels of all urinary RAAS components correlate with HbA1c in T1D, only urinary angiotensinogen and ACE activity correlate with ACR, suggesting that these factors reflect an intermediary pathogenic link between hyperglycemia and albuminuria within the normal range.

Background: Tobacco consumption adversely affects cardiovascular (CV) disease (CVD) and risk profile, including hypertension. The long-term effect of cigarette smoking on blood pressure (BP) in adolescents is still, however, equivocal. Thus, the current study examined the CV hemodynamics in male adolescent cigarette smokers versus non-smokers. Methods: Resting heart rate, systolic (SBP) and diastolic (DBP) BP, mean arterial pressure (MAP), pulse pressure (PP), and rate pressure products (RPP) were examined using automatic oscillatory method, while smoking status was determined with Youth Risk Behavior Survey (YRBS). Results: After covariating for cofactors, the ANCOVA showed that CV hemodynamics were lower (p &lt; 0.05), in the male adolescent smokers versus non-smokers. Additionally, regression showed that smoking predicted the reduction in SBP (20.6%), DBP (5.0%), MAP (13.4%), PP (7.5%), and RPP (13.4%). Conclusion: The results suggest that cigarette smoking lowers CV hemodynamics in adolescent. However, more studies are needed to describe the mechanism(s) for lowering CV hemodynamics and explain the relationship of adolescent smoking with adulthood CVDs.

Objective: This study aimed to assess the correlation between blood pressure levels and stress condition in adolescents (14–19 years). Design and Method: Cross-sectional study on 262 teenager population (115 male, 147 female) in Riau Archipelago, Indonesia without prior history of hypertension, who underwent standardised psychological assessment by trained psychologists for stress resilience (1–9 scale), and the blood pressure were assessed. Results: Mean Systolic Blood Pressure and mean Diastolic Blood Pressure were 119.5 (SD 18.8) and 75.1 (SD 10.9) mmHg respectively (124.53 (SD 20.6) & 77.12 (SD 11.3) in males, 115.56 (SD 16.4) and 73.52 (SD 10.4) in females). Mean age was 16.62 (SD 1.1). Mean blood pressure (MBP) showed significant correlation with age. From 262 participants, 35 participants (13.3%) had hypertension, 14 participants (5.3%) had obese (RR = 5.12; 95% CI 3.78–6.92). MBP showed significant correlation with stress condition (p < 0.05). Conclusions: These findings suggest that stress condition may contribute high blood pressure in adolescents.

Di-2-ethylhexyl phthalate (DEHP) is a plasticizer that is used to impart flexibility to polyvinyl chloride products. Patients have an increased exposure to phthalates through contact with DEHP-containing medical devices, including: storage bags containing blood, plasma, intravenous fluids, total parenteral nutrition, tubing associated with their administration, nasogastric tubes, enteral feeding tubes, catheters, extracorporeal membrane oxygenation (ECMO) circuits, hemodialysis tubing, respiratory masks and endotracheal tubes. Human health concerns pertaining to DEHP exposure are linked to its endocrine-disrupting properties. Accordingly, increased exposure has been associated with cancer, metabolic disturbances, reproductive and neurological disorders, and cardiovascular disease. As an example, epidemiological studies have shown a link between DEHP exposure and elevated systolic blood pressure in adolescents. Despite bans and restrictions on the use of DEHP-containing medical devices in other countries, there is currently no mandate from the Food &amp; Drug Administration for the use of DEHP-free devices and storage containers. The objective of this study was to quantify the impact of in vivo DEHP exposure on cardiovascular function; thereby, providing additional information for regulatory decisions by the scientific, medical and regulatory community. Healthy C57BL/6 male mice were implanted with radiotelemetry transmitters; briefly, the transmitter catheter was placed in the carotid artery and biopotential leads were routed subcutaneously to collect electrocardiogram (ECG) signals. After surgical recovery, pre-exposure data was collected, and thereafter, animals were exposed to 0.2 mg/g DEHP or control diet. We observed a significant increase in systolic pressure in DEHP-treated (145 + 3 mmHg) vs control animals (136 + 1 mmHg). We also detected an increase in diastolic and mean arterial pressure in DEHP-treated (119 + 5 and 132 + 3 mmHg, respectively) vs control animals (107 + 2 and 121 + 2 mmHg). Our previous reports have shown that DEHP diminishes cardiac contractility, which suggests that these effects on blood pressure are likely attributed to alterations in sympathetic tone and/or an increase in vascular resistance.

