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Uber AM, Han J, Grimm P, Montez-Rath ME, Chaudhuri A. Defining systolic blood pressure normative values in hospitalized pediatric patients: a single center experience. Pediatr Res 2024; 95:1860-1867. [PMID: 38326477 DOI: 10.1038/s41390-024-03059-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/12/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Normative blood pressure (BP) values and definition of hypertension (HTN) in children in outpatient setting cannot be reliably used for inpatient therapy initiation. No normative exists to describe HTN in hospitalized pediatric populations. We aimed to study the prevalence of hypertension and produce normative BP values in hospitalized children. METHODS Cross sectional observational study of all children hospitalized on acute care floors, ≥2 and <18 years age, at Stanford Children's Hospital, from Jan-01-2014 to Dec-31-2018. Cohort included 7468 hospital encounters with a total of 118,423 automated, oscillometric, BPs measured in the upper extremity during a hospitalization of >24 hours. RESULTS Overall prevalence of HTN, defined by outpatient guidelines, was 12-48% in boys and 6-39% in girls, stage 1 systolic HTN in 12-38% of boys and 6-31% of girls, stage 2 systolic HTN in 3-10% of boys and 1-8% of girls. Centile curves were derived demonstrating overall higher BP reading for hospitalized patients compared to the outpatient setting. CONCLUSION Higher blood pressures are anticipated during hospitalization. Thresholds provided by the centile curves generated in this study may provide the clinician with some guidance on how to manage hospitalized pediatric patients based on clinical circumstances. IMPACT Hospitalized children have higher blood pressures compared to patients in the ambulatory setting, hence outpatient normative blood pressure values cannot be reliably used for inpatient therapy initiation. No normative exists to describe hypertension in hospitalized pediatric populations. The thresholds provided by the centile curves generated in this study may provide the clinician with some guidance on how to manage hospitalized pediatric patients based on clinical circumstances.
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Affiliation(s)
- Amanda M Uber
- Department of Nephrology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Jialin Han
- Department of Nephrology, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul Grimm
- Department of Pediatrics (Nephrology), Stanford University School of Medicine, Stanford, CA, USA
| | - Maria E Montez-Rath
- Department of Nephrology, Stanford University School of Medicine, Stanford, CA, USA
| | - Abanti Chaudhuri
- Department of Pediatrics (Nephrology), Stanford University School of Medicine, Stanford, CA, USA.
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Khan AA, Gupta PK, Baranwal AK, Jayashree M, Sahoo T. Comparison of Blood Pressure Measurements by Currently Available Multiparameter Monitors and Mercury Column Sphygmomanometer in Patients Admitted in Pediatric Intensive Care Unit. Indian J Crit Care Med 2023; 27:212-221. [PMID: 36960118 PMCID: PMC10028710 DOI: 10.5005/jp-journals-10071-24424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Background The multiparameter monitor (MPM) is replacing mercury column sphygmomanometers (MCS) in acute care settings. However, data on the former's accuracy in critically ill children are scarce and mostly extrapolated from adults. We compared non-invasive blood pressure (NIBP) measurements by MPMs with MCS in pediatric intensive care unit (PICU). Patients Adequately sedated and hemodynamically stabilized children (age, 1-144 months) were prospectively enrolled. Materials and methods Three NIBP measurements were obtained from MCS (Diamond®, India) and MPM (Intellivue MX800® or Ultraview SL®) in rapid succession in the upper limb resting in supine position. Respective three measurements were averaged to obtain a paired set of NIBP readings, one each from MCS and MPM. Such readings were obtained thrice a day. NIBP readings were then compared, and agreement was assessed. Results From 39 children [median age (IQR), 30 (10-72) months], 1,690 sets of NIBP readings were obtained. A-third of readings were from infants and children >96 months, while 383 (22.6%) readings were from patients on inotropes. Multiparameter monitors gave significantly higher NIBP readings compared to MCS [median systolic blood pressure (SBP), 6.5 (6.4-6.7 mm Hg); diastolic blood pressure (DBP), 4.5 (4.3-4.6 mm Hg); mean arterial pressure (MAP), 5.3 (5.1-5.4 mm Hg); p < 0.05]. It was consistent across age, gender, and critical care characteristics. Multiparameter monitors overestimated SBP in 80% of readings beyond the maximal clinically acceptable difference (MCAD). Conclusions Non-invasive blood pressure readings from MCS and MPMs are not interchangeable; SBP was 6-7 mm Hg higher with the latter. Overestimation beyond MCAD was overwhelming. Caution is required while classifying systolic hypotension with MPMs. Confirmation with auscultatory methods is advisable. More studies are required to evaluate currently available MPMs in different pediatric age groups. How to cite this article Khan AA, Gupta PK, Baranwal AK, Jayashree M, Sahoo T. Comparison of Blood Pressure Measurements by Currently Available Multiparameter Monitors and Mercury Column Sphygmomanometer in Patients Admitted in Pediatric Intensive Care Unit. Indian J Crit Care Med 2023;27(3):212-221.
