Prevalence Of Elevated Blood Pressure Research Articles

Body composition and physical activity as mediators in the relationship between socioeconomic status and blood pressure in young South African women: a structural equation model analysis

ObjectivesVarying hypertension prevalence across different socioeconomic strata within a population has been well reported. However, the causal factors and pathways across different settings are less clear, especially in sub-Saharan Africa....

Pediatric Hypertension.

The prevalence of elevated blood pressure and hypertension in children and adolescents has increased over the past decade. This trend is most likely related to increases in primary hypertension associated with increasing obesity rates in children. Lifestyle as well as genetics play a significant role in the development of primary hypertension. Hypertension in children and adolescents is under-recognized and undertreated. The 2017 Revised Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents aimed to create new normative blood pressure tables using data from healthy weight children, meaning between the 5th and 85th percentile per the Centers for Disease Control and Prevention. Another important objective was to simplify normative data to ease screening and detection of elevated blood pressures. The consequences of chronic hypertension are significant, with its major affect being in poor cardiovascular health outcomes both in childhood and early adulthood. Challenges to detection and adequate treatment should be overcome with continued education and awareness to prevent the long-term effects of uncontrolled hypertension that starts in childhood. [Pediatr Ann. 2018;47(12):e499-e503.].

Influence of change in blood pressure status from childhood to adulthood on renal dysfunction: a cohort study

Objective: To investigate the influence of change in blood pressure status from childhood to adulthood on renal damage. Methods: Data were obtained from Beijing Blood Pressure Cohort initiated from 1987. 3 198 children and adolescents aged 6-18 years from 6 primary and 6 middle schools in Chaoyang, Xicheng and Haidian Districts of Beijing were enrolled at baseline by using a cluster random sampling method, and 1 222 participants were followed up during 2010-2012. The measurements included weight, height, and blood pressure at baseline and microalbumin, serum creatinine, cystatin C and blood pressure at follow-up. Based on blood pressure status in childhood and adulthood, the participants were divided into four groups: participants with normal blood pressure in both childhood and adulthood, participants with elevated blood pressure in childhood but normal blood pressure in adulthood, participants with normal blood pressure in childhood but elevated blood pressure in adulthood, and participants with elevated blood pressure in both childhood and adulthood. Multivariate linear regression model was used to investigate the association of change in blood pressure from childhood to adulthood on renal dysfunction. Results: The prevalence of elevated blood pressure in childhood and adulthood was 17.9% and 39.9%, respectively. The P(50) (P(25)-P(75)) of microalbumin was 5.7(3.0-12.0) mg/L, and the concentration of eGFR and cystatin C were (118.0±19.8)% and (0.734±0.184)mg/L, respectively. With adjustment for sex, baseline age and follow-up years, compared with participants with persistently normal blood pressure from childhood to adulthood, participants with normal blood pressure in childhood but elevated blood pressure in adulthood had significantly higher levels of microalbumin (β=0.502, 95%CI: 0.320-0.684) and cystatin C (β=0.049, 95%CI: 0.025-0.073). After adjustment for sex, baseline age, follow-up duration, and adult BMI, smoking and drinking, participants with normal blood pressure in childhood and elevated blood pressure in adulthood had higher levels of adult urine microalbumin (β=0.322, 95%CI: 0.128-0.516) and cystatin C (β=0.032, 95%CI:0.007-0.057). Conclusion: An increase in blood pressure during childhood and adulthood has an adverse impact on renal functional damage in adulthood. These findings underscore the importance of maintaining normal blood pressure during life course to prevent the development of chronic kidney disease.

Prevalence of Hypertension in Children.

