Selection process of papers included in the component analysis.

<p>Selection process of papers included in the component analysis.</p

Characteristics of included studies.

<p>Characteristics of included studies.</p

Component themes.

<p>Component themes.</p

Moving Focus from Weight to Health. What Are the Components Used in Interventions to Improve Cardiovascular Health in Children?

<div><p>Introduction</p><p>Obesity in childhood impacts on many areas of the child’s current and future health, including their cardiovascular health. To date many attempts have been made to design interventions to tackle excess childhood weight but with limited success. We aimed to establish the components common to interventions in children that improve cardiovascular health parameters.</p><p>Methods</p><p>We searched the following databases: EMBASE 1974-week 3 November 2014, Ovid Medline 1946 Present, and PsychINFO 1967-Present for studies reporting interventions in healthy young people under the age of 18. Included interventions had to contain an education component and have been carried out in a community, school, or clinical setting. Papers had to report on at least one of the pre-specified CVD risk parameters and at least one non-biological outcome from knowledge, attitudes or behaviours.</p><p>Results</p><p>We retrieved 2451 papers, from which 12 studies (18 papers) of 3046 participants were included. From the selected papers we identified four component themes; Health Behaviours, Self-Concept, Practical and Cognitive Tools, and Intervention Characteristics. The subcomponents that made up these themes were fairly consistent across the studies analysed although the studies varied in their duration, settings and children with which they were carried out. Nine of the studies were able to bring about positive change in at least one biological and one non-biological aspect of child cardiovascular health.</p><p>Conclusion</p><p>The component themes identified here were common to intervention studies that had success in improving parameters of cardiovascular health. We suggest that the focus of childhood health interventions be moved from weight onto cardiovascular health parameters and that future interventions use the lessons learned by their predecessors to incorporate those components that are associated with successful interventions.</p></div

Numbers of studies reporting 24-hour blood pressure variability measures as a prognostic index of cardiovascular events.

<p>Providing continuous expressions of relative risk.</p><p>* Includes studies reporting relative risks/hazard ratios based on pooled data from other studies.</p><p>†Further data from an extra study could not be included as there was insufficient information to extract the data</p><p>‡Night-day ratio; SD—standard deviation, ARV—average real variability, CoV—coefficient of variation</p><p>Numbers of studies reporting 24-hour blood pressure variability measures as a prognostic index of cardiovascular events.</p

Associations of night-day ratio with cardiovascular outcomes.

<p>Relative risks:>1 increased risk;< 1 reduced risk. Pooled relative risk for all CV events, hypertensive population excluding de la Sierra 2012 only (did not control for treatment): 1.25 (1.00, 1.56), I-squared = 79.0%; excluding Verdecchia 1997 only:1.07 (0.99, 1.17), I-squared = 23.7%; excluding de la Sierra 2012 and Verdecchia 1997: 1.12 (0.98, 1.27), I-squared 33.6%.</p

Associations of systolic night dipping 1 with cardiovascular outcomes: non-dippers verses dippers, excluding risers and dippers.

<p>Relative risks:>1 increased risk;< 1 reduced risk. Pooled relative risk for all CV events, hypertensive populations, excluding Minutolo 2009 (non-dialysis chronic kidney disease): 1.61 (1.24, 2.10)</p

Heterogeneity of Prognostic Studies of 24-Hour Blood Pressure Variability: Systematic Review and Meta-Analysis

<div><p>In addition to mean blood pressure, blood pressure variability is hypothesized to have important prognostic value in evaluating cardiovascular risk. We aimed to assess the prognostic value of blood pressure variability within 24 hours. Using MEDLINE, EMBASE and Cochrane Library to April 2013, we conducted a systematic review of prospective studies of adults, with at least one year follow-up and any day, night or 24-hour blood pressure variability measure as a predictor of one or more of the following outcomes: all-cause mortality, cardiovascular mortality, all cardiovascular events, stroke and coronary heart disease. We examined how blood pressure variability is defined and how its prognostic use is reported. We analysed relative risks adjusted for covariates including the appropriate mean blood pressure and considered the potential for meta-analysis. Our analysis of methods included 24 studies and analysis of predictions included 16 studies. There were 36 different measures of blood pressure variability and 13 definitions of night- and day-time periods. Median follow-up was 5.5 years (interquartile range 4.2–7.0). Comparing measures of dispersion, coefficient of variation was less well researched than standard deviation. Night dipping based on percentage change was the most researched measure and the only measure for which data could be meaningfully pooled. Night dipping or lower night-time blood pressure was associated with lower risk of cardiovascular events. The interpretation and use in clinical practice of 24-hour blood pressure variability, as an important prognostic indicator of cardiovascular events, is hampered by insufficient evidence and divergent methodologies. We recommend greater standardisation of methods.</p></div

Studies included in systematic review.

<p>Abbreviations: <i>(excl)</i>—Excluded from analysis of relative risks; ARV—average real variability; CoV—coefficient or variation; CV—cardiovascular; MS—morning surge; SD—standard deviation.</p><p>*Relative risks/hazard ratios based on meta-analysis</p><p>^a Given for subgroups of patients so mean for all patients was estimated by calculating a weighted average</p><p>^b Provided separate relative risks for hypertensive and normotensive patients for night-day ratio (Boggia 2007, n = 3436 hypertensive, n = 4022 normtensive, CV events and all-cause mortality, systolic BP; Hansen 2006, n = 682 hypertensive, n = 1018 normotensive, CV events, systolic and diastolic BP)</p><p>Studies included in systematic review.</p

Components of 24-hour BP variability measures.

<p>Based on 24 studies included in the review.</p><p>^astandard deviation / mean BP</p><p>^b average of absolute value of successive pairs of BP measurements</p><p>^c weighted average of day standard deviation and night standard deviation</p><p>^dpercentage nocturnal fall</p><p>^e difference of mean day BP and mean night BP</p><p>^f adjusted day-night difference, (mean day BP-mean night BP)/mean 24-hour BP</p><p>^gmean BP in 2 hours after awakening—mean BP in 2 hours preawakening</p><p>^hdifference between BP on rising and BP in 30 minutes before rising</p><p>ⁱdifference between mean BP in first hours after awakening and mean BP in last hour preawakening</p><p>^jdifference between mean BP in 3 hours after awakening and mean BP in 3 hours preawakening</p><p>^kdifference between mean BP in 2 hours after awakening and mean of the 3 BP readings centred on the lowest BP readings during sleep</p><p>^ldifference between mean BP in 2 hours after awakening and mean of all the BP readings during sleep</p><p>^mdifference between mean BP in 2 hours after awakening and lowest mean of 3 BP consecutive BP readings during the night</p><p>ⁿ≥20/15mmHg rise in first two BP readings from 7am compared to average night BP</p><p>Components of 24-hour BP variability measures.</p