Two decades of arterial blood pressure assessment in children and adolescents in Poland - past and present

Publikacja ta nie jest wyczerpującym przeglądem piśmiennictwa oraz ośrodków zajmujących się badaniami związanymi z problematyką nadciśnienia tętniczego u dzieci i młodzieży. Jest to artykuł wskazujący na wybrane typy badań ciśnienia i nadciśnienia tętniczego prowadzonych u dzieci i młodzieży w Polsce. Zainteresowanie badaniem i pomiarem ciśnienia było domeną najczęściej kardiologów i nefrologów, którzy rozumieli potrzebę kontroli ciśnienia, a normy były przyjęte arbitralnie. Prowadzenie badań epidemiologicznych dotyczących częstości występowania nadciśnienia tętniczego u dzieci i młodzieży wymaga innego podejścia niż u osób dorosłych. Najważniejszymi i wszechstronnymi dokumentami dotyczącymi problematyki ciśnienia u dzieci są raporty amerykańskie opracowane przez Grupę Roboczą ds. Kontroli Ciśnienia u Dzieci. Pierwsze prace kliniczne dotyczące nadciśnienia tętniczego u dzieci i młodzieży najczęściej obejmują problematykę nadciśnienia wtórnego, które może rozwijać się w przebiegu wielu chorób. Aktualnie problematyka nadciśnienia tętniczego wtórnego i pierwotnego u dzieci i młodzieży jest poruszana na konferencjach i szkoleniach nie tylko pediatrycznych, lecz także poświęconych hipertensjologii dorosłych. Wzrastające odsetki dzieci z nadciśnieniem tętniczym oraz innymi czynnikami ryzyka chorób układu krążenia, wskazują na potrzebę kontynuowania różnych typów badań w tym zakresie.This publication does not intend to summarize relevant literature or give a review of centers which are involved in studies on arterial hypertension. It is meant to show a selection of research of Arterial Blood Pressure (BP) in children and adolescents in Poland. Traditionally, Cardiologists and Nephrologists used to be particularly interested in BP since they seem to understand best the importance and need of regular BP check-ups and used arbitrary stated norms. However, epidemiological assessment of the prevalence of arterial hypertension in children and adolescents calls for an approach that is different to the one applied to adults. The Reports by American Task Force for the Control of Arterial BP in Children represent the most important and comprehensive papers in this field. The first clinical articles on hypertension in children and adolescents most often would deal with secondary hypertension which can be a feature in many diseases. Currently, the subject of primary and secondary hypertension in children is talked about not only at pediatric conferences or courses but also at those on adult hypertension. The increasing occurrence of hypertension in children along with other circulatory risk factors suggest the need for the continuation of various modes of research in this field

Percentile distribution of blood pressure readings in relation to body mass index: a populationbased cross-sectional study ADOPOLNOR

Recent upward trends toward elevated blood pressure and increased weight expressed in terms of body mass index in children and adolescents call for regular monitoring of their physical growth and age-related changes in blood pressure. This requires adequate tools - reference values of a normal blood pressure range. The main objective of this study was to provide sex- and BMI-specific percentile reference values for systolic and diastolic blood pressure based on the adolescent Polish population, participants in the ADOPOLNOR study. A cross-sectional survey was carried out on a representative, randomly selected cohort of 4,941; 2,451 male and 2,490 female students aged 10-18 years, residents in Wielkopolska province and its capital, the city of Poznań. All examinations were performed in school nursery rooms during morning hours according to standard procedures. Body height and weight were measured and BMI was calculated. Blood pressure was measured twice on each occasion on the right arm using a fully calibrated TECH MED TM-Z mercury gauge sphygmomanometer with sets of exchangeable cuffs and a clinical stethoscope. The blood pressure classification was determined using the surveillance method. For each participant, the mean of measurements taken on each of the three occasions was calculated and served as his/her final blood pressure value. Using the LMS method, fitted percentile curves were created for BMI-related systolic and diastolic blood pressure. The findings revealed that age related blood pressure pattern was similar in boys and girls. It showed a steady increase of systolic and diastolic blood pressure with age. There was a positive correlation between the systolic and diastolic blood pressure indicating that when systolic blood pressure increased so diastolic did (r=0.61 at p<0.01). Boys were likely to have relatively higher mean values of systolic and diastolic blood pressure and steeper slope for BMI-related change in blood pressure than girls. Similar pattern was found for age-related changes in BMI. The quotation of 3rd, 5th, 10th, 15th, 25th, 50th, 75th, 85th, 90th, 95th, and 97th at any given BMI between 12 kg/m2 and 35 kg/m2 provided indication of the entire variation in blood pressure of adolescent males and females aged 10-18 years. The sex- and BMI-specific reference values and charts for systolic and diastolic blood pressure may be a useful tool in monitoring blood pressure for early detection of its abnormal level and treatment of children and adolescents with high blood pressure

