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Association between obesity and the severity of ambulatory hypertension in children and adolescents


Authors: K. Babinská 1;  L. Kovács 1;  V. Jankó 1;  T. Dallos 1;  J. Feber 2
Authors place of work: 2. detská klinika, Lekárska fakulta Univerzity Komenského a Detskej fakultnej nemocnice s poliklinikou, Bratislava, Slovenskoprednosta prof. MUDr. L. Kovács, DrSc., MPH 1;  Division of Nephrology, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Canadaprednosta J. Feber, MD, FRCPC 2
Published in the journal: Čes-slov Pediat 2014; 69 (2): 67-76.
Category: Original Papers

Výsledky pôvodne publikované v časopise Journal of the American Society of Hypertension [28] sa v danom článku uvádzajú na základe Vancouverskej dohody editorov svetových lekárskych časopisov o dvojjazyčnej publikácii [29, 30] s písomným súhlasom vydavateľa.

Summary

Introduction and methods:
The goal of our study was to analyze the association between obesity and the severity of ambulatory hypertension in obese children. A total of 109 patients with primary obesity ages 7 to 18 years (mean ± SD age 14.1±3.1) were enrolled. Patients were divided into three groups according to body mass index (BMI) Z-scores: group 1 (n=27): BMI >1.65 and <3.28 standard deviation scores (SDS); group 2 (n=55): BMI >3.29 and <4.91 SDS; group 3 (n=27): BMI >4.92 SDS. Definition and staging of ambulatory hypertension was based on blood pressure (BP) levels and BP load, obtained from ambulatory BP monitoring (ABPM).

Results:
Only 24% of individuals had ambulatory normotension, 25% had ambulatory prehypertension, 3% had hypertension, and 48% had severe ambulatory hypertension (BP load over 50%). The severity of hypertension increased significantly with the degree of obesity (P=0.0027). Daytime systolic (SDS=0.32, 1.24, 1.86), diastolic (SDS= -0.42, 0.56, 0.93), and mean arterial (SDS= -0.01, 0.85, 1.36) BPs increased significantly with increased BMI, whereas the nighttime pressure remained elevated regardless of the degree of obesity. Isolated nighttime hypertension was observed in 25% of patients and 38% were classified as nondippers.

Conclusion:
Almost 50% of children with obesity and hypertension detected on ABPM suffer from severe ambulatory hypertension. BMI is associated with the severity of ambulatory hypertension and the increase of daytime BP.

Key words:
blood pressure, children and adolescents, hypertension, obesity


Zdroje

1. Hayman LL. The cardiovascular impact of the pediatric obesity epidemic: Is the worst yet to come? J Pediatr 2011; 158: 709–714.

2. Herman KM, Craig CL, Gauvin L, Katzmarzyk PT. Tracking of obesity and physical activity from childhood to adulthood: the Physical Activity Longitudinal Study. Int J Pediatr Obes 2009; 4: 281–288.

3. Chen X, Wang Y. Tracking of blood pressure from child-hood to adulthood: a systematic review and meta-regression analysis. Circulation 2008; 117: 3171–3180.

4. Brady TM, Solomon BS, Neu AM, Siberry GK, Parekh RS. Patient-, provider-, and clinic-level predictors of unrecognized elevated blood pressure in children. Pediatrics 2010; 125: e1286–e1293.

5. Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, Jacobson M, et al. Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertension 2008; 52: 433–451.

6. Ruiz Pons M, García Nieto V, García MG, García Mérida M, Valenzuela Hdez C, Aguirre-Jaime A. Reduced nocturnal systolic blood pressure dip in obese children. Nefrologia 2008; 28: 517–524.

7. Aguilar A, Ostrow V, De Luca F, Suarez E. Elevated ambulatory blood pressure in a multi-ethnic population of obese children and adolescents. J Pediatr 2010; 156: 930–935.

8. Lurbe E, Invitti C, Torro I, Maronati A, Aguilar F, Sartorio A, et al. The impact of the degree of obesity on the discrepancies between office and ambulatory blood pressure values in youth. J Hypertens 2006; 24: 1557–1564.