In 2017, the American Academy of Pediatrics issued a new clinical practice guideline for defining hypertension in children as an update to the previous Fourth Report guidelines issued in 2004. Prevalence of confirmed pediatric hypertension in children has ranged from 2% to 4% based on previous guidelines yet it is unknown what the prevalence is under the new guideline. We estimated the prevalence of elevated blood pressure, stage 1, and stage 2 hypertension by the new American Academy of Pediatrics guideline in our school-based blood pressure screening program. New prevalence estimates were compared with Fourth Report prevalence estimates in the same population by sex, age, and height factors. In 22 224 students aged 10 to 17 years screened in school as part of the Houston Pediatric and Hypertension Program at the University of Texas McGovern Medical School, the prevalence of elevated blood pressure (previously called prehypertension) increased from 14.8% by Fourth Report to 16.3% by the new American Academy of Pediatrics guideline. This increase in elevated blood pressure resulted from differential classification changes in younger and older children. Prevalence of confirmed hypertension remains at 2% to 4% in this population, however shorter children <13 years old and taller, older children 13+ years old are systematically more likely to be diagnosed with hypertension by new guidelines.

A17223 The prevalence of elevated blood pressure in children and adolescents in Africa

Objectives: We did the first systematic review and meta-analysis to provide estimates of the prevalence of elevated blood pressure and assess associated factors among children and adolescents in Africa. Methods: We did a comprehensive literature search to identify articles published from Jan 1, 1996, to Feb 2, 2017, and searched the reference list of retrieved articles. We used a random-effects model to estimate the prevalence of elevated blood pressure across studies and heterogeneity (I2) was assessed via the χ2 test on Cochran's Q statistic. Results: We included 51 studies in qualitative synthesis and 25 in the meta-analysis reporting data of a pooled sample of 54196 participants aged 2–19 years. Prevalence of elevated blood pressure varied widely across studies (range 0.2–24.8%). The pooled prevalence of elevated blood pressure (systolic or diastolic blood pressure ≥95th percentile) was 5.5% (95% CI 4.2–6.9) (Figure 1), whereas that of slightly elevated blood pressure (systolic or diastolic blood pressure ≥90th percentile and < 95th percentile) was 12.7% (2.1–30.4). The prevalence of elevated blood pressure was largely associated with body-mass index (BMI), with a prevalence of elevated blood pressure six times higher in obese (30.8%, 95% CI 20.1–42.6) versus normal-weight children (5.5%, 3.1–8.4; p < 0.0001). Conclusion: This study suggests a high prevalence of elevated blood pressure among children and adolescents in Africa, with overweight and obesity being an important risk factor. Efforts to address this burden of elevated blood pressure in children and adolescents should mainly focus on primary prevention at the community level, by promoting healthy lifestyles and avoiding other cardiovascular risk factors, especially overweight and obesity.

A3672 Role of waist circumference in predicting elevated blood pressure among children and adolescents with normal body mass index

Objectives: To examine the waist circumference (WC)'s predict role to elevate blood pressure (BP) among children and adolescents aged 7–17 years old who have normal body mass index (BMI), and provide scientific evidence for prevention and intervention of elevated BP in children and adolescents. Methods: Data were combined from the China Health and Nutrition Survey, which was conducted during the period of 1993–2011. A total of 9038 children and adolescents aged 7–17 years old who had normal BMI were included in the final data analysis. Data were on gender, age, WC, systolic blood pressure (SBP), diastolic blood pressure (DBP), and the prevalence of elevated BP. After adjusted for sex and age, the multiple liner regression model was used to analyze the trend in mean BP with increase of WC levels. Logistic regression model was conducted to examine the trend in elevated BP prevalence and the risk of elevated BP with increase of WC levels. Results: Both the mean value of BP and prevalence of elevated BP showed rising trends with the increase of WC levels among children and adolescents with normal BMI (SBP/DBP ranged from 96.0/63.1 mmHg to 102.4/68.0 mmHg; prevalence of elevated BP ranged from 6.9% to 21.8%, all P < 0.001), independently of age and sex. When WC < P25 as the referent group, the risk for elevated BP were 1.39, 1.70, 2.21 and 3.10, for groups of WC > = P25 and WC < P50, WC > = P50 and WC < P75, WC > = P75 and WC < P90, and WC > = P90, respectively, independently of age and sex(P < 0.01). Conclusion: WC can be used as an important predictor of elevated BP in children and adolescents. BMI should be in combined with WC in order to more effectively prevent risk of elevated BP in children and adolescents.