Revealing burden of elevated blood pressure among Polish adolescent participants in a population-based ADOPOLNOR study: prevalence and potent risk factors

New category for elevated blood pressure introduced and described by JNC-7 for adults and adopted by the 2004 Working Group for children and adolescents stands for a pre-sign to hypertension. The ongoing rise in prevalence of high blood pressure in children and adolescents demands their regular screening. The objective of this study was to determine prevalence of elevated BP in Polish adolescents and explain the role of sex, age and body weight status as potent risk factors for this condition. A population-based cross-sectional survey was carried out on a sample of 4,941 students (2,451 boys and 2,490 girls) aged 10-18, participants in the ADOPOLNOR study. Body height and weight were measured and BMI was calculated. Blood pressure was measured twice on each visit on the right arm using a fully calibrated TECH MED TM-Z mercury gauge sphygmomanometer with sets of exchangeable cuffs and a clinical stethoscope. The blood pressure classification was determined using the surveillance method. The depended outcome variable was the elevated BP compared to normal BP for systolic (SBP), diastolic (DBP) and combined SBP and/or DBP. Explanatory variables included demographic characteristics, sex and age, and weight status. Two-way ANCOVA, Chi-square Pearson correlation, and multivariate logistic regression analysis (MLRA) were performed using the STATISTICA 13.1 data analysis software system; p-value <0.05 was considered statistically significant (StatSoft Inc. Tulsa, OK, USA). A clear gender pattern was found in prevalence of elevated BP with girls being more likely than boys to have elevated BP (4.9%, 5.3% and 7.4% for SBP, DBP and combined SBP and/or DBP in girls vs 3.5%, 3.5% and 5.9% in boys). The proportion of both genders with elevated BP gradually increased with age with 4.8% (SBP), 2.8% (DBP) and 5.8% (SBP and/or DBP), and 5.1%, 6.4% and 8.4% in early and late adolescence, respectively. Fifteen percent of obese adolescents had elevated SBP, 14.3% elevated DBP and 17.8% had elevated either SBP and/or DBP combined. At multivariate approach, the adjusted odds ratio for predictors of elevated BP revealed sex, age and weight status for SBP and SBP and/or DPB combined. Age and weight status were predictive for elevated DBP. Weight status (BMI) showed the highest predictive potential of elevated BP for both genders. The likelihood of developing elevated BP increased at least twice with each BMI category increase. Thus, overweight and obese adolescents were twice (overweight) and 4 to 5 times (obese) more likely than their normal weight counterparts in developing elevated BP. The study results confirmed predictive potential of sex, age, and weight status in developing elevated BP in adolescents. The highest odds of the weight status indicate that it is the strongest confounder of elevated BP condition

Height-specific blood pressure cutoffs for screening elevated and high blood pressure in children and adolescents: an International Study.

Pediatric blood pressure (BP) reference tables are generally based on sex, age, and height and tend to be cumbersome to use in routine clinical practice. In this study, we aimed to develop a new, height-specific simple BP table according to the international child BP reference table based on sex, age and height and to evaluate its performance using international data. We validated the simple table in a derivation cohort that included 58,899 children and adolescents aged 6-17 years from surveys in 7 countries (China, India, Iran, Korea, Poland, Tunisia, and the United States) and in a validation cohort that included 70,072 participants from three other surveys (China, Poland and Seychelles). The BP cutoff values for the simple table were calculated for eight height categories for both the 90th ("elevated BP") and 95th ("high BP") percentiles of BP. The simple table had a high performance to predict high BP compared to the reference table, with high values (boys/girls) of area under the curve (0.94/0.91), sensitivity (88.5%/82.9%), specificity (99.3%/99.7%), positive predictive values (93.9%/97.3%), and negative predictive values (98.5%/97.8%) in the pooled data from 10 studies. The simple table performed similarly well for predicting elevated BP. A simple table based on height only predicts elevated BP and high BP in children and adolescents nearly as well as the international table based on sex, age, and height. This has important implications for simplifying the detection of pediatric high BP in clinical practice