9. Lurbe E, Alvarez V, Liao Y, Tacons J, Cooper R, Cremades B, et al. The impact of obesity and body fat distribution on ambulatory blood pressure in children and adolescents. Am J Hypertens 1998; 11: 418–424.

10. Kotsis V, Stabouli S, Bouldin M, Low A, Toumanidis S, Zakopoulos N. Impact of obesity on 24-hour ambulatory blood pressure and hypertension. Hypertension 2005; 45: 602–607.

11. Maggio AB, Aggoun Y, Marchand LM, Martin XE, Herrmann F, Beghetti M, et al. Associations among obesity, blood pressure, and left ventricular mass. J Pediatr 2008; 152: 489–493.

12. Lurbe E, Torro I, Aguilar F, Alvarez J, Alcon J, Pascual JM, et al. Added impact of obesity and insulin resistance in nocturnal blood pressure elevation in children and adolescents. Hypertension 2008; 51: 635–641.

13. Kim YK, Kim HU, Song JY. Ambulatory blood pressure monitoring and blood pressure load in obese children. Korean Circ J 2009; 39: 482–487.

14. Sevcikova L, Rovny I, Novakova J, Hamada J, Tatara M, Janechova H, Sedova M. Body development of infants and children in Slovakia. Results of the 6th National Survey in 2001. Bratislava: National Institute of Public Health of the Slovak Republic, 2004.

15. Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009; 20: 629–637.

16. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics 2005; 115: e500–e503.

17. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents – an IDF consensus report. Pediatr Diabetes 2007; 8: 299–306.

18. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555–576.

19. Wühl E, Witte K, Soergel M, Mehls O, Schaefer F, German Working Group on Pediatric Hypertension. Distribution of 24-h ambulatory blood pressure in child-ren: normalized reference values and role of body dimensions. J Hypertens 2002; 20: 1995–2007.

20. Lurbe E, Sorof JM, Daniels SR. Clinical and research aspects of ambulatory blood pressure monitoring in children. J Pediatr 2004; 144: 7–16.

21. Török K, Pálfi A, Szelényi Z, Molnár D. Circadian variability of blood pressure in obese children. Nutr Metab Cardiovasc Dis 2008; 18: 429–435.

22. Eissa MA, Meininger JC, Nguyen TQ, Chan W. The relationship of ambulatory blood pressure to physical activity in a tri-ethnic population of obese and nonobese adolescents. Am J Hypertens 2007; 20: 140–147.

23. Soergel M, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R, et al. Oscillometric twenty-four-hour ambulatory blood pressure values in healthy child-ren and adolescents: a multicenter trial including 1141 subjects. J Pediatr 1997; 130: 178–184.

24. Di Salvo G, Pacileo G, Del Giudice EM, Natale F, Limongelli G, Verrengia M, et al. Abnormal myocardial deformation properties in obese, non-hypertensive children: an ambulatory blood pressure monitoring, standard echocardiographic, and strain rate imaging study. Eur Heart J 2006; 27: 2689–2695.

25. Stabouli S, Kotsis V, Papamichael C, Constantopoulos A, Zakopoulos N. Adolescent obesity is associated with high ambulatory blood pressure and increased carotid intimal-medial thickness. J Pediatr 2005; 147: 651–656.

26. Falkner B, Gidding SS, Portman R, Rosner B. Blood pressure variability and classification of prehypertension and hypertension in adolescence. Pediatrics 2008; 122: 238–242.

27. Litwin M, Niemirska A, Sladowska-Kozlowska J, Wierzbicka A, Janas R, Wawer ZT, et al. Regression of target organ damage in children and adolescents with primary hypertension. Pediatr Nephrol 2010; 25: 2489–2499.

28. Babinska K, Kovacs L, Janko V, Dallos T, Feber J. Association between obesity and the severity of ambulatory hypertension between children and adolescents. Journal of the American Society of Hypertension (JASH) 2012; 6 (5): 356–363.

29. Lundberg GD. Statement by the International Committee of Medical Journal Editors (ICMJE) on duplicate or redundant publications. JAMA 1993; 270: 2495.

30. Kovács L. O citáciách, impakte a o našom časopise. Čes-slov Pediat 2008; 63 (5): 239–242.

Štítky
Neonatology Paediatrics General practitioner for children and adolescents
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