Current topic: Measurement and interpretation of blood pressure

Goonasekera, Chulananda; Dillon, M J

doi:10.1136/adc.82.3.261

Cited by 57 publications

(49 citation statements)

References 43 publications

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“…Although a child's current blood pressure may fall within the population-based range of normality, a previously undetected pattern of relative increases in blood pressure across percentile lines over time may still effectively render that patient "hypertensive." 22 This is consistent with the observation that children with high normal blood pressure during adolescence have a greater tendency to develop hypertension during adulthood. 23 Nonetheless, many health care providers underdiagnose hypertension in children.…”

Section: Epidemiologysupporting

confidence: 91%

Obesity Hypertension in Children

Sorof

Daniels²

2002

Hypertension

818

157

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Abstract-Obesity has become an increasingly important medical problem in children and adolescents. In national surveys from the 1960s to the 1990s, the prevalence of overweight in children grew from 5% to 11%. Outcomes related to childhood obesity include hypertension, type 2 diabetes mellitus, dyslipidemia, left ventricular hypertrophy, nonalcoholic steatohepatitis, obstructive sleep apnea, orthopedic problems, and psychosocial problems. Once considered rare, primary hypertension in children has become increasingly common in association with obesity and other risk factors, including a family history of hypertension and an ethnic predisposition to hypertensive disease. Obese children are at approximately a 3-fold higher risk for hypertension than nonobese children. In addition, the risk of hypertension in children increases across the entire range of body mass index (BMI) values and is not defined by a simple threshold effect. As in adults, a combination of factors including overactivity of the sympathetic nervous system (SNS), insulin resistance, and abnormalities in vascular structure and function may contribute to obesity-related hypertension in children. The benefits of weight loss for blood pressure reduction in children have been demonstrated in both observational and interventional studies. Obesity in childhood should be considered a chronic medical condition that is likely to require long-term management. Ultimately, prevention of obesity and its complications, including hypertension, is the goal. Key Words: hypertension, obesity Ⅲ children Ⅲ epidemiology Ⅲ cardiovascular diseases Ⅲ risk factors O besity has become an increasingly important medical problem in children and adolescents. Many of the outcomes associated with obesity that were previously thought of as diseases of adults are now affecting children as well. Outcomes related to childhood obesity include hypertension, type 2 diabetes mellitus, dyslipidemia, left ventricular hypertrophy, nonalcoholic steatohepatitis, obstructive sleep apnea, and orthopedic problems (such as slipped capital-femoral epiphysis), as well as social and psychological problems. 1 Obesity is also the most common nutritional problem among children in developed countries. This epidemic of pediatric obesity has resulted in great concern regarding the management of obesity and its complications. Although prevention would be an optimum strategy, it may be difficult to identify children at risk of obesity before they become overweight. Even with appropriate preventive approaches, it is likely that many children will become overweight and require treatment to prevent the long-term sequelae of obesity, such as cardiovascular morbidity and mortality. 2 In concert with the increasing prevalence of obesity in children, pediatric hypertension has undergone an epidemiological shift. The conventional wisdom has been that hypertension in children is a relatively rare condition most commonly associated with renal disease. In actuality, secondary hypertension in children resulting from re...

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Section: Epidemiologysupporting

confidence: 91%

Obesity Hypertension in Children

Sorof

Daniels²

2002

Hypertension

818

157

View full text Add to dashboard Cite

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“…As a limitation of this field study, single measurements of blood pressure are less reliable than repeated controls, 19,20 which were not available in our study. Less erroneous diagnostics would allow for more precise risk estimates.…”

Section: Discussionmentioning

confidence: 55%

“…Hypertension was defined as diastolic blood pressure above the 95th reference percentile, 19,20 using the reference values of Sörgel et al 21 Body fat was calculated from BIA according to Wabitsch et al 22 …”

Section: Cutoff Values and Formulasmentioning

confidence: 99%

Obesity and blood pressure—results from the examination of 2365 schoolchildren in Germany

Reich

Müller

Gelbrich³

et al. 2003

Int J Obes

100

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OBJECTIVES: To investigate the relationship between different indices of body fat and blood pressure in children and adolescents. DESIGN: Cross-sectional cohort study along with regular public health service examinations in school classes two, five and nine. PARTICIPANTS: A total of 2365 healthy schoolchildren aged 8-16 y. MEASUREMENTS: Body mass index (BMI), skinfolds, waist-hip ratio, body fat determined by bioelectric impedance analysis and blood pressure. RESULTS: In comparison with recently published normative data, a significant increase of obesity was found. There is a higher prevalence of obesity in children with lower education. A positive association between body fat and hypertension was observed in children aged above 10 y. The BMI had the strongest association with blood pressure among the indices of body fat considered here. CONCLUSION: Obesity is an increasing problem even among schoolchildren. This observation should be treated seriously as the relationship of body fat to cardiovascular risk is detectable already at a young age. Attention should be paid to the dependence of obesity on the level of education. The analysis suggests that BMI should be the preferred index to assess body fat.

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“…For this reason the importance of repeated BP measurements over time to demonstrate a persistent rise in BP is stressed, with the use of the same, validated method of BP measurement during follow-up being recommended, thus permitting a more accurate interpretation of the BP level [4]. Even with this approach, errors of measurement, as well as interpretation, are possible [21]. It is also important that reactive increases in BP due to emotion, pain, increased sympathetic tone, etc., are excluded and that other conditions associated with transient increases in BP, such as acute nephritis, some drugs, etc., are considered [4].…”

Section: Confirmation Of Truly Elevated Bpmentioning

confidence: 99%

A diagnostic approach for the child with hypertension

Varda

Gregorič

2005

Pediatr Nephrol

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Hypertension during childhood is not rare, with an estimated prevalence of between 1% and 2%, although it is often an underrecognized clinical entity. Elevated blood pressure may be a sign of underlying disease or it may represent early onset of essential hypertension. In recent years the measurement of blood pressure has been emphasized as an important component of the routine pediatric physical examination that enables early detection of children with hypertension. In the evaluation of the child with documented blood pressure elevation, confirmation of truly and persistently elevated blood pressure is of the utmost importance. In addition, a thorough history and a full clinical examination are essential. These are followed by appropriate investigations, which are tailored to the age of the child and to the severity of the blood pressure elevation. Investigations should not only focus on a search for the underlying cause, but also on establishing effects on target organs, complications or additional diseases and on assessment of the total cardiovascular risk to the individual patient. An algorithm, which is a valuable diagnostic tool for the diagnosis and management of the child with hypertension, is presented. All children with confirmed hypertension need long-term follow-up, counseling and treatment. In those cases where an underlying cause of the hypertension is detected, the established diagnosis then determines the specific therapy and management.

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Current topic: Measurement and interpretation of blood pressure

Cited by 57 publications

References 43 publications

Obesity Hypertension in Children

Obesity Hypertension in Children

Obesity and blood pressure—results from the examination of 2365 schoolchildren in Germany

A diagnostic approach for the child with hypertension

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