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

The triglyceride to high-density lipoprotein ratio identifies children who may be at risk of developing cardiometabolic disease

Aim: It is important to develop simple, reliable methods to identify high-risk individuals who may benefit from intervention. This study investigated the association between the triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio and cardiometabolic risk, cardiorespiratory fitness and physical activity in children. Methods: Anthropometric, biochemical parameters, cardiorespiratory fitness and accelerometry determined physical activity were assessed in 155 children (80 girls) from 10 to 14 years of age from Bedfordshire, UK. Participants were grouped into high and low TG/HDL ratio groups, according to published thresholds. MANCOVA and logistic regression were used in the analysis. Results: Cardiometabolic risk factor levels were significantly higher in participants with a high TG/HDL ratio (p < 0.05). The odds of having high waist circumference (OR = 13.99; 95% CI 2.93, 69.25), elevated systolic blood pressure (5.27; 1.39, 20.01), high non-HDL cholesterol (19.47; 4.42, 85.81) and ≥2 cardiometabolic risk factors (15.32; 3.10, 75.79) were higher in participants with a high TG/HDL ratio. The TG/HDL ratio values were significantly lower in those with high cardiorespiratory fitness (p = 0.01), but there was no association with physical activity. Conclusion: These findings support the use of the TG/HDL ratio to identify children with cardiometabolic risk factors who may be at risk of developing cardiometabolic disease

Is the measurement of blood pressure by automatic monitor in the South American pediatric population accurate? SAYCARE Study

ABSTRACT: This study aimed to test the validity of an automatic oscillometric device to measure the blood pressure (BP) in children (n 5 191) and adolescents (n 5 127) aged 3 to 18 years.Methods: Systolic BP (SBP) and diastolic BP (DBP) levels were measured simultaneous by automaticdevice and mercury column with Y-connection. To verify the validity, Bland-Altman plots and limits of agreement of 95% (95% LOA), specificity and sensitivity of the device, and the grade of British Hypertension Society (BHS) criteria were used. Results: The monitor measurements demonstrated lower measurement bias (mean difference [95% LOA]): 1.4 (29.9 to 12.8) mmHg in children and 4.3 (27.8 to 16.5) mmHg in adolescents for SBP. For DBP, it was 2.2 (27.4 to 11.7) mmHg in children and 1.4 (28.4 to 11.1) mmHg in adolescents. The sensitivity in children was 21.4 (95% CI 5 16.3-26.6), and in adolescents, it was 20.0 (95% CI 5 13.2-26.8); the specificity was 95.9 (95% CI 5 93.4-98.4) in children and 100.0 (95% CI 5 100.0-100.0) in adolescents. The monitor-tested ratings are Grade B for SBP in children and SBP and DBP in adolescents and Grade C for DBP in children. Conclusions: The automatic monitor presented high values of specificity and lower values of sensitivity to the diagnosis of HBP; however, it can be considered accurate (lower measurement bias) and valid for epidemiological and clinical practice in accordance with BHS criteria

Therapeutic Lifestyle Changes for Hypertension and Cardiovascular Risk Reduction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72505/1/j.1524-6175.2003.02179.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

Photoplethysmography for an independent measure of pulsatile pressure under controlled flow conditions

Noninvasive continuous blood pressure measurements are desirable for patients and clinicians. This work proposes and validates a method for transmural pressure measurement using photoplethysmography (PPG) in an in vitro setup that allows control of pressure and flow conditions. The optimum pulsatile volume measure is obtained by comparing parameters extracted from the photoplethysmographic signal (AC amplitude, normalized pulse volume (NPV) and adjusted pulse volume (APV)). Pulsatile volume can then provide pressure measurements using the exponential pressure-volume (P-V) relationship and validated using the gold standard catheter pressure measurement. Pressure, red (R) and infrared (IR) PPG signals were recorded continuously in two arterial models with different cross-sectional areas (Model 1 and Model 2) utilising a pulsatile pump. Flow rates were controlled by varying pumping frequencies at low and high stroke volumes. The optimum method for estimation of the pulsatile volume is through APV, which had a highly significant correlation (r (2)  =  0.99, p  <  0.001) for Model 1 and (r (2)  =  0.98, p  <  0.001) for Model 2. APV obtained a significantly better fit when compared to NPVIR (r (2)  =  0.73, z  =  25.85, p  <  0.001), NPVR (r (2)  =  0.95, z  =  12.26, p  <  0.001), IRAC (r (2)  =  0.52, z  =  28.29, p  <  0.0001) and RAC (r (2)  =  0.92, z  =  15.27, p  <  0.0001) in Model 1, and when compared to NPVIR (r (2)  =  0.92, z  =  10.23, p  <  0.0001), NPVR (r (2)  =  0.96, z  =  5.08, p  <  0.001) IRAC (r (2)  =  0.63, z  =  22.47, p  <  0.0001) and RAC (r (2)  =  0.92, z  =  17.70, p  <  0.0001) in Model 2. These preliminary findings suggest that APV could be used as a potential non-invasive continuous method of blood pressure measurement at different flow conditions