The association between the malnutrition and blood pressure in Chinese Han students aged 7-18 years in 2014

Objective: This study aimed to explore the association between malnutrition and the level of blood pressure (BP) as well as elevated BP (EBP) in Han students aged 7 to 18 years in China. Methods: 170 037 subjects with normal nutritional status and malnutrition were enrolled in this study from 2014 Chinese National Surveys on Students' Constitution and Health with a multi-stage stratified cluster random sampling framework covering 31 provinces, autonomous regions and municipalities after the exclusion of 44 317 overweight and obese students. According to the standard of "Screening Standard for Malnutrition of School-age Children and Adolescents" (WS/T456-2014), the nutritional status of children were classified into two categories, normal nutritional status and malnutrition containing stunting, mild wasting and moderate severe wasting. The level of BP and prevalence of EBP were compared between students with normal nutritional status and malnutrition. The multivariate logistic regression model was used to analyze the association between malnutrition and EBP. Results: The levels of systolic BP (SBP) and diastolic BP (DBP) in Chinese Han students aged 7-18 years who were non-overweight and non-obesity status were (103.4±12.3) and (64.7±9.5) mmHg (1 mmHg=0.133 kPa), respectively. The prevalence of EBP, systolic EBP and diastolic EBP in Chinese Han malnourished students (N=21 012) were 3.1% (n=649), 1.5% (n=324) and 2.1% (n=445), respectively, which was significantly lower than those (N=148 320) with normal nutritional status (4.5% (n=6 707), 2.6% (n=3 872) and 2.7% (n=3 959)), and the corresponding differences were statistically significant (P<0.05). The OR (95%CI) between malnutrition and EBP was 0.68 (0.62-0.73), which were 0.65 (0.58-0.72) and 0.68 (0.60-0.77) for boys and girls. The OR (95%CI) between EBP and stunting as well as mild wasting and moderate severe wasting were 0.69 (0.62-0.77), 0.63 (0.55-0.72) and 0.79 (0.60-1.05), respectively. Conclusion: The level of BP and prevalence of EBP in Chinese Han students with malnutrition were lower than those with normal nutritional status. The negative correlation existed between malnutrition and EBP in Chinese Han students aged 7 to 18 years.

Surveillance of Pediatric Hypertension Using Smartphone Technology

IntroductionElevated blood pressure is becoming increasingly common in the pediatric population. Hypertension costs nearly $51 billion/year, and cardiovascular disease is responsible for 17% of the nation's health care expenditures. Traditionally, time-consuming and complicated interpretation standards result in infrequent pediatric blood pressure screenings. This may lead to the under-diagnosis of pediatric hypertension. Early detection of elevated blood pressure is important in order to prevent hypertension related conditions such as, target organ damage, left ventricular hypertrophy, and cerebrovascular disease. The aim of this study was to observe the prevalence of pediatric hypertension among children and adolescents age 3–18 using the smartphone application Pedia BP®. The purpose of this study was to (1) identify the prevalence of elevated blood pressure in a sample of children and adolescents and (2) evaluate any association between BMI, age, and blood pressure classification. MethodA quantitative, descriptive study was conducted to evaluate the prevalence of pediatric hypertension in 81 preschool and school age children. App users were trained with the online take2heart course available at take2heart.com. The manual systolic and diastolic blood pressure readings were entered into the application, along with the patient's gender, age, height, and weight. Pedia BP® instantly calculated the blood pressure classification of the patient based on percentiles. Quantitative data from the Pedia BP® data repository were analyzed using descriptive statistics. ResultsWe found that 54.3% of our sample were normotensive, 23.5% had prehypertension, 13.6% had stage 1 hypertension, and 8.6% had stage 2 hypertension. As seen in Figure 3, the majority of subjects with stage 1 (72.7%) and stage 2 hypertension (57.1%) were found in school-age children. We found that 3.7% of children were underweight, 48.1% were at a healthy weight, 21% were overweight, and 27.2% were obese. DiscussionPedia BP® was shown to be an effective screening tool to easily classify blood pressure readings on an individual basis. The prevalence of hypertension in our sample was higher than previously reported in the literature. Annual evaluation of blood pressures in preschool and school age children are warranted to identify and address hypertension. Pedia BP® was shown to be an effective screening tool to easily classify blood pressure readings on an individual basis. Pedia BP® offers benefits not only for patients, but for primary care providers, nurses, economists, insurance companies, hospitals, and clinics. Ultimately, Pedia BP® (1) increases awareness of elevated blood pressures among children and adolescents, (2) engages the health care community to screen for elevated blood pressures, (3) implements innovative technology, and (4) activates the potential for a population-based surveillance tool.

