Screening For Elevated Blood Pressure Research Articles

Prevalence trend of high normal blood pressure and elevated blood pressure in Chinese Han children and adolescents aged 7-17 years from 2010 to 2019

Objective: To investigate the prevalence trend of high normal blood pressure and elevated blood pressure in children and adolescents aged 7 to 17 years in China from 2010 to 2019. Methods: Students aged 7-17 years were selected from the Chinese National Survey on Students' Constitution and Health from 2010 to 2019. High normal blood pressure and elevated blood pressure were determined according to the "Reference of screening for elevated blood pressure among children and adolescents aged 7-18 years" (WS/T 610-2018). The Chi-square test was performed to determine whether there was a difference in the prevalence of high normal blood pressure and elevated blood pressure by gender, residence and age group. Results: In 2019, the prevalence of high normal blood pressure in children and adolescents aged 7-17 years was 15.3% (29 855/195 625), which was higher in boys (20.2%, 19 779/97 847) and rural areas (15.4%, 15 066/97 567) than that in girls (10.3%, 10 076/97 778) and urban areas (15.1%, 14 789/98 058), respectively (all P<0.05). The prevalence of elevated blood pressure was 13.0% (25 377/195 625), which was higher in girls (13.2%, 12 925/97 778) and rural areas (14.1%, 13 753/97 567) than that in boys (12.7%, 12 452/97 847) and urban areas (11.9%, 11 624/98 058) (all P<0.05). From 2010 to 2019, the prevalence of high normal blood pressure showed an increasing trend, with an annual average growth rate from 1.14% to 3.18%. The overall prevalence of elevated blood pressure also showed an increasing trend from 2010 to 2019 but decreased in 2014. The annual average growth rate of elevated blood pressure was-1.07% from 2010 to 2014 and 9.33% from 2014 to 2019. About 17 provinces had an increasing trend in the prevalence of elevated blood pressure from 2010 to 2014, and 22 provinces with an increasing trend from 2014 to 2019. There were obvious regional differences in the annual average growth rate of the prevalence of high normal blood pressure and elevated blood pressure. The regions with the highest annual average growth rate of the prevalence of high normal blood pressure were the Northeast (5.47%) from 2010 to 2014 and the Western region (5.21%) from 2014 to 2019. For elevated blood pressure, the Northeast had the highest annual average growth rate from 2010 to 2014 (12.35%), while the Central (15.79%) and Western (12.87%) had the highest growth rate from 2014 to 2019. Conclusion: From 2010 to 2019, the prevalence of high normal blood pressure and elevated blood pressure in Chinese Han children and adolescents aged 7 to 17 shows an increasing trend, with regional disparities.

English

Obesity is associated with diverse morbidities, and elevated blood pressure has been suggested to be associated with increased body weight. This study therefore aimed to determine the relationship between obesity and elevated blood pressure among adolescent. This is a cross-sectional study. Consenting adolescents aged 10 to 18 years completed a pretested semi-structured questionnaire. Anthropometric parameters and blood pressure were measured using standard methods. Data were analysed using descriptive and inferential statistics. A total of 1000 adolescents were recruited with male to female ratio of 1:1. The mean age was 14.05&plusmn;1.98 years. Early adolescence was predominant (43.3%). The prevalence of obesity was 1.3% while overweight was 4.1%. There was female preponderance for both overweight (53.7%) and obesity (53.8%). Sixty&ndash;nine (6.9%) had systolic hypertension while 50 (5.0%) had diastolic hypertension. Three (23.1%) obese and four (9.8%) overweight adolescents had statistically significant elevated systolic blood pressure in the hypertensive range (&chi;2 = 11.306, p = 0.015). One (7.7%) obese and four (9.8%) overweight subjects had statistically significant elevated diastolic blood pressure (&chi;2 = 9.803, p = 0.029). Routine screening for elevated blood pressure in schools is highly recommended among school-aged adolescents especially the obese and overweight. Key words: Adolescents, blood pressure, Nigeria, obesity, overweight.