Background: The prevalence of essential hypertension in children and adolescents has increased dramatically over the past decade attributed to a rising prevalence of obesity, high salt diet and lack of exercise. Traditionally high blood pressure in adolescents required extensive work up to determine a cause, but given the changing demographics this policy needs to be reviewed. Objectives/method: The study aimed describe the risk factors, demographics, target organ damage and aetiology of hypertension in a cohort of young hypertensives (aged 15 - 30 years) referred to a tertiary hypertension clinic at Groote Schuur Hospital, by retrospectively reviewing the folders over a three-month period. Results: Thirty eight patients were identified with a mean age of 22 years. Essential hypertension was diagnosed in 82% of patients, and 71% of patients had a family history of hypertension. The median systolic blood pressure (BP) at first visit was 132 mmHg and diastolic BP 84mmHg. The median BMI was 25.4 kg/m2 and 68% had some form of target organ damage. Twenty six percent were current smokers and 8% had abused metamphetamines. Recognised secondary causes of hypertension were renal artery stenosis (four) and primary aldosteronism (one). Conclusions: In a cohort of young hypertensives patients the dominant cause was essential hypertension. Although the prevalence of obesity was surprisingly low compared to previously published studies, significant lifestyle issues were identified. 68% had target organ damage suggesting the disease was not benign. These preliminary results indicate that larger cohorts need to be studied to develop new policies for assessment and treatment of young people with hypertension in South Africa.

Laparoscopic transposition of lower-pole crossing vessels: Long-term follow-up of 33 patients at puberty

Background Adolescents with elevated body mass index BMI are at increased risk for future development of obesity related diseases as adults The applications of stress reduction programs such as yoga training especially for youth are few This study tested the impact of yoga yoga stretching and postures meditation alternate nostril breathing delivered in a high school setting The objective was to determine the impact of yoga on exercise habits and blood pressure BP among a population of overweight adolescents Methods Forty adolescents Female Male Black White mean age plusmn yrs with BMI for age ge th percentile by gender BMI ge for girls ge for boys from high school health physical education classes were assigned to weekly hour sessions of yoga at school n or evaluation only control n conditions Participants were evaluated at pre and months post test and at months follow up Ambulatory BP measurements were obtained over hour periods in the natural setting using Space Labs BP monitors A lifestyle behavior survey assessed exercise habits and physical activity Results Self reported yoga home practice averaged min day range min day mean times per week range times per week Differences between groups at baseline did not reach statistical significance A significant group by time interaction was observed for hr systolic BP such that the yoga group decreased from plusmn to plusmn mmHg compared to an increase plusmn to plusmn mm Hg in the control group across the month study p lt hr diastolic BP decreased in the yoga group from plusmn to plusmn mm Hg while the controls increased from plusmn to plusmn mm Hg across the month study p lt The yoga group increased in days week with gt min of hard aerobic exercise from plusmn to plusmn compared to a decrease in the control group plusmn to plusmn across the month study p lt Conclusion The findings were observed over a relatively short intervention period and suggest beneficial impact of yoga upon blood pressure and exercise in overweight adolescents Replication and verification in a larger group with a longer follow up is warranted

Early smoking is considered an indicator for risky behaviour in adolescents. Although social indicators predicting adolescent smoking are known, biological indicators have not been defined. This study aimed to establish whether salivary testosterone could be used as a "predictive biomarker" for smoking-associated peer pressure. Saliva samples were collected from Bruneian adolescents (aged 13-17 years) by the passive drool method. Salivary testosterone concentration was determined by enzyme-linked immunosorbent assay. Salivary testosterone concentration and smoking-associated peer pressure indicators were compared between adolescent males and females and statistical significance was determined by an independent samples t-test. A significant positive relationship between smoking-associated peer pressure and salivary testosterone levels in adolescents was found. However, this relationship was not significant when males and females were considered separately. Our data suggest that students who have tried cigarette smoking and have friends who are cigarette smokers have higher salivary testosterone levels.

Association between general and abdominal obesity with high blood pressure: difference between genders

Objective: Tobacco consumption adversely affects cardiovascular (CV) disease (CVD) and risk profile, including hypertension. The long-term effect of cigarette smoking on blood pressure (BP) in adolescents is still, however, equivocal. Thus, the current study examined the CV indices in male adolescent cigarette smokers versus nonsmokers.Method: Resting heart rate, systolic BP (SBP) and diastolic BP (DBP), mean arterial pressure (MAP), pulse pressure (PP) and rate pressure products (RPP) were examined using automatic oscillatory method, while smoking status was determined with Youth Risk Behavior Survey.Results: After controlling for cofactors, the ANCOVA showed that CV measures in the male adolescent smokers were lower (p < 0.05) than nonsmokers. Additionally, regression showed that smoking status explained 20.6% of SBP, 5.0% of DBP, 13.4% of MAP, 7.5% of PP and 13.4% of RPP.Conclusion: The results suggest that cigarette smoking lowers CV measures in adolescents. However, more studies are needed to describe the mechanism(s) for lowering CV measures and explain the relationship of adolescent smoking with adulthood CVDs.