ETHNIC AND GENDER FEATURES OF WEIGHT INFLUENCE AT BLOOD PRESSURE OF ADOLESCENTS WITH 12–13 YEARS OLD

Objective: to learn interconnection of obesity, abdomen overweight and blood pressure (BP) among adolescents with 12–13 years Design and method: Cross-sectional study. Adolescents were evaluated at their schools after parent consent. There were included in the study 1473 (middle age, SD 12,1 ± 0,002). Age, gender, nationality, BP, height, weight, abdominal circumference (AC), body mass index (BMI). BP was measured three times by oscilometric method and high BP was defi ned as systolic BP (SBP) and/or diastolic BP (DBP) > = p95 for age, gender and height percentile; O/O as BMI > = p85 for gender and age; and increased AC as > = p90 for age and gender. Results: 1473 adolescents were evaluated (48,8% males). The prevalence of elevated BP was 12,6%. For comparison, according to ethnicity, the two most numerous groups were identified, of which the Kazakh population was 87% (n = 1282) and Russian 13% (n = 191) adolescents. By weight, BMI, SBP, DBP, AC revealed statistically significant differences (p < 0,001). According to the study in the boys’ population, the following data were found in the structure of individuals with normal BP for BMI: overweight in 4, 7% (n = 59), obesity in 0,7% (n = 9). In the structure of individuals with hypertension in boys, the BMI score was: overweight 19,4% (n = 36), obesity in 1,6% (n = 3). In the Kazakh population, a statistically significant difference was noted in boys (chi square Pearson = 39,49, df = 4, p < 0,001), as well as in girls (chi square Pearson = 33,99, df = 4, p < 0,001). In the Russian population, the girls had a statistically significant difference (chi square Pearson = 34.0, df = 4, p < 0.001). Conclusions: Prevalence of elevated BP in a population of 12 to 13 years-12,6%. In both groups statistically significant differences in BMI, SBP, DBP, AC parameters were revealed. In the Kazakh population of both sexes and girls of the Russian population, statistically significant differences in the structure of BMI distribution in groups with normal BP and were revealed.

Persistence of elevated blood pressure during childhood and adolescence: a school-based multiple cohorts study.

Blood pressure (BP) screening is advocated in children. However, identification of children with sustained elevated BP is difficult because of high BP variability. We assessed the tracking of BP and the persistence of elevated BP across childhood and adolescence. Three cohorts of children from schools in the Seychelles were examined on two occasions at 3-4-year intervals. Obesity was defined as BMI at least 95th sex-specific, and age-specific percentile. On each visit, BP was based on the average of two readings and elevated BP was defined as BP at least 95th sex-specific, age-specific, and height-specific percentile. Data was collected in 4519 children of mean ages of 5.5 and 9.2 years, 6065 of ages of 9.2 and 12.5 years, and 5967 of ages of 12.5 and 15.6 years, respectively. Prevalence of elevated BP was 10% at age 5.5 years, 10% at 9.2 years, 7% at 12.5 years, and 9% at 15.6 years, respectively. Among children with elevated BP at the initial visit, the proportions who had elevated BP at the subsequent visit 3-4 years later was 13% between ages of 5.5 and 9.2 years, 19% between 9.2 and 12.5 years, and 27% between 12.5 and 15.6 years. These proportions were higher among obese children with elevated BP, that is, 33, 35, and 39%, in each cohort, respectively. Tracking coefficients were slightly larger for SBP (range of tracking coefficients: 0.23-0.40) than for DBP (range: 0.19-0.35), and increased with age. By comparisons, tracking coefficients for BMI were much higher (range: 0.74-0.84). During childhood and adolescence, having an elevated BP on one occasion is a weak predictor of elevated BP 3-4 years later. Tracking is, however, larger in older and obese children than in younger and nonobese children.

