Prediction of Primary vs Secondary Hypertension in Children

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91106/1/j.1751-7176.2012.00603.x.pd

Comparison of blood pressure levels among four age groups of Chinese children matched by height

Hypertension in children is frequently undiagnosed. Normal blood pressure is currently defined as a function of two continuous variables, age and height for each gender. Applying the current cutoff values to assess a child's blood pressure is time consuming. To separate the independent effect of age from that of height on blood pressure, we conducted a multiple group matched study to investigate if blood pressure levels in children with a given height distribution vary with age. An equal number of 2539 Chinese children from each of the four age groups (7, 8, 9 and 10 years) were individually matched by height, sex and geographic region. We used the matching technique to force the four age groups to have an identical height distribution. Systolic and diastolic blood pressures significantly increased with increasing age before matching. After matching, four groups had strikingly similar levels of blood pressures, and the differences among four groups were small and not statistically significant. Once height is taken into consideration, age has little impact on blood pressure. Our findings, if confirmed in children of other ages, suggest that blood pressure percentile charts can be considerably simplified by establishing normal percentiles according to height alone for each gender

Obesity and the Metabolic Syndrome in Korean Adolescents

This study evaluated the prevalence of metabolic syndrome and investigated its association with being overweight in Korean adolescents. Data were obtained from 1,393 students between 12 and 13 yr of age in a cross-sectional survey. We defined the metabolic syndrome using criteria analogous to the Third Report of the Adult Treatment Panel (ATP III) as having at least three of the following: fasting triglycerides ≥100 mg/dL; HDL <50 mg/dL; fasting glucose ≥110 mg/dL; waist circumference >75th percentile for age and gender; and systolic blood pressure >90th percentile for age, gender, and height. Weight status was assessed using the age- and gender-specific body mass index (BMI), and a BMI ≥85th percentile was classified as overweight. Of the adolescents, 5.5% met the criteria for the metabolic syndrome, and the prevalence increased with weight status; it was 1.6% for normal weight and 22.3% in overweight (p<0.001). In multivariate logistic regression analyses among adolescents, overweight status was independently associated with the metabolic syndrome (odds ratio, 17.7; 95% confidence interval, 10.0-31.2). Since childhood metabolic syndrome and obesity likely persist into adulthood, early identification helps target interventions to improve future cardiovascular health

Association between vascular endothelial growth factor and hypertension in children and adolescents type I diabetes mellitus

The aim of the study was to analyse the relationship between the serum level of vascular endothelial growth factor (VEGF) and the incidence of hypertension (HT) in children and adolescents with type I diabetes mellitus (T1DM). One hundred and five patients with T1DM were enrolled in the study. The control group consisted of 30 healthy controls. All the T1DM patients were subjected to biochemical analyses, ophthalmologic examination and 24-h blood pressure monitoring. Besides, all the patients and healthy controls had serum VEGF levels measured with the use of the ELISA methodology. The essence of our research is that patients with T1DM and HT and with microalbuminuria (MA) and diabetic retinopathy (DR) (MA/DR) are characterized by a significantly higher level of VEGF (340.23±93.22 pg ml–1) in blood serum in comparison with the group of T1DM patients without HT and MA/DR (183.6±96.6 pg ml–1) and with healthy controls (145.32±75.58 pg ml–1). In addition, the VEGF level was significantly higher in T1DM patients, who presented all three complications, that is HT, retinopathy and MA in comparison with T1DM patients without HT, but with MA/DR (P=0.036). On the other hand, no statistically significant differences (P=0.19) were noted in the level of VEGF in serum between T1DM patients without HT and MA/DR and the healthy control group. At a further stage of analysis, using the method of multiple regression, it was shown that systolic pressure, HbA1c and duration of disease are independent factors influencing the concentration of VEGF. Summarizing, the measurement of VEGF serum levels allows for the identification of groups of patients who have the highest risk of HT and, subsequently, progression of vascular complications

