Racial differences of early vascular aging in children and adolescents

Kruger, Ruan; Gafane-Matemane, Lebo F.; Kagura, Juliana

doi:10.1007/s00467-020-04593-5

Cited by 16 publications

(14 citation statements)

References 155 publications

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“…We also showed that $14% of the children were in the range of elevated BP and $23% in the range of hypertension (stage 1 ¼ 21% or stage 2 ¼ 1.8%), albeit the lowest BP values for each child were used. A recent review reported a summary of all studies that compared BP among different ethnic groups and indicated higher BP mostly in black or Hispanic compared with white children [36] but we did not find any significant differences in ethnicity or sex proportions between BP categories. In our study, the number of children with elevated BP or hypertension as well as overweight or obesity is of great concern and underlines the importance of the current global efforts in reducing these health problems among children and adolescents, supporting the generalizability of our findings.…”

Section: Discussioncontrasting

confidence: 91%

A demographic approach to assess elevated blood pressure and obesity in prepubescent children: the ExAMIN Youth South Africa study

Kruger¹,

Kruger²,

Monyeki

et al. 2021

Journal of Hypertension

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Background: Obesity and hypertension prevalence among children are a concern, with limited evidence available on sex and ethnic differences in childhood blood pressure. We aimed to determine the number of children with hypertension and obesity to identify unique adiposity and blood pressure characteristics by sex and ethnicity, and to estimate the odds of having elevated blood pressure with increasing adiposity. Methods: We included 1062 healthy children (5–9 years of age) in an observational school-based study in South Africa. Pediatric validated automated devices were used to measure brachial blood pressure and performed pulse wave analysis to assess central hemodynamics. Standard anthropometry was carried out to determine body composition and demographic questionnaires were completed. Results: Almost 20% of children were overweight/obese and 14.1% had elevated blood pressure or hypertension (22.8%). Ethnic differences included greater adiposity in white compared with black children (all P < 0.0001), but higher DBP and total vascular resistance in black compared with white children (both P < 0.05). DBP and total vascular resistance were also higher in girls than boys (both P < 0.01). A 51–60% increased risk of developing elevated blood pressure was observed for 1SD (standard deviation) increase of sex-specific BMI [1.60 (1.4–1.8); P < 0.0001] and waist/height ratio [1.51 (1.3–1.7); P < 0.0001]. Conclusion: Unique sex and ethnic differences in body composition and blood pressure exist in prepubescent children, with overweight/obesity increasing the risk of elevated blood pressure. Our findings support primary prevention strategies to combat the growing burden of hypertension and obesity-related diseases in youth. Trial registration: The study is registered on ClinicalTrials.gov (NCT04056377).

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Section: Discussioncontrasting

confidence: 91%

A demographic approach to assess elevated blood pressure and obesity in prepubescent children: the ExAMIN Youth South Africa study

Kruger¹,

Kruger²,

Monyeki

et al. 2021

Journal of Hypertension

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“…While ethnic differences in CVD risk are documented, little is known about the exact genetic, epigenetic, and physiological determinants of such differences. The majority of child and adolescent studies reported higher BP, higher carotid intima media thickness (cIMT) [18], increased left ventricular mass [19] and higher pulse wave velocity (PWV) [20,21] among Black African, African-American, African-Caribbean and Hispanic populations in particular compared to Asian and White populations. These race-specific differences are to some extent explained by potential differences in intrauterine growth followed by effects of early weight gain and growth in body height and current stature [22].…”