The Childhood Role in Development of Primary Hypertension.

Primary hypertension is not just an adult disorder. Current US population data on children and adolescents demonstrate a prevalence of elevated blood pressure (BP) and hypertension combined of over 10%. Recent reports from prospective cohort studies describe an association of high BP in childhood with hypertension in young adulthood. Excess adiposity is strongly associated with higher BP in childhood and increases risk for hypertension in adulthood. In addition to overweight/obesity, other exposures that raise the risk for high BP include low birthweight, dietary sodium, and stress. Using intermediate markers of cardiovascular injury, studies on hypertensive children report findings of cardiac hypertrophy, vascular stiffness, and early atherosclerotic changes. Impaired cognitive function has also been demonstrated in hypertensive children. Recent advances in clinical and translational research support the concept that the evolution of primary hypertension begins in childhood.

The prevalence of elevated blood pressure in a sample of slovene children and adolescents: a pilot study

IntroductionThe aim of our study was to determine the prevalence of prehypertensive and elevated blood pressure in the hypertensive range (elevated BP) and obtain some anthropometric measures in Slovene children and adolescents.MethodsIn the cross-sectional study lasting one year, we measured BP using mercury sphygmomanometers, as well as height, weight, waist, and hip circumferences in schools. Data from regular check-ups (oscillometric measurements) were also added to increase the sample size. Participants were 2-19 years old. For statistical analysis, we used two-sided multivariate analysis of variance, Pearson’s r, and chi-squared test.ResultsFrom altogether 1594 participants, 723 (45.4%) were boys and 871 (54.6%) girls. The prevalence of elevated BP on a single oscillometric blood-pressure measurement was 12.0% (95% CI: 10.3 to 13.9), and an additional 13.9% (95% CI: 12.0 to 15.9) had prehypertensive BP. In Riva-Rocci measurements, elevated BP was present in only 7.1% (95% CI: 4.9 to 10.1) and prehypertensive BP additionally in 3.9% (95% CI: 2.4 to 6.4) in comparison to oscillometric measurements, which showed higher prevalence. Importantly, overweight participants had a 1.75 times greater relative risk for prehypertensive BP (95% CI: 1.22 to 2.53; p<0.01). Obesity carried a 1.79 times greater relative risk (95% CI: 1.22 to 2.63; p<0.01) for BP outside of the normotensive BP range.ConclusionArterial hypertension is becoming an important public health problem, especially due to the childhood obesity. It seems to concern also Slovene young population with prevalence of elevated BP at around 7.1% after a single auscultatory BP measurement.

Elevated blood pressure and its predictors among secondary school students in Sarawak: a cross-sectional study.

Hypertension is a health issue affecting adolescents. Accumulating evidence affirms that elevated blood pressure begins in childhood and tracks into adulthood. This cross-sectional study was conducted to determine the prevalence of elevated blood pressure and its predictors among secondary school students in Sarawak, Malaysia. A total of 2,461 secondary school students aged 12-17 years from 19 schools in Sarawak participated in the study. Questionnaire was used to obtain socio-demographic data, parental history of hypertension, and self-reported physical activity. Anthropometric and blood pressure measurements were taken. Data was entered and analysed using SPSS version 23.0. The prevalence of adolescents with elevated blood pressure, overweight, central obesity, and overfat were 30.1%, 24.3%, 13.5%, and 6.7%, respectively. Multivariate logistic regression demonstrated the predictors significantly associated with elevated blood pressure among respondents: overweight (adjusted odds ratio=3.144), being male (adjusted odds ratio=3.073), being Chinese (adjusted odds ratio=2.321) or Iban (adjusted odds ratio=1.578), central obesity (adjusted odds ratio=2.145), being overfat (adjusted odds ratio=1.885), and being an older adolescent (adjusted odds ratio=1.109). Parental history of hypertension, locality, and physical activity showed no significant associations. The obesity epidemic must be tackled at community and school levels by health education and regulation of school canteen foods.