Blood pressure and body mass index in an ethnically diverse sample of adolescents in Paramaribo, Suriname

<p>Abstract</p> <p>Background</p> <p>High blood pressure (BP) is now an important public health problem in non-industrialised countries. The limited evidence suggests ethnic inequalities in BP in adults in some non-industrialised countries. However, it is unclear whether these ethnic inequalities in BP patterns in adults reflect on adolescents. Hence, we assessed ethnic differences in BP, and the association of BP with body mass index (BMI) among adolescents aged 12–17 years in Paramaribo, Suriname.</p> <p>Methods</p> <p>Cross-sectional study with anthropometric and blood pressure measurements. A random sample of 855 adolescents (167 Hindustanis, 169 Creoles, 128 Javanese, 91 Maroons and 300 mixed-ethnicities) were studied. Ethnicity was based on self-reported ethnic origin.</p> <p>Results</p> <p>Among boys, Maroons had a lower age- and height-adjusted systolic BP than Creoles, and a lower diastolic BP than other ethnic groups. However, after further adjustment for BMI, only diastolic BP in Maroons was significantly lower than in Javanese (67.1 versus 70.9 mmHg). Creole boys had a lower diastolic BP than Hindustani (67.3 versus 70.2 mmHg) and Javanese boys after adjustment for age, height and BMI. Among girls, there were no significant differences in systolic BP between the ethnic groups. Maroon girls, however, had a lower diastolic BP (65.6 mmHg) than Hindustani (69.1 mmHg), Javanese (71.2 mmHg) and Mixed-ethnic (68.3 mmHg) girls, but only after differences in BMI had been adjusted for. Javanese had a higher diastolic BP than Creoles (71.2 versus 66.8 mmHg) and Mixed-ethnicity girls. BMI was positively associated with BP in all the ethnic groups, except for diastolic BP in Maroon girls.</p> <p>Conclusion</p> <p>The study findings indicate higher mean BP levels among Javanese and Hindustani adolescents compared with their African descent peers. These findings contrast the relatively low BP reported in Javanese and Hindustani adult populations in Suriname and underscore the need for public health measures early in life to prevent high BP and its sequelae in later life.</p

Associations Between Screen-Based Sedentary Behavior and Cardiovascular Disease Risk Factors in Korean Youth

The purposes of this study were to: 1) describe the patterns of screen-based sedentary behaviors, and 2) examine the association between screen-based sedentary behavior and cardiovascular disease (CVD) risk factors in representative Korean children and adolescents, aged 12 to 18 yr, in the Korean National Health and Nutrition Examination Survey. Screen-based sedentary behavior was measured using self-report questionnaires that included items for time spent watching TV and playing PC/video games. Physical activity was measured using items for frequency and duration of moderate-to-vigorous physical activity (MVPA). CVD risk factors such as body mass index (BMI), waist circumference, LDL cholesterol, HDL cholesterol, total cholesterol, triglycerides, glucose, systolic blood pressure, and diastolic blood pressure were measured. Boys spent more time playing PC/video games, and girls spent more time watching TV. After adjusting for age, gender, annual household income, and MVPA, an additional hour of watching TV was significantly associated with the risk of overweight (OR 1.17 [95% CI 1.03-1.33]), high abdominal adiposity (OR 1.27 [1.06-1.51]), and low HDL cholesterol (OR 1.27 [1.10-1.47]). An additional hour spent playing PC/video games also increased the risk of high abdominal adiposity (OR 1.20 [1.03-1.40]). Prospective observations and interventions are needed to determine causal relationships between screen-based sedentary behavior and CVD risk profiles in Korean youth