Elevated blood pressure positively associates with alpha-1 microglobulin in prepubescent children: the ExAMIN Youth SA study.

Hypertension is a growing health concern in childhood populations and individuals of African descent. As the kidneys play a significant role in blood pressure regulation, we compared alpha-1 microglobulin (A1M) as a marker of proximal tubular function between young healthy black and white children (n = 957; aged: 5-9 years) and explored its association with blood pressure. The black children had higher levels of A1M (P < 0.001) and higher DBP (P < 0.001) when compared with their white counterparts. In multiple regression analysis, SBP (adj. R2 = 0.173, β = 0.151; P < 0.001) and DBP (adj. R2 = 0.110, β = 0.179; P < 0.001) associated positively with A1M in the black children. In binary logistic regression, each standard deviation increase in A1M increased the odds of having elevated blood pressure by 28% (P = 0.002) in the black group, independent of age, sex, BMI z-score and body height. No significance was reached in the white children. Our findings highlight the importance of a marker of proximal tubular function, especially in children of black ethnicity, in the setting of elevated blood pressure. Early childhood screening for elevated blood pressure remains essential in order to promote primary prevention of hypertension and early onset kidney damage in children.

Association between endurance quality and blood pressure levels in Han students aged 13-18 years in China, 2014

Objective: To analyze the association between the endurance quality and blood pressure levels in Han students aged 13-18 years in China. Methods: We used the data of Han students aged 13-18 years from 2014 Chinese National Survey on Students' Constitution and Health. Elevated blood pressure and its components, including isolated elevated SBP, isolated elevated DBP, and mix elevated blood pressure, were evaluated according to the reference of screening for elevated blood pressure among children and adolescents aged 7-18 years. The students' endurance quality was scored according to the National Standards for Students' Physical Health (2014 revision) and categorized based on their percentiles into four groups as follows: P(0)-, P(25)-, P(50)-, and P(75)-P(100). Trend χ(2) test was used to analyze the trend of the detection rates of elevated blood pressure and its components in different groups of endurance quality. Logistic regression model was used to estimate the odds ratio (OR) for elevated blood pressure and its components in different endurance quality groups and P(0)-group was set as reference group. Quantile regression model was used to analyze the association between different blood pressure levels and endurance quality. Results: The detection rate of elevated blood pressure in the students aged 13-18 years in China in 2014 was 9.2%. The detection rate of elevated blood pressure and its components decreased with the improvement of endurance quality (P<0.001). With the P(0)-endurance quality group as reference, the OR(95%CI) were 0.89(0.84-0.95), 0.81(0.76-0.86) and 0.79(0.74-0.84) respectively in P(25)-, P(50)- and P(75)-P(100) endurance quality groups respectively. The negative association existed between endurance quality and elevated blood pressure in overweight, obese and normal students, but not in malnourished students. The quantile regression analysis results showed that in overweight and obese students, the SBP levels at the P(10), P(25), P(50), P(75), P(9)0 and P(95) groups were negatively associated with the endurance quality, and the DBP levels at the P(25) and above group were negatively associated with the endurance quality. In malnourished and normal students, only some levels of DBP were negatively associated with the endurance quality. Conclusions: The negative association existed between endurance quality and elevated blood pressure in Han students aged 13-18 years in China. In overweight and obese students, the association between endurance quality and blood pressure level was stronger. Improving students' endurance quality may facilitate the prevention of elevated blood pressure.