Abstract P348: Association Between Sleep Apnea and Blood Pressure Control Among African-Americans, the Jackson Heart Study

Background: African-Americans have the highest prevalence of elevated blood pressure (BP) and poorer BP control than other racial/ethnic groups in the US. Untreated sleep apnea, common among minority populations, may explain the high prevalence of uncontrolled BP. We studied the association of objective measurements of sleep apnea severity with resistant hypertension and uncontrolled BP among African-Americans in the Jackson Heart Study (JHS) Sleep Ancillary study. Methods: Between 2012 and 2016, JHS participants (N=913) underwent an in-home sleep apnea study (measuring nasal pressure, abdominal and thoracic inductance plethysmography, oximetry, position, ECG); resting blood pressure; anthropometry; and completed questionnaires. Sleep apnea was defined as an apnea-hypopnea index &gt; 15 and nocturnal hypoxemia was quantified as % sleep time &lt;90% oxyhemoglobin saturation (%Sat&lt;90%). Elevated BP was defined as systolic BP ≥ 140 mmHg or diastolic BP &gt; 90mmHg. Controlled BP was defined as systolic BP &lt;140mmHg or diastolic BP &lt;90mmHg. Uncontrolled BP was defined as having elevated BP with use of &lt; 2 antihypertensive medications. Resistant hypertension was defined as having elevated BP while on 3-4 antihypertensive medications with one being a diuretic; or use of &gt; 4 antihypertensive medications. The study sample was limited to individuals with prevalent hypertension (N=613). Multinomial models were fit to determine the association between sleep apnea severity and resistant hypertension or uncontrolled BP (vs. controlled BP) adjusted for age, sex, education, smoking status, obesity (body mass index&gt;30) and diabetes. Results: The study sample had a mean age of 54.8 years, were predominately female (69.8%), obese (57.8%), and college educated (52.7%). Approximately 40.5% had sleep apnea, which was untreated in 95% of individuals. Among the sample, 25.4% had uncontrolled BP and 4.9% were classified as resistant hypertension. After adjustment for confounders, individuals with sleep apnea had a 2.6-fold higher odds of resistant hypertension (95% confidence interval: 1.1, 5.9). A standard deviation higher %Sat&lt;90% was associated with a 41% higher odds (1.1, 1.8) of resistant hypertension after adjustment for covariates. Sleep apnea and %Sat&lt;90% were not related to uncontrolled BP. Conclusion: Among our sample of African-Americans in the JHS, sleep apnea was related to resistant hypertension but not uncontrolled BP. The study identifies the high burden of untreated sleep apnea in African-Americans and its association with resistant hypertension, a significant risk factor for stroke and heart disease. Research is needed on the impact of treating sleep apnea as a strategy for decreasing resistant hypertension, and thus, narrowing cardiovascular health disparities.

Comparison of Surgical and Medical Therapy for Type 2 Diabetes in Severely Obese Adolescents