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Affiliation(s)
- Adil Ahmed Khan
- Department of Neonatology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Pramod Kumar Gupta
- Department of Biostatistics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Kumar Baranwal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muralidharan Jayashree
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanushree Sahoo
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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High blood pressure in children and adolescents: current perspectives and strategies to improve future kidney and cardiovascular health. Kidney Int Rep 2022; 7:954-970. [PMID: 35570999 PMCID: PMC9091586 DOI: 10.1016/j.ekir.2022.02.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 02/08/2023] Open
Abstract
Hypertension is one of the most common causes of preventable death worldwide. The prevalence of pediatric hypertension has increased significantly in recent decades. The cause of this is likely multifactorial, related to increasing childhood obesity, high dietary sodium intake, sedentary lifestyles, perinatal factors, familial aggregation, socioeconomic factors, and ethnic blood pressure (BP) differences. Pediatric hypertension represents a major public health threat. Uncontrolled pediatric hypertension is associated with subclinical cardiovascular disease and adult-onset hypertension. In children with chronic kidney disease (CKD), hypertension is also a strong risk factor for progression to kidney failure. Despite these risks, current rates of pediatric BP screening, hypertension detection, treatment, and control remain suboptimal. Contributing to these shortcomings are the challenges of accurately measuring pediatric BP, limited access to validated pediatric equipment and hypertension specialists, complex interpretation of pediatric BP measurements, problematic normative BP data, and conflicting society guidelines for pediatric hypertension. To date, limited pediatric hypertension research has been conducted to help address these challenges. However, there are several promising signs in the field of pediatric hypertension. There is greater attention being drawn on the cardiovascular risks of pediatric hypertension, more emphasis on the need for childhood BP screening and management, new public health initiatives being implemented, and increasing research interest and funding. This article summarizes what is currently known about pediatric hypertension, the existing knowledge-practice gaps, and ongoing research aimed at improving future kidney and cardiovascular health.
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Haddad S, Boukhayma A, Caizzone A. Continuous PPG-Based Blood Pressure Monitoring Using Multi-Linear Regression. IEEE J Biomed Health Inform 2021; 26:2096-2105. [PMID: 34784288 DOI: 10.1109/jbhi.2021.3128229] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this work, we present a photoplethysmography-based blood pressure monitoring algorithm (PPG-BPM) that solely requires a photoplethysmography (PPG) signal. The technology is based on pulse wave analysis (PWA) of PPG signals retrieved from different body locations to continuously estimate the systolic blood pressure (SBP) and the diastolic blood pressure (DBP). The proposed algorithm extracts morphological features from the PPG signal and maps them to SBP and DBP values using a multiple linear regression (MLR) model. The performance of the algorithm is evaluated on the publicly available Multiparameter Intelligent Monitoring in Intensive Care (MIMIC I) database. We utilize 28 data-sets (records) from the MIMIC I database that contain both PPG and brachial arterial blood pressure (ABP) signals. The collected PPG and ABP signals are synchronized and divided into intervals of 30 seconds, called epochs. In total, we utilize 47153 \textit{clean} 30-second epochs for the performance analysis. Out of the 28 data-sets, we use only 2 data-sets (records 041 and 427 in the MIMIC I) with a total of 2677 \textit{clean} 30-second epochs to build the MLR model of the algorithm. For the SBP, a standard deviation of error (SDE) of 8.01 mmHg and a mean absolute error (MAE) of 6.10 mmHg between the arterial line and the PPG-based values are achieved, with a Pearson correlation coefficient r = 0.90, . For the DBP, an SDE of 6.22 mmHg and an MAE of 4.65 mmHg between the arterial line and the PPG-based values are achieved, with a Pearson correlation coefficient r = 0.85, . We also use a binary classifier for the BP values with the positives indicating SBP ≥ 130 mmHg and/or DBP ≥ 80 mmHg and the negatives indicating otherwise. The classifier results generated by the PPG-based SBP and DBP estimates achieve a sensitivity and a specificity of 79.11% and 92.37%, respectively.
