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

Birth weight and birth length, and blood pressure in children and adolescents

Wstęp Masa urodzeniowa ciała może determinować wartość ciśnienia tętniczego (BP) w późniejszym wieku. Celem pracy była ocena wpływu masy i długości urodzeniowej ciała na wartość BP u dzieci i młodzieży w Polsce. Materiał i metody Badanie przekrojowe przeprowadzono w grupie 6097 osób (2949 chłopców i 3148 dziewcząt) w wieku 7-18 lat (średnio 12,6 ± 3,4 roku), zamieszkałych w woj. śląskim (n = 2386), mazowieckim (n = 1906) i wielkopolskim (n = 1805). BP mierzono sfigmomanometrem rtęciowym, zgodnie z obowiązującymi zaleceniami. Informację o urodzeniowej masie i długości ciała uzyskano z danych zawartych w książeczce zdrowia dziecka. Wyniki Ciśnienie skurczowe (SBP) wynosiło średnio 110,2 ± 11,5 mm Hg, natomiast rozkurczowe (DBP) - 67,8 ± 7,8 mm Hg. Masa urodzeniowa ciała wynosiła średnio 3338,2 ± 527,9 g, a długość urodzeniowa ciała - 53,2 ± 5,5 cm. Parametry te były były one najwyższe w woj. mazowieckim i wynosiły odpowiednio: 3370,4 ± 535,4 g i 54,5 ± 3,3 cm. Wartości BP oraz badanych parametrów noworodkowych były istotnie statystycznie wyższe u chłopców niż dziewcząt, z wyjątkiem woj. wielkopolskiego. Po uwzględnieniu roli płci, wieku, aktualnego BMI, miejsca zamieszkania oraz czasu trwania ciąży, nie wykazano znamiennego wpływu masy urodzeniowej ciała (w kg) na wartość BP (odpowiednie współczynniki regresji liniowej wynosiły: bSBP = = –0,4; p = 0,3 oraz bDBP = 0,2; p = 0,5). Udokumentowano natomiast dodatni, istotny wpływ długości urodzeniowej na wartość BP (bSBP = 0,05; p = 0,04 oraz bDBP = 0,07; p = 0,0006). Wnioski Wyniki badania ujawniły niewielki, ale istotny statystycznie wpływ długości urodzeniowej na wartość BP w późniejszym wieku oraz brak wpływu masy urodzeniowej ciała na wartość BP u dzieci i młodzieży w Polsce.Background Birth weight may influence on blood pressure (BP) at later life. The study aimed to test whether birth weight and birth length program blood pressure at later life in children and adolescents in Poland. Materials and methods A cross-sectional study was performed in a randomly selected sample of 6097 children and adolescents (2949 boys and 3148 girls), aged 7-18 (mean 12.6 ± 3.4), inhabitants of Silesia Region (n = 2386), Masovia Region (n = 1906) and Wielkopolska Region (n = = 1805). BP was taken using a mercury sphygmomanometer, following the current guidelines. Birth outcomes were obtained from routine obstetrical records. Results Mean systolic blood pressure (SBP) was 110.2 ± 11.5 mm Hg and diastolic blood pressure (DBP) was 67.8 ± 7.8 mm Hg. Mean birth weight was 3338.2 ± 527.9 g, and birth length was 53.2 ± 5.5 cm. Both parameters were the highest in children in Masovia Region; 3370.4 ± 535.4 g and 54.5 ± 3.3 cm, respectively. BP and birth outcomes were statistically significantly higher in boys than in girls, except Wielkopolska Region. After adjustment for gender, age, current BMI, place of residence and time of gestation, no statistically significant impact of birth weight (in kg) on BP was found, with the coefficients of linear regression bSBP = -0.4 (p = 0.3) and bDBP = 0.2 (p = 0.5). However, statistically significant impact of birth length on BP was confirmed: bSBP = 0.05 (p = 0.04) and bDBP = 0.07 (p = 0.0006). Conclusions The results revealed small but positive and statistically significant impact of birth length on BP at later life in children in Poland. However, no role of birth weight in BP alteration was found

Trends in premature mortality rates among the Polish population due to cardiovascular diseases

ObjectivesAt the end of the 20th century, after years of negligence in the prevention of cardiovascular diseases, Poland was struggling with very high premature mortality. The period of 1991–2005 brought significant improvements since the general public introduced beneficial dietary modifications. This paper aims to analyze the changes in the rate of premature mortality due to tobacco-dependent cardiovascular diseases in Poland in 2008–2017.Material and MethodsThe time trends of deaths occurring under the age of 65 years caused by ischemic heart disease, cerebrovascular disease, atherosclerosis and aortic aneurysm were analyzed. Both standardized and crude premature mortality rates were used, as well as mortality rates for patients grouped into 5-year age ranges with a breakdown by gender. The joinpoint model was used to determine these time trends.ResultsPremature mortality due to the analyzed cardiovascular diseases decreased linearly in 2008–2017. In the case of ischemic heart disease and cerebrovascular diseases, the decrease amounted to approx. 5% per year, both in the female and male population. However, in the case of atherosclerosis and aortic aneurysms, the rate of mortality reduction ranged 4–7% per year. The reduction concerned all the examined age groups, but with different dynamics. The most considerable annual decrease was observed in the group of patients aged 40–44 years (7.9% for females and 8.9% for males). Along with the increase in age, the dynamics of reduction decreased.ConclusionsIn 2008–2017, Poland experienced a decline in premature mortality due to tobacco-related cardiovascular diseases, particularly in the age group of 40–44 years. The decline may have been associated, among other things, with a reduction in exposure to tobacco smoke, one of the cardiovascular risk factors