Section: Risk Factors For Eva In Youthmentioning

confidence: 99%

Vascular Ageing in Youth: A Call to Action

Climie

Park

Avolio

et al. 2021

Heart, Lung and Circulation

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Extensive evidence shows that risk factors for cardiovascular disease (CVD) begin to develop early in life. Childhood obesity and elevated blood pressure (BP) have become overwhelmingly challenging, with 57% of today's children predicted to be obese by the age of 35 years, and global rates of hypertension in children and adolescents increasing by 75% from 2000 to 2015. Thus, there is an urgent need for tools that can assess early CVD risk in youth, which may lead to better risk stratification, preventative intervention, and personalised medicine. Vascular ageing (the deterioration in vascular structure and function) is a pivotal progenitor of health degeneration associated with elevated BP. Exposure to adverse environmental and genetic factors from fetal life promotes the development and accumulation of subclinical vascular changes that direct an individual towards a trajectory of early vascular ageing (EVA)-an independent predictor of target organ damage in the heart, brain, and kidneys. Therefore, characterising vascular ageing from youth may provide a window into cardiovascular risk later in life. However, vascular ageing measurements only have value when techniques are accurate/validated and when reliable thresholds are available for defining normal ranges and ranges that signal increased risk of disease. The aim of this paper is to summarise current evidence on the importance of vascular ageing assessment in youth and the impact of interventions to prevent or delay EVA, to highlight the need for standardisation and validation of measurement techniques in children and adolescents, and the importance of establishing reference values for vascular ageing measures in this population.

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“…Cardiovascular disease (CVD) is the leading cause of mortality worldwide, accounting for over 17 million deaths yearly ( 1 ). Among the most prominent risk factors for CVD is early vascular aging, characterized by arterial stiffness (arteriosclerosis) ( 2 ). There is extensive evidence that risk factors for CVD occur early in life, causing premature organ damage that tracks into adulthood ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Practice Change Needed for the Identification of Pediatric Hypertension in Marginalized Populations: An Example From South Africa

et al. 2022

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Introduction:Hypertension in children has increased globally over the past 20 years; yet, little is known about this issue among disadvantaged communities from low- and middle-income countries. Age-, sex-, and height-adjusted normative tables are the “gold” standard for the diagnosis and estimation of pediatric hypertension worldwide, but it is unclear whether the use of international standards is appropriate for all contexts. The purpose of this study was to evaluate and compare different international references to identify hypertension among South African school-aged children from disadvantaged communities.MethodsBlood pressure, weight, and height were measured in a cohort of 897 children aged 8–16 years from eight peri-urban schools in the Eastern Cape of South Africa. Cross-sectional prevalence of hypertension was calculated according to American, German, and global normative tables, as well as pseudo-normative data from the own study population. Isolated systolic hypertension and body mass index (BMI) were considered markers for cardiovascular disease. Multinomial logistic regression was used to compare the likelihood of blood pressure categorization with increasing BMI levels.ResultsHypertension prevalence ranged from 11.4% with the pseudo-normative study tables to 28.8% based on the German reference. Global guidelines showed the highest agreement both among international standards (92.5% with American guidelines) and with the study reference (72.5%). While the global and the American references presented higher systolic over diastolic hypertension rates (23.6 vs. 10.6% and 24.2 vs. 14.7%, respectively), the American guidelines predicted the highest increased risk for hypertension stage 2 [odds ratio, 1.72 (95% confidence interval: 1.43–2.07)] with raising levels of BMI.ConclusionOur results support the heterogeneity of blood pressure estimates found in the South African literature, and highlight the underrepresentation of African children in international guidelines. We call for caution in the use of international standards in different contexts and advocate for the development of normative tables that are representative of the South African pediatric population necessary to ensure an accurate identification of hypertension both from the clinical and epidemiological perspective.

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Racial differences of early vascular aging in children and adolescents

Cited by 16 publications

References 155 publications

A demographic approach to assess elevated blood pressure and obesity in prepubescent children: the ExAMIN Youth South Africa study

A demographic approach to assess elevated blood pressure and obesity in prepubescent children: the ExAMIN Youth South Africa study

Vascular Ageing in Youth: A Call to Action

Practice Change Needed for the Identification of Pediatric Hypertension in Marginalized Populations: An Example From South Africa

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