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Haddad S, Boukhayma A, Di Pietrantonio G, Barison A, de Preux G, Caizzone A. Photoplethysmography Based Blood Pressure Monitoring Using the Senbiosys Ring. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1609-1612. [PMID: 34891593 DOI: 10.1109/embc46164.2021.9630161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this work, we evaluate the accuracy of our cuffless photoplethysmography based blood pressure monitoring (PPG-BPM) algorithm. The algorithm is evaluated on an ultra low power photoplethysmography (PPG) signal acquired from the Senbiosys Ring. The study involves six male subjects wearing the ring for continuous finger PPG recordings and non-invasive brachial cuff inflated every two to ten minutes for intermittent blood pressure (BP) measurements. Each subject performs the required recordings two to three times with at least two weeks difference between any two recordings. In total, the study includes 17 recordings 2.21 ± 0.89 hours each. The PPG recordings are processed by the PPG-BPM algorithm to generate systolic BP (SBP) and diastolic BP (DBP) estimates. For the SBP, the mean difference between the cuff-based and the PPG-BPM values is -0.28 ± 7.54 mmHg. For the DBP, the mean difference between the cuff-based and the PPG-BPM values is -1.30 ± 7.18 mmHg. The results show that the accuracy of our algorithm is within the 5 ± 8 mmHg ISO/ANSI/AAMI protocol requirement.
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Assessment of diastolic blood pressure with the auscultatory method in children and adolescents under exercise conditions. Hypertens Res 2021; 44:1009-1016. [PMID: 33837280 DOI: 10.1038/s41440-021-00657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/21/2021] [Accepted: 03/03/2021] [Indexed: 02/03/2023]
Abstract
Controversy surrounds whether to define resting diastolic blood pressure (DBP) as the onset of the fourth or fifth Korotkoff phase (K4, sound muffling, or K5, sound disappearance) in children and adolescents. Although undetectable in some children (due to sounds continuing to zero cuff pressure), K5 is currently recommended for consistency with adult practice and because K4 can be difficult to discern or undetectable. However, to our knowledge, no studies have specifically assessed the reliability of measuring DBP with K4 and K5 in children and adolescents under exercise conditions. We therefore measured DBP before and immediately after a Bruce protocol stress test in 90 children and adolescents aged 12.3 ± 3.5 years (mean ± SD) in a cardiology clinic setting. When detected, K4 and K5 were 63.5 ± 9.2 and 60.2 ± 12.6 mmHg, respectively, at rest and 59.2 ± 14.6 mmHg (p = 0.028 vs rest) and 52.9 ± 18.3 mmHg (p < 0.001), respectively, immediately post-exercise. K4 and K5 were not detected in 41% and 4% of participants at rest or in 29% and 37% post-exercise, respectively, while K5 resulted in unrealistic DBP values (<30 mmHg) in an additional 11%. Better exercise performance was associated with a more frequent absence of K5 post-exercise, and after excluding participants performing at <10th percentile for age, post-exercise K4 was absent in 23%, and plausible K5 values were not obtained in 59% (p < 0.001). Although neither K4 nor K5 alone were reliable measures of DBP immediately post-exercise, a novel hybrid approach using K4, if detected, or K5, if not, produced reasonable DBP measurements in 97% of participants.
