High Blood Pressure in Overweight and Obese Youth: Implications for Screening

Koebnick, Corinna; Black, Maureen M.; Wu, Jun; Martinez, Mayra P.; Smith, Ning; Kuizon, Beatriz D.; Cuan, David; Young, Deborah Rohm; Lawrence, Jean M.; Jacobsen, Steven J.

doi:10.1111/jch.12199

Cited by 60 publications

(55 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, the impact of higher BMI was greatest among the higher blood pressure groups, suggesting excess body weight may be particularly problematic for individuals already on a trajectory toward developing higher blood pressure. Our results support recommendations for blood pressure screening of children and adolescents who are overweight and obese 32 and population-based strategies that focus on maintaining a healthy weight. Similar to previous longitudinal studies 19 , we found that cigarette smoking was a significant risk factor and associated with an upward shift in trajectories for those in the high-normal and prehypertensive groups (approximately 75% of population).…”

Section: Discussionsupporting

confidence: 73%

Childhood to Early-Midlife Systolic Blood Pressure Trajectories

et al. 2015

View full text Add to dashboard Cite

Previous studies examining blood pressure change over time have modelled an “average” population trajectory. Recent research among older adults suggests there may be subgroups with different blood pressure trajectories. Identifying subgroups at risk of developing adult hypertension early in life can inform effective risk reduction efforts. We sought to identify different systolic blood pressure trajectories from childhood, their correlated risk factors and early midlife cardiovascular outcomes. Blood pressure data at ages 7, 11, 18, 26, 32 and 38 years from a longitudinal, representative birth cohort study (n=975) were used to identify four distinct trajectory groups via group-based trajectory modeling: ‘normal’ (21.8%), ‘high-normal’ (43.3%), ‘prehypertensive’ (31.6%), and ‘hypertensive’ (4.2%). The categories refer to blood pressure beginning at age 7 and most recently measured at age 38. Family history of high blood pressure (OR=43.23, 95% CI 5.27, 354.65), male gender (OR=109.48, 95% CI=26.82, 446.96), being first born (OR=2.5 95% CI=1.00, 8.69) and low birthweight (OR=2.79, 95% CI 2.49, 3.09) were associated with hypertensive group membership (compared to the normal group). Higher body mass index and cigarette smoking resulted in increasing blood pressure across trajectories, particularly for the higher blood pressure groups. Prehypertensive and hypertensive trajectory groups had worse cardiovascular outcomes by early midlife. Harmful blood pressure trajectories are identifiable in childhood, associated with both antecedent and modifiable risk factors over time, and predict adult cardiovascular disease risk. Early detection, subsequent targeted prevention and/or intervention may reduce the lifecourse burden associated with higher blood pressure.

show abstract

Section: Discussionsupporting

confidence: 73%

Childhood to Early-Midlife Systolic Blood Pressure Trajectories

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Subjects at validation sites were more likely to be obese, and more likely to have stage 2 systolic BP elevation at their incident elevated BP measurement, than subjects at the derivation site. Presence of obesity and stage 2 systolic BP elevation would likely confer higher risk of subsequent hypertension, 32, 33 and the risk of hypertension was demonstrably higher at validation sites compared to the derivation site. Although these baseline covariates (systolic BP percentile, prior BP, and BMI percentile) were included in our regression model predicting hypertension risk, case mix differences across sites could nonetheless have contributed to poor external validation, 29 because the relative weights of various covariates were based upon a population at lower risk of eventually developing hypertension.…”

Section: Discussionmentioning

confidence: 96%

Predicting Hypertension Among Children With Incident Elevated Blood Pressure

Daley

Reifler

Johnson

et al. 2017

Academic Pediatrics

View full text Add to dashboard Cite

Objectives To develop a model to predict hypertension risk among children with incident elevated blood pressure (BP); to test the external validity of the model. Methods A retrospective cohort study was conducted in 3 organizations: Kaiser Permanente Colorado was the model derivation site; HealthPartners of Minnesota and Kaiser Permanente Northern California served as external validation sites. During study years 2006 through 2012, all children aged 3 through 17 years with incident elevated BP in an outpatient setting were identified. The predictor variables were demographic and clinical characteristics collected during routine care. Cox proportional hazards regression was used to predict subsequent hypertension, and diagnostic statistics were used to assess model performance. Results Among 5598 subjects at the derivation site with incident elevated BP, 160 (2.9%) developed hypertension during the study period. Eight characteristics were used to predict hypertension risk: age; sex; race; BP preceding incident elevated BP; body mass index percentile; systolic BP percentile; diastolic BP percentile; and clinical setting of the incident elevated BP. At the derivation site, the model discriminated well between those at higher versus lower risk of hypertension (c-statistic 0.77). At external validation sites, the observed risk of hypertension was higher than the predicted risk, and the model showed poor discrimination (c-statistic ranged from 0.64 to 0.67). Conclusions Among children with incident elevated BP, a risk model demonstrated good internal validity with respect to predicting subsequent hypertension. However, the risk model did not perform well at two external validation sites, which may limit transportability to other settings.

show abstract

“…This sharp progression of probability is also evident in kids and adolescents [8–10], though a significant decline might be observed in the past 10 years [11]. …”

Section: Obesity As a Comorbidity In Arterial Hypertensionmentioning

confidence: 98%

Obesity and hypertensive heart disease: focus on body composition and sex differences

Simone

Mancusi

Izzo

et al. 2016

Diabetol Metab Syndr

View full text Add to dashboard Cite

There is evidence that hypertension is frequently associated with overweight/obesity even in kids and adolescents. Either conditions influence development of left ventricular (LV) hypertrophy (LVH), through different biological and hemodynamic mechanisms: obesity is conventionally thought to elicit a coherent growth of LV chamber dimensions and myocardial wall thickness (eccentric LV geometry), whereas a more accentuated increase in wall-thickness (concentric LV geometry) is attributed to hypertension. While during youth these differences are visible, proportion of LV concentric geometry, the most harmful LV geometric pattern, sharply raises in obese individuals during middle age, and becomes the most frequent geometric patterns among obese-hypertensive individuals. Two conditions with elevated hemodynamic impact, severe obstructive sleep apnea and masked hypertension contribute to the development of such a geometric pattern, but non-hemodynamic factors, and specifically body composition, also influence prevalence of concentric LV geometry. Contrasting a general belief, it has been observed that adipose mass strongly influences LV mass, particularly in women, especially when fat-free mass is relatively deficient. Thus, though blood pressure control is mandatory for prevention and reduction of LVH in obese hypertensive patients, without reduction of visceral adiposity regression of LVH is difficult. Future researches should be addressed on (1) assessing whether LVH resulting from alteration of body composition carries the same prognosis as pressure overload LVH; (2) defining tissue characterization of the hypertrophic heart in obese-hypertensive patients; (3) evaluating whether assessment of hemodynamic loading conditions and biological markers can help defining management of the association of obesity with hypertension.

show abstract

High Blood Pressure in Overweight and Obese Youth: Implications for Screening

Cited by 60 publications

References 37 publications

Childhood to Early-Midlife Systolic Blood Pressure Trajectories

Childhood to Early-Midlife Systolic Blood Pressure Trajectories

Predicting Hypertension Among Children With Incident Elevated Blood Pressure

Obesity and hypertensive heart disease: focus on body composition and sex differences

Contact Info

Product

Resources

About