Effect of blood pressure measurement on detection of elevated blood pressure in Tibetan adolescents

Objective: To analyze the influence of different number of blood pressure measurement on the detection of elevated blood pressure in Tibetan adolescents and provide scientific reference for standardizing the number of blood pressure measurement and accurately diagnosing elevated blood pressure in adolescents. Methods: Data were from the project "survey of the risk factors for elevated blood pressure among Tibetan adolescents" conducted from August to September 2018 in Shigatse in Tibet. A total of 2 822 Tibetan adolescents aged 12-17 years, including 1 275 boys (45.2%), were recruited by a convenient, stratified cluster sampling method. Each participant underwent three consecutive blood pressure measurements. Elevated blood pressure was defined according to the Health Industry Criterion of China: WS/T 610-2018 "Reference of screening for elevated blood pressure among children and adolescents aged 7-18 years" . Analysis of variance and χ(2) test were used to analyze the effect of different blood pressure measurement on blood pressure levels and detection of elevated blood pressure, respectively. Results: SBP and DBP decreased substantially across three consecutive blood pressure measurements[SBP: (112.7±9.7), (110.7±9.7) and (110.2±9.5) mmHg (1 mmHg=0.133 kPa); DBP: (62.7±8.2), (61.1±8.5) and (60.6±8.5) mmHg; P value for trend<0.001]. The detection rates of elevated blood pressure based on three blood pressure measurements were 12.8%, 8.7% and 7.9%, respectively (P value for trend <0.001). Of note, the difference in the detection of elevated blood pressure based on the second blood pressure measurement or based on the average value of the second and third blood pressure measurements showed no significance (8.7% and 7.2%, P=0.039). Conclusions: Blood pressure levels and the detection of elevated blood pressure in adolescents decreased substantially across three consecutive blood pressure measurements. The second blood pressure measurement might be sufficient for screening elevated blood pressure in adolescents.

Hypertension in children in sub-Saharan Africa: primordial prevention is crucial

Hypertension in children in sub-Saharan Africa: primordial prevention is crucial

The method of blood pressure evaluation among children and adolescents aged 7 to 17 years old in China

The national health industry standard (WS/T 610-2018), 'the reference of screening for elevated blood pressure among children and adolescents aged 7-to 18-years-old', plays a significant role in the standardization of the blood pressure evaluation, the early detection of high blood pressure, and the early intervention of hypertension and other chronic non-communicable diseases among Chinese children and adolescents. This standard gives screening thresholds for blood pressure assessment of children and adolescents in different genders, ages, and heights. Given the complexity of applying this standard, it is error-prone and less efficient to evaluate blood pressure one by one or program this procedure. Therefore, this study provides a SPSS package based on the standard for researchers to download and use, combined with specific cases to guide the use of this package to evaluate the blood pressure of children and adolescents step by step, which could empower researchers to accurately and efficiently conduct blood pressure screening for children and adolescents in China.

Performance of User-Friendly Screening Tools for Elevated Blood Pressure in Children.

Hypertension is frequently undiagnosed in children. Several methods have been developed to simplify screening for elevated blood pressure (BP) in children. to assess the performance of different screening tools in identifying elevated BP in the pediatric population. Data sources such as PubMed, Embase, Web of Science, Cochrane, and Scopus were searched up to March 2016. Studies providing measures of diagnostic performance of screening tools and that used age-, sex-, and height-specific BP percentile as the reference standard were included. Data regarding the population, screening tools used to define elevated BP, and diagnostic criteria of BP were extracted. Available data on true-positive, false-positive, true-negative, and false-negative results were also extracted to construct a 2 × 2 contingency table. A total of 16 eligible studies that evaluated 366 321 children aged 3 to 18 years were included in the meta-analysis. Nine screening tools were included in this study, in which the BP-to-height ratio, the modified BP-to-height ratio, and tables based on age categories had the highest sensitivities (97-98%) but moderate specificities (71-89%). Limitations included that BP measurements in most studies were based on 1 visit only and there was heterogeneity between the studies. Several user-friendly screening tools could improve the screening of elevated BP in the pediatric population.

Consumption of nattokinase is associated with reduced blood pressure and von Willebrand factor, a cardiovascular risk marker: results from a randomized, double-blind, placebo-controlled, multicenter North American clinical trial.