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Hacıhamdioğlu DÖ, Koçak G, Doğan BN, Koyuncu E. Challenges in choosing the appropriate guidelines for use in children and adolescents with hypertension. Arch Pediatr 2021; 28:451-458. [PMID: 34226065 DOI: 10.1016/j.arcped.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/21/2021] [Accepted: 05/16/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND This study was designed to observe the effect of antihypertensive treatment on blood pressure (BP) and target organ damage in patients followed up according to the American Academy of Pediatrics Hypertension Guidelines (AAPG). The results were also assessed in comparison with the definitions and target organ damage according to the European Society of Hypertension Guidelines 2016 (ESHG). MATERIALS AND METHODS A total of 44 (34 male) out of 140 patients were enrolled in the study and the mean age was 14±3.19years. The follow-up period was at least 12months. All patients underwent the following assessments: anthropometrical measurements of body mass index (BMI), left ventricular mass index (LVMI), and biochemical parameters according to the relevant guidelines. The pre-treatment and post-treatment datasets collected were compared. RESULTS The frequency of symptomatic patients decreased from 88% to 30%. After treatment, 29.4% (n=13) of patients still had elevated and stage 1 hypertension (HT) according to the AAPG. These patients were older and had higher BMI z-scores, LVMI z-scores, mean BP indices, and also had longer symptom duration than normotensive patients (P<0.001). When patients were assessed according to the ESHG, 34.1% (n=15) of patients had high-normal stage 1 and stage 2 HT. While 53.3% (n=8) of the patients aged 13-15years were classified as having high-normal stage 1 and stage 2 HT according to the ESHG, 33.3% (n=5) were classified as having elevated BP and stage 1 HT according to the AAPG. Additionally, 36.4% (n=4) of the patients aged≥16years were classified as having high-normal and stage 1 HT according to the ESHG, whereas 45.5% (n=5) were classified as having elevated BP and stage 1 HT according to the AAPG. CONCLUSION To control HT in children with higher BMI z-scores, higher LVMI z-scores, and higher BP indices, an earlier and more intensive approach is needed. Considering that the duration of exposure to HT may also affect the LVMI, adjusting age and gender or decreasing the current thresholds for LVMI may lead to an earlier diagnosis for more patients. According to the present classifications, the ESHG covers more children aged between 13 and 15years in contrast to the AAPG, which covers more patients aged≥16years. However, further studies are needed to confirm these results.
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Affiliation(s)
- D Ö Hacıhamdioğlu
- Bahçeşehir University Faculty of Medicine, Medical Park Göztepe Hospital, Department of Pediatrics, Division of Pediatric Nephrology, Istanbul, Turkey.
| | - G Koçak
- Bahçeşehir University Faculty of Medicine, Medical Park Göztepe Hospital, Department of Pediatrics, Division of Pediatric Nephrology, Istanbul, Turkey
| | - B N Doğan
- Bahçeşehir University Faculty of Medicine, Istanbul, Turkey
| | - E Koyuncu
- Bahçeşehir University Faculty of Medicine, Istanbul, Turkey
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Ni Y, Szpiro AA, Young MT, Loftus CT, Bush NR, LeWinn KZ, Sathyanarayana S, Enquobahrie DA, Davis RL, Kratz M, Fitzpatrick AL, Sonney JT, Tylavsky FA, Karr CJ. Associations of Pre- and Postnatal Air Pollution Exposures with Child Blood Pressure and Modification by Maternal Nutrition: A Prospective Study in the CANDLE Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:47004. [PMID: 33797937 PMCID: PMC8043131 DOI: 10.1289/ehp7486] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Limited data suggest air pollution exposures may contribute to pediatric high blood pressure (HBP), a known predictor of adult cardiovascular diseases. METHODS We investigated this association in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study, a sociodemographically diverse pregnancy cohort in the southern United States with participants enrolled from 2006 to 2011. We included 822 mother-child dyads with available address histories and a valid child blood pressure measurement at 4-6 y. Systolic (SBP) and diastolic blood pressures (DBP) were converted to age-, sex-, and height-specific percentiles for normal-weight U.S. children. HBP was classified based on SBP or DBP ≥ 90 th percentile. Nitrogen dioxide (NO 2 ) and particulate matter ≤ 2.5 μ m in aerodynamic diameter (PM 2.5 ) estimates in both pre- and postnatal windows were obtained from annual national models and spatiotemporal models, respectively. We fit multivariate Linear and Poisson regressions and explored multiplicative joint effects with maternal nutrition, child sex, and maternal race using interaction terms. RESULTS Mean PM 2.5 and NO 2 in the prenatal period were 10.8 [standard deviation (SD): 0.9] μ g / m 3 and 10.0 (SD: 2.4) ppb, respectively, and 9.9 (SD: 0.6) μ g / m 3 and 8.8 (SD: 1.9) ppb from birth to the 4-y-old birthday. On average, SBP percentile increased by 14.6 (95% CI: 4.6, 24.6), and DBP percentile increased by 8.7 (95% CI: 1.4, 15.9) with each 2 - μ g