Excess Mortality of Males Due to Chronic Obstructive Pulmonary Disease (COPD) in Poland

At present, female life expectancy exceeds male life expectancy almost worldwide. However, numerous studies indicate that this disparity is gradually decreasing. In Poland, the gender gap in life expectancy peaked in 1991 when it amounted to 9.2 years. Since then, a narrowing of the gap has been observed, reaching 8 years in 2021. Decreasing differences in life expectancy between men and women in Poland were mainly the result of a reduction in mortality due to ischaemic heart disease, cerebrovascular disease, and a number of malignancies.Less attention has been paid to chronic obstructive pulmonary disease (COPD) although it is the third leading cause of death worldwide. This paper includes an analysis of mortality due to chronic obstructive pulmonary disease COPD. The male excess mortality was calculated as the ratio of mortality rates in the male population scaled up to the corresponding rates in the female population using both crude and standardised detailed mortality rates. The Joinpoint model was used to determine time trends. It was shown that from 2008 to 2021, the excess mortality of men due to COPD in Poland decreased by 3.3% per year from 2.4 to 1.7 when using crude coefficients, while when standardised coefficients were applied, it decreased significantly by 3.9% per year from 3.8 to 2.4. The decrease in the excess mortality of men in Poland was due to a simultaneous decrease in mortality in the population in general; however, a greater decrease was observed in the male population. The mortality of men and women, and, at the same time, the excess mortality of men caused by COPD in Poland decreased faster in the period studied than in other European countries

Cohen’s Kappa Coefficient as a Measure to Assess Classification Improvement following the Addition of a New Marker to a Regression Model

The need to search for new measures describing the classification of a logistic regression model stems from the difficulty in searching for previously unknown factors that predict the occurrence of a disease. A classification quality assessment can be performed by testing the change in the area under the receiver operating characteristic curve (AUC). Another approach is to use the Net Reclassification Improvement (NRI), which is based on a comparison between the predicted risk, determined on the basis of the basic model, and the predicted risk that comes from the model enriched with an additional factor. In this paper, we draw attention to Cohen’s Kappa coefficient, which examines the actual agreement in the correction of a random agreement. We proposed to extend this coefficient so that it may be used to detect the quality of a logistic regression model reclassification. The results provided by Kappa‘s reclassification were compared with the results obtained using NRI. The random variables’ distribution attached to the model on the classification change, measured by NRI, Kappa, and AUC, was presented. A simulation study was conducted on the basis of a cohort containing 3971 Poles obtained during the implementation of a lower limb atherosclerosis prevention program

Incidence of scoliotic posture in school screening of urban children and adolescents: the case of Poznań, Poland

Postural defects including scoliotic posture constitute one of the most frequently observed health problems in school-aged children. The incidence of this multifactorial condition has been observed to increase recently. The aim of the study was to assess the incidence of scoliotic posture in primary and secondary school students living in a large city. The sample consisted of 1,325 boys and 1,355 girls, aged 6 to 18, living in the city of Poznań. Their postures were assessed through skilled visual inspection method based on the criteria delineated by Wiktor Dega. Additionally, measurements of scoliotic deformities were taken using the Bunnell’s scoliometer. It was found that the incidence of scoliosis assessed on the basis of Dega’s postural defect chart amounted in total to 14.6% in boys and 17% in girls. No substantial differences between boys and girls in particular age categories were found. Scoliometer examination appeared to be a more accurate method for screening scoliosis and revealed higher incidence of this condition in total and both in boys and girls as compared to the visual screening method. The contractures which may lead to scoliotic posture appeared most frequently in the knee joints, both in boys and in girls. The incidence of lateral spinal curvatures was related to age and increased with age. Scoliometer proved to be a more effective tool in detecting lateral spinal curvatures and should be more widely used in school healthcare

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

Environmental variation in the prevalence of hypertension in children and adolescents – is blood pressure higher in children and adolescents living in rural areas?

Introduction Despite considerable progress in diagnostic methods and treatment options, cardiovascular diseases constitute a serious health issue in Poland, and hypertension is considered one of the main risk factors in the incidence of the diseases. Objectives The aim of this study is to assess the values of arterial blood pressure among adolescents in the context of urban and rural environments. Material and Methods The study was carried out on a representative, randomly selected group of youths aged 10–18 years, participating in the ADOPOLNOR project. Prior to blood pressure measurement, each pupil was assessed according to anthropomorphic principles. The BP measurements strictly followed the guidelines of the Fourth Protocol of the American Working Group of High Blood pressure in Children and Adolescents. Results Mean values of systolic blood pressure (SBP) in boys in rural areas were higher in every age group than in the boys in urban areas. Higher values of systolic and diastolic blood pressure were observed also in girls in rural areas. BP values sufficiently high for the diagnosis of hypertension were observed in 12.8% of the rural boy population but only in 6.7% of the boys from the urban environment. The difference is statistically significant. The girls in rural areas (13.3%) had twice the incidence of elevated BP values in comparison with the girls in urban areas (7.2%) and, as in boys, the difference is statistically significant. Conclusions The high proportion of pupils with elevated arterial blood pressure observed in the rural areas of Wielkopolska calls for regularly performed BP assessment and monitoring in this populati

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