Pathophysiology of hypertension in obese children: a systematic review

Abstract

Hypertension is increasingly common in overweight and obese children. The mechanisms behind the development of hypertension in obesity are complex, and evidence is limited. In order to effectively treat obese children for hypertension, it is important to have a deeper understanding of the pathophysiology of hypertension in obese children. The present review summarizes the main factors associated with hypertension in obese children and discusses their potential role in its pathophysiology. Systematic searches were conducted in PubMed and EMBASE for articles published up to October 2014. In total, 60 relevant studies were included. The methodological quality of the included studies ranged from weak to strong. Several factors important in the development of hypertension in obese children have been suggested, including endocrine determinants, such as corticosteroids and adipokines, sympathetic nervous system activity, disturbed sodium homeostasis, as well as oxidative stress, inflammation and endothelial dysfunction. Understanding the pathophysiology of hypertension in overweight and obese children is important and could have implications for its screening and treatment. Based on solely cross-sectional observational studies, it is impossible to infer causality. Longitudinal studies of high methodological quality are needed to gain more insight into the complex mechanisms behind the development of hypertension in obese children.

Hypertension in childhood obesity

“…Furthermore, obesity‐induced insulin resistance and hyperinsulinaemia activate the SNS. Both, RAAS and SNS activation have synergistic effects on renal sodium retention and impaired renal pressure natriuresis and may subsequently induce hypertension . Proinflammatory cytokines and oxidative stress contribute to vascular endothelial dysfunction, impaired local vasodilatory response and increased peripheral resistance (Fig.…”

A study on prevalence of pre-hypertension in relation to various obesity indicators in tenth standard healthy school children aged 14 to 16 years

“…Several factors important in the development of hypertension in obese children have been suggested which includes endocrine determinants, such as corticosteroids and adipokines, sympathetic nervous system activity, disturbed sodium homeostasis, as well as oxidative stress, inflammation and endothelial dysfunction. 23 We have used age, sex, specific Indian standard charts in our study to derive percentile values of all the study cases for all obesity indicators WC, WHtR, BMI and BP The total prevalence of overweight and obese adolescents according to BMI >23Eq in our study was 8.38% (4.51% overweight and 3.87% obese). This was almost similar to prevalence of overweight children seen by Kuriyan et al 7.8%.…”

Effectiveness of individual and group programmes to treat obesity and reduce cardiovascular disease risk factors in pre‐pubertal children

“…In children and adolescents, BMI is strongly related to high BP. 31 At baseline, moderate hypertension ranged from 20% at rest to 81% by ambulatory monitoring, but no effect of treatment A or B could be seen compared to controls. The attendance rate at exercise sessions was low in both groups and physical activity levels decreased in group A compared to B.…”

“…In children and adolescents, BMI is strongly related to high BP . At baseline, moderate hypertension ranged from 20% at rest to 81% by ambulatory monitoring, but no effect of treatment A or B could be seen compared to controls.…”