Waist circumference and risk of elevated blood pressure in children: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Increasing childhood obesity has become a major health threat. This cross-sectional study reports associations between schoolchildren's waist circumference (WC) and risk of elevated blood pressure.</p> <p>Methods</p> <p>We measured height, weight, neck and waist circumference, and blood pressure in regular health examinations among children in grade 1 (ages 6-7 years) at six elementary schools in Taipei County, Taiwan. Elevated blood pressure was defined in children found to have mean systolic or diastolic blood pressure greater than or equal to the gender-, age-, and height-percentile-specific 95th-percentile blood pressure value.</p> <p>Results</p> <p>All 2,334 schoolchildren were examined (response rate was 100% in the six schools). The mean of systolic and diastolic blood pressure increased as WC quartiles increased (p < 0.0001). The prevalence of elevated blood pressure for boys and girls within the fourth quartile of waist circumference was 38.9% and 26.8%, respectively. In the multivariate logistic regression analyses, the adjusted odds ratios of elevated blood pressure were 1.78 (95% confidence interval [CI] = 1.13-2.80), 2.45 (95% CI = 1.56-3.85), and 6.03 (95% CI = 3.59-10.1) for children in the second, third, and fourth waist circumference quartiles compared with the first quartile. The odds ratios for per-unit increase and per increase of standard deviation associated with elevated blood pressure were 1.14 (95% CI = 1.10-1.18) and 2.22 (95% CI = 1.76-2.78), respectively.</p> <p>Conclusions</p> <p>Elevated blood pressure in children was associated with waist circumference. Not only is waist circumference easier to measure than blood pressure, but it also provides important information on metabolic risk. Further research is needed on effective interventions to identify and monitor children with increased waist circumference to reduce metabolic and blood pressure risks.</p

Waist circumference cut-off values for the prediction of cardiovascular risk factors clustering in Chinese school-aged children: a cross-sectional study

Background: Waist circumference has been identified as a valuable predictor of cardiovascular risk in children. The development of waist circumference percentiles and cut-offs for various ethnic groups are necessary because of differences in body composition. The purpose of this study was to develop waist circumference percentiles for Chinese children and to explore optimal waist circumference cut-off values for predicting cardiovascular risk factors clustering in this population.----- ----- Methods: Height, weight, and waist circumference were measured in 5529 children (2830 boys and 2699 girls) aged 6-12 years randomly selected from southern and northern China. Blood pressure, fasting triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and glucose were obtained in a subsample (n = 1845). Smoothed percentile curves were produced using the LMS method. Receiver-operating characteristic analysis was used to derive the optimal age- and gender-specific waist circumference thresholds for predicting the clustering of cardiovascular risk factors.----- ----- Results: Gender-specific waist circumference percentiles were constructed. The waist circumference thresholds were at the 90th and 84th percentiles for Chinese boys and girls respectively, with sensitivity and specificity ranging from 67% to 83%. The odds ratio of a clustering of cardiovascular risk factors among boys and girls with a higher value than cut-off points was 10.349 (95% confidence interval 4.466 to 23.979) and 8.084 (95% confidence interval 3.147 to 20.767) compared with their counterparts.----- ----- Conclusions: Percentile curves for waist circumference of Chinese children are provided. The cut-off point for waist circumference to predict cardiovascular risk factors clustering is at the 90th and 84th percentiles for Chinese boys and girls, respectively

Construct validity of a continuous metabolic syndrome score in children

<p>Abstract</p> <p>Objective</p> <p>The primary purpose of this study was to examine the construct validity of a continuous metabolic syndrome score (cMetS) in children. The secondary purpose was to identify a cutpoint value(s) for an adverse cMetS based on receiver operating characteristic (ROC) curve analysis.</p> <p>Methods</p> <p>378 children aged 7 to 9 years were assessed for the metabolic syndrome which was determined by age-modified cutpoints. High-density-lipoprotein cholesterol, triglycerides, the homeostasis assessment model of insulin resistance, mean arterial pressure, and waist circumference were used to create a cMetS for each subject.</p> <p>Results</p> <p>About half of the subjects did not possess any risk factors while about 5% possessed the metabolic syndrome. There was a graded relationship between the cMetS and the number of adverse risk factors. The cMetS was lowest in the group with no adverse risk factors (-1.59 ± 1.76) and highest in those possessing the metabolic syndrome (≥3 risk factors) (7.05 ± 2.73). The cutoff level yielding the maximal sensitivity and specificity for predicting the presence of the metabolic syndrome was a cMetS of 3.72 (sensitivity = 100%, specificity = 93.9%, and the area of the curve = 0.978 (0.957-0.990, 95% confidence intervals).</p> <p>Conclusion</p> <p>The results demonstrate the construct validity for the cMetS in children. Since there are several drawbacks to identifying a single cut-point value for the cMetS based on this sample, we urge researchers to use the approach herein to validate and create a cMetS that is specific to their study population.</p