Because of the substantial increase in the occurrence of type 2 diabetes in the pediatric population and the medical complications of this condition, therapies are urgently needed that will achieve better glycemic control than standard medical management. To compare glycemic control in cohorts of severely obese adolescents with type 2 diabetes undergoing medical and surgical interventions. A secondary analysis of data collected by the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) consortia was performed. Teen-LABS enrolled 242 adolescents (≤19 years of age) from March 1, 2007, through December 31, 2011. TODAY randomized 699 participants (aged 10-17 years) from July 24, 2004, through February 25, 2009. Data analysis was performed from July 6, 2015, to June 24, 2017. Anthropometric, clinical, and laboratory data from adolescents with severe obesity and type 2 diabetes who underwent treatment with metabolic or bariatric surgery in the Teen-LABS study or medical therapy in the TODAY study were compared. Teen-LABS participants underwent a primary bariatric surgical procedure; TODAY participants were randomized to receive metformin therapy alone or in combination with rosiglitazone or an intensive lifestyle intervention; insulin therapy was given in cases of progression of disease. Glycemic control, body mass index, prevalence of elevated blood pressure, dyslipidemia, abnormal kidney function, and clinical adverse events were measured. Data from 30 participants from Teen-LABS (mean [SD] age at baseline, 16.9 [1.3] years; 21 [70%] female; 18 [66%] white) and 63 from TODAY (mean [SD] age at baseline, 15.3 [1.3] years; 28 [44%] female; 45 [71%] white) were analyzed. During 2 years, mean hemoglobin A1c concentration decreased from 6.8% (95% CI, 6.4%-7.3%) to 5.5% (95% CI, 4.7% -6.3%) in Teen-LABS and increased from 6.4% (95% CI, 6.1%-6.7%) to 7.8% (95% CI, 7.2%-8.3%) in TODAY. Compared with baseline, the body mass index decreased by 29% (95% CI, 24%-34%) in Teen-LABS and increased by 3.7% (95% CI, 0.8%-6.7%) in TODAY. Twenty-three percent of Teen-LABS participants required a subsequent operation during the 2-year follow-up. Compared with medical therapy, surgical treatment of severely obese adolescents with type 2 diabetes was associated with better glycemic control, reduced weight, and improvement of other comorbidities. These data support the need for a well-designed, prospective controlled study to define the role of surgery for adolescents with type 2 diabetes, including health and surgical outcomes.

Trends in the prevalence of metabolic syndrome and its components in the United States 2007–2014

BackgroundRecent trends in the prevalence of metabolic syndrome (MetS) and its components among U.S. adults are not known. MethodsWe performed an updated analysis using the National Health and Nutrition Examination Survey 2007–2014 data to investigate the latest trends of prevalence of MetS and its components. MetS was defined based on the modified National Cholesterol Education Program-Adult Treatment Panel III criteria. Multiple regression models were used to assess linear trends over the years, after adjusting for sex, age, and race/ethnicity, as appropriate. Sampling weights were considered to account for complex sampling design, and all estimates were adjusted by age by a direct method. ResultsDuring 2007–2014, the age-adjusted weighted prevalence (±standard error) of MetS among U.S. adults was 34.3 ± 0.8%. In age-stratified analysis, 54.9 ± 1.7% of elderly population aged 60 and over had MetS. When evaluating trends from 2007 to 2014, the prevalence of MetS remained stable in all sex, age, and race/ethnicity groups (P-trends > 0.100 for all). Among the components of MetS, the prevalence of hypertriglyceridemia and fasting hyperglycemia decreased (P-trend <0.050). However, the prevalence of abdominal obesity significantly increased, especially in women (P-trend = 0.009). The prevalence of elevated blood pressure and low high-density lipoprotein cholesterol level remained stable. ConclusionsThe prevalence of MetS remained stable during 2007–2014. However, it was still prevalent in the U.S., especially among the elderly population. The prevalence of abdominal obesity continued to increase in women for which more efforts should be made.

Elevated blood pressure among primary school children in Dar es salaam, Tanzania: prevalence and risk factors

BackgroundWhilst the burden of non-communicable diseases is increasing in developing countries, little data is available on blood pressure among Tanzanian children. This study aimed at determining the blood pressure profiles and risk factors associated with elevated blood pressure among primary school children in Dar es Salaam, Tanzania.MethodsWe conducted a cross sectional survey among 446 children aged 6–17 years from 9 randomly selected primary schools in Dar es Salaam. We measured blood pressure using a standardized digital blood pressure measuring machine (Omron Digital HEM-907, Tokyo, Japan). We used an average of the three blood pressure readings for analysis. Elevated blood pressure was defined as average systolic or diastolic blood pressure ≥ 90th percentile for age, gender and height.ResultsThe proportion of children with elevated blood pressure was 15.2% (pre-hypertension 4.4% and hypertension 10.8%). No significant gender differences were observed in the prevalence of elevated BP. Increasing age and overweight/obese children were significantly associated with elevated BP (p = 0.0029 and p < 0.0001) respectively. Similar associations were observed for age and overweight/obesity with hypertension. (p = 0.0506 and p < 0.0001) respectively. In multivariate analysis, age above 10 years (adjusted RR = 3.63, 95% CI = 1.03–7.82) was significantly and independently associated with elevated BP in this population of school age children.ConclusionsWe observed a higher proportion of elevated BP in this population of school age children. Older age and overweight/obesity were associated with elevated BP. Assessment of BP and BMI should be incorporated in school health program in Tanzania to identify those at risk so that appropriate interventions can be instituted before development of associated complications.