ObjectiveThe objective of this study is to evaluate the effects of consumption of nattokinase on hypertension in a North American hypertensive population with associated genetic, dietary, and lifestyle factors. This is in extension of, and contrast to, previous studies on Asian populations.Materials and methodsA randomized, double-blind, placebo-controlled, parallel-arm clinical study was performed to evaluate nattokinase (NSK-SD), a fermented soy extract nattō from which vitamin K2 has been removed. Based on the results from previous studies on Asian populations, 79 subjects were enrolled upon screening for elevated blood pressure (BP; systolic BP ≥130 or diastolic BP ≥90 mmHg) who consumed placebo or 100 mg nattokinase/d for the 8-week study duration. Blood collections were performed at baseline and 8 weeks for testing plasma renin activity, von Willebrand factor (vWF), and platelet factor-4. Seventy-four people completed the study with good compliance.ResultsConsumption of nattokinase was associated with a reduction in both systolic and diastolic BP. The reduction in systolic BP was seen for both sexes but was more robust in males consuming nattokinase. The average reduction in diastolic BP in the nattokinase group from 87 mmHg to 84 mmHg was statistically significant when compared to that in the group consuming placebo, where the average diastolic BP remained constant at 87 mmHg (P<0.05), and reached a high level of significance for males consuming nattokinase, where the average diastolic BP dropped from 86 mmHg to 81 mmHg (P<0.006). A decrease in vWF was seen in the female population consuming nattokinase (P<0.1). In the subpopulation with low plasma renin activity levels at baseline (<0.29 ng/mL/h), an increase was seen for 66% of the people after 8-week consumption of nattokinase (P<0.1), in contrast to only 8% in the placebo group.ConclusionThe data suggest that nattokinase consumption in a North American population is associated with beneficial changes to BP in a hypertensive population, indicating sex-specific mechanisms of action of nattokinase’s effect on vWF and hypertension.

Screening for cardiovascular disease risk factors beginning in childhood

Cardiovascular diseases (CVD) are the leading cause of death worldwide. Individual detection and intervention on CVD risk factors and behaviors throughout childhood and adolescence has been advocated as a strategy to reduce CVD risk in adulthood. The U.S. National Heart, Lung, and Blood Institute (NHLBI) has recently recommended universal screening of several risk factors in children and adolescents, at odds with several recommendations of the U.S. Services Task Force and of the U.K. National Screening committee. In the current review, we discuss the goals of screening for CVD risk factors (elevated blood pressure, abnormal blood lipids, diabetes) and behaviors (smoking) in children and appraise critically various screening recommendations. Our review suggests that there is no compelling evidence to recommend universal screening for elevated blood pressure, abnormal blood lipids, abnormal blood glucose, or smoking in children and adolescents. Targeted screening of these risk factors could be useful but specific screening strategies have to be evaluated. Research is needed to identify target populations, screening frequency, intervention, and follow-up. Meanwhile, efforts should rather focus on the primordial prevention of CVD risk factors and at maintaining a lifelong ideal cardiovascular health through environmental, policy, and educational approaches.

Screening for Elevated Blood Pressure in Children and Adolescents

Although screening for elevated blood pressure (BP) in adults is beneficial, evidence of its beneficial effects in children is not clear. Elevated BP in children is associated with atherosclerosis early in life and tracks across the life course. However, because of the high variability in BP, tracking is weak, and having an elevated BP in childhood has a low predictive value for having elevated BP later in life. The absolute risk of cardiovascular diseases associated with a given level of BP in childhood and the long-term effect of treatment beginning in childhood are not known. No study has experimentally evaluated the benefits and harm of BP screening in children. One modeling study indicates that BP screen-and-treat strategies in adolescents are moderately cost-effective but less cost-effective than population-wide interventions to decrease BP for the reduction of coronary heart diseases. The US National Heart, Lung, and Blood Institute and the European Society of Hypertension recommend that children 3 years of age and older have their BP measured during every health care visit. According to the US Preventive Services Task Force, there is no sufficient evidence to recommend for or against screening, but their recommendations have to be updated. Whether the benefits of universal BP screening in children outweigh the harm has to be determined. Studies are needed to assess the absolute risk of cardiovascular diseases associated with elevated BP in childhood, to evaluate how to simplify the identification of elevated BP, to evaluate the long-term benefits and harm of treatment beginning in childhood, and to compare universal and targeted screening strategies.