The aim of this cross-sectional study was to investigate the association between consumption of sugar-sweetened and diet soft drinks with blood pressure (BP) in adolescents. Fifth graders of 20 public schools were invited to participate in an intervention aimed at behavioral dietary changes and had their BP, weight, and height measured at baseline. Type and frequency of soft drink consumption were assessed using a food and beverages frequency questionnaire, and students were classified as nonconsumers, sugar-sweetened soft drink consumers, and diet soft drink consumers. Of the 574 students invited, 512 were examined and 488 had their BP measured. Of these, 25 (5.1%) reported to be nonconsumers, 419 (85.9%) were sugar-sweetened soft drink consumers, and 44 (9%) were diet soft drink consumers. Mean SBP and DBP were 101.3/57.8, 102.6/58.8, and 106.0/61.3 mmHg for these three groups of consumption, respectively. After adjustment for sex, age, BMI, physical activity, addition of salt to food, and education of the head of the family, SBP was 5.4 mmHg higher in the diet soft drink consumers group compared with the nonconsumers group and 3.3 mmHg higher compared with the sugar-sweetened consumers group (P value of trend = 0.01). Moreover, DBP was also higher among diet soft drink consumers compared with nonconsumers, with a difference of 3.3 mmHg, and compared with sugar-sweetened consumers, with a difference of 2.3 mmHg (P value of trend = 0.04). The results indicate that the consumption of soft drink is associated with increased BP, which is further increased by drinking diet type sodas.

Allopurinol lowers blood pressure in adolescents and has other vasoprotective effects. Whether similar benefits occur in older individuals remains unclear. We hypothesized that allopurinol is associated with improved cardiovascular outcomes in older adults with hypertension. Data from the United Kingdom Clinical Research Practice Datalink were used. Multivariate Cox-proportional hazard models were applied to estimate hazard ratios for stroke and cardiac events (defined as myocardial infarction or acute coronary syndrome) associated with allopurinol use over a 10-year period in adults aged >65 years with hypertension. A propensity-matched design was used to reduce potential for confounding. Allopurinol exposure was a time-dependent variable and was defined as any exposure and then as high (≥300 mg daily) or low-dose exposure. A total of 2032 allopurinol-exposed patients and 2032 matched nonexposed patients were studied. Allopurinol use was associated with a significantly lower risk of both stroke (hazard ratio, 0.50; 95% confidence interval, 0.32-0.80) and cardiac events (hazard ratio, 0.61; 95% confidence interval, 0.43-0.87) than nonexposed control patients. In exposed patients, high-dose treatment with allopurinol (n=1052) was associated with a significantly lower risk of both stroke (hazard ratio, 0.58; 95% confidence interval, 0.36-0.94) and cardiac events (hazard ratio, 0.65; 95% confidence interval, 0.46-0.93) than low-dose treatment (n=980). Allopurinol use is associated with lower rates of stroke and cardiac events in older adults with hypertension, particularly at higher doses. Prospective clinical trials are needed to evaluate whether allopurinol improves cardiovascular outcomes in adults with hypertension.

Criterion-referenced cut-points for health-related fitness measures are lacking. This study aimed to determine the associations between aerobic fitness and high blood pressure levels (HBP) to determine the cut-points that best predict HBP among adolescents. This cross-sectional school-based study with sample of 875 adolescents aged 14-19 years was conducted in southern Brazil. Aerobic fitness was assessed using the modified Canadian Aerobic Fitness Test (mCAFT). Systolic and diastolic blood pressure were measured by the oscillometric method with a digital sphygmomanometer. Analyses controlled for sociodemographic variables, physical activity, body mass and biological maturation. Receiver Operating Characteristic (ROC) curves demonstrated that mCAFT measures could discriminate HBP in both sexes (female: AUC = 0.70; male: AUC = 0.63). The cut-points with the best discriminatory power for HBP were 32 mL·kg-1·min-1 for females and 40 mL·kg-1·min-1 for males. Females (OR = 8.4; 95% CI: 2.1, 33.7) and males (OR: 2.5; CI 95%: 1.2, 5.2) with low aerobic fitness levels were more likely to have HBP. mCAFT measures are inversely associated with BP and cut-points from ROC analyses have good discriminatory power for HBP.