Blood pressure pattern among adults in Lagos: Analysis of data from public health screenings

Background: Knowledge of the pattern of blood pressure (BP) in a population is useful in documenting within-population differences in hypertension prevalence as well as identifying groups at increased risk of complications. Materials and Methods: BP data obtained from 1061 participants in population screenings carried out in five local government areas within Lagos were analyzed. BPs were measured in both arms with individuals seated and the limb supported on a table by medical interns using a mercury sphygmomanometer. The higher of the two recordings was taken as the patient's BP. Results: The study population was made up of 54.5% females with an overall mean age of 39.2 ± 15.0 years and a range of 18–84 years. Mean systolic and diastolic BPs increased significantly and progressively with age in both male and female participants. BP was elevated in 35.6% of the study population with 48.3% of those having moderate-to-severely elevated BP. The prevalence of elevated BP increased with age; however, there was no significant difference in the prevalence of elevated BP between male and female participants. Between 11% and 20% of individuals aged 18–29 years had elevated BP, with the proportion being much higher among males than females. Conclusion: The study provides further evidence supporting the fact that hypertension is highly prevalent, is severe, and may have an onset earlier in life among African populations. There is need to institute polices focused on prevention, early detection, and prompt treatment of hypertension.

A Collaborative Approach to Childhood Obesity Surveillance From a Local Health Department.

DuPage County Health Department collected de-identified data from health forms submitted by participating schools for academic years 2011-2015 for kindergarten, sixth-, and ninth-grade students to determine the prevalence of obesity and elevated blood pressure among public school students. The prevalence of obesity in students for the 2014-2015 school year was 15.1%, and the prevalence of elevated blood pressure was 22.8%. Students in the "obese" body mass index percentile category had an elevated blood pressure prevalence of 44.2%, which was higher than students in the "nonobese" category (P < .001). Significant differences were also observed both by sex and by grade. The results identify the need to support implementation and evaluation of policies to reduce childhood obesity and improve health outcomes. By partnering with schools to obtain preexisting health data, state or local health departments with limited resources may replicate these methods to develop a childhood obesity surveillance system.

Elevated blood pressure in the developing world: a role for clinical pharmacists.

The objective of this study was to evaluate the prevalence and patient knowledge of elevated blood pressure amongst a cross-section of patients in underserved communities in three selected low-income countries worldwide: El Salvador, India and Kenya. Mobile medical clinics were established as part of medical mission trips in El Salvador, India and Kenya. Willing male and female patients, at least 25 years of age, who presented at each clinic were screened for elevated blood pressure, including 332 patients in El Salvador, 847 patients in India and 160 patients in Kenya. Patients were classified into Stage I or II elevated blood pressure based on modified JNCVII guidelines. A questionnaire was completed regarding their knowledge about the existence and management of their disease state. Of the 1339 patients screened, 368 presented with elevated blood pressure (27%). Of these patients, 147 had been previously informed of hypertension or an elevated blood pressure (39.9%), 28 reported receiving antihypertensive medication (7.6%) and 24 reported awareness of non-pharmaceutical treatment options (6.5%). In Kenya, 81 patients were screened in a rural setting and 79 in an urban setting. Patients demonstrating controlled blood pressure were 63 (78%) and 38 (48%), respectively, demonstrating a significant difference between the rural versus urban settings (P = 0.00359). All regions demonstrated similar trends in the prevalence of elevated blood pressure, highlighting the need for increased disease state education in these regions.