Clinical Manifestations of Asymptomatic Polycystic Kidney Disease

Source: Mekahli D, Woolf AS, Bockenhauer D. Similar renal outcomes in children with ADPKD diagnosed by screening or presenting with symptoms. Pediatr Nephrol. 2010; 25(11): 2275-2282; doi: 10.1007/s00467-010-1617-8Investigators from Great Ormond Street Hospital for Children, London, conducted a retrospective study of children with autosomal dominant polycystic kidney disease (ADPKD) to compare the renal outcomes in children detected because of symptoms versus those discovered through family screening. Data on children who were referred with a clinical suspicion of ADPKD between 1987 and 2007 were reviewed.Study patients included 31 children (17 male) who were asymptomatic and diagnosed by ultrasound screening (Group 1), and 16 (9 male) who presented with symptoms (Group 2). Presenting symptoms in those in Group 2 included urinary tract infection in six, and abdominal, back, or loin pain in five. Mean age at diagnosis (Group 1: 7.7 years; Group 2: 6.3 years) and at last follow-up (Group 1: 12.4 years; Group 2: 11.1 years) was similar in the two groups. At last follow-up, enlarged kidneys were present in 51% of Group 1 patients and 56% of Group 2 patients. There were also no differences in the rates of hypertension (15%), microalbuminuria (36%), or decreased glomerular filtration rate (39%) between children in the two groups. An additional 15% of patients had borderline hypertension at last follow-up.The authors conclude that children at risk for ADPKD should be screened for hypertension and microalbuminuria as overt abnormalities do occur.Dr Greenbaum has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.ADPKD, which affects 1 in 500 to 1,000 people, is more common than cystic fibrosis and sickle cell disease combined and it is one of the most common causes of end stage renal disease in adults.3 A child of a parent with ADPKD has a 50% chance of inheriting the disease. Yet, ADPKD receives limited emphasis in pediatrics because it is considered to be an adult disease, without the need for therapeutic intervention during childhood.Previous studies have shown that children with a diagnosis of ADPKD are at increased risk for developing hypertension and that even the presence of borderline hypertension increases the risk of left ventricular hypertrophy in this patient population.1–2 Nevertheless, current recommendations are to defer imaging or genetic testing in children at risk for ADPKD, partially due to concerns about medical insurance and the psychological stress of diagnosis.3 In contrast, diagnostic evaluation, including ultrasound of the kidneys, commonly occurs in children with symptomatic ADPKD, leading to a definitive diagnosis.The current study is unique in that it compares renal outcomes in asymptomatic children who were diagnosed based on screening with children diagnosed due to symptoms. The results of the study call into question the assumption that symptomatic children are more likely to have important renal manifestations. Some major limitations are the retrospective design of the study and the possibility of selection bias of more severe asymptomatic patients cared for at a tertiary care center. In addition, the sample sizes were small and there was no report of statistical power.The investigators emphasize that asymptomatic children may have clinically important manifestations, early recognition of which may improve outcome. There is evidence that treatment of hypertension or borderline hypertension, preferably with an angiotensin-converting enzyme inhibitor or angiotensin II-receptor blocker, is beneficial in children with ADPKD.4 Moreover, there are a variety of studies assessing the efficacy of medications that may slow the progression of ADPKD.3 It seems likely that such interventions may need to be initiated during childhood to provide maximum benefit.Careful screening for elevated blood pressure is necessary in all children at risk for ADPKD; even borderline hypertension should prompt further evaluation. In the future, if novel interventions to slow progression are proven beneficial, it is likely that definitive screening via ultrasound or genetic testing during childhood will be a part of routine care.

Disparities in Pediatric Preventive Care in the United States, 1993-2002

To quantify physician-reported preventive counseling and screening during well-child visits (WCVs) and to examine racial and ethnic disparities in these activities. Cross-sectional study using the National Ambulatory Medical Care Survey, January 1993 through December 2002. Office-based physician practices. Children from birth to 18 years old who were seen by a physician for a WCV. Preventive counseling and screening. Well-child visits were shorter for Latino children than for white or black children. At WCVs, white children were more likely to receive preventive counseling than were black or Latino children (72% vs 61% vs 61%, respectively; P = .01) but not more likely to receive screening for elevated blood pressure, anemia, vision and hearing acuity, or lead toxicity. There were no differences in secondary diagnoses made at WCVs for white, black, or Latino children (15% vs 17% vs 14%, respectively; P = .65). The children who received the least counseling were Latino children in the public sector non-health maintenance organization setting (counseled at 39% of visits) and Latino children who self-paid for the visits (counseled at 26% of visits). After adjusting for possible confounders, including medications prescribed at the visit, black and Latino children were less likely to receive counseling than were white children (odds ratios, 0.68 and 0.63; 95% confidence interval, 0.48-0.97 and 0.44-0.90, respectively), and black children were less likely to receive preventive screening services (odds ratios, 0.65; 95% confidence interval, 0.45-0.93). By physician report in a nationally representative sample, black and Latino children received less counseling at WCVs than did white children. These disparities were unexplained by the competing demands of other secondary diagnoses or medications prescribed or dispensed.

Health Screening and Developmental Disabilities

Abstract Adults with developmental disabilities often experience health disparities when compared with the general population. Early detection of risk of disease may help to reduce such disparities, but many adults often do not participate in preventive health care at recommended levels. The aim of the present study was to describe health screening activities involving a large group of adults and explore how factors, such as living arrangement, type and severity of disability, and age, influence reported rates of participation. The study involved administering surveys to adults with disabilities and their immediate support persons (parents, carers, and professional support workers) and asking whether adults had visited a general practitioner (GP) and what was their participation in preventive services during the previous 12‐month period. Participation in preventive screening services ranged between 3% (screening for sexually transmitted infection) and 58% (screening for elevated blood pressure), and rates for certain services appeared low, particularly in comparison with equivalent screenings in the general population. Results showed a relationship between participation rates and living situation, type of disability, and age, but not severity of disability. The results suggest that higher rates of participation in preventative health activities among those enrolled in formal services may reflect a greater obligation or concern among paid workers and possibly a lack of awareness of health issues by families, and also that screening disparities may be attributed to GPs who may be applying guidelines from the general population but who are not aware of disability‐specific issues when examining adults with disabilities.

Tracking of Elevated Blood Pressure Values in Adolescent Athletes at 1-Year Follow-up

Resting blood pressures were measured in 467 adolescents during preparticipation physical examinations for high school sports. Fifty-seven of the athletes (12.2%) had significantly elevated blood pressures. Forty-three (79.6%) of 54 subjects demonstrated significantly and persistently elevated blood pressures at 1-year follow-up. A family history of hypertension was positively associated with elevated blood pressures in 46 (80.7%) of 57 subjects compared with controls (23/410 [5.6%]). Consistent with previous studies, subjects with elevated blood pressures had a greater body weight (94.5 +/- 25.7 kg) compared with normotensive subjects (75.2 +/- 14.0 kg). Subjects with elevated blood pressures engaged in heavy resistance weight training (three times a week or more) more often (41/57 [71.9%]) than normotensive subjects (65/410 [15.8%]). These data support the idea that blood pressures measured during routine preparticipation physical examinations for high school sports are a useful tool in screening for elevated blood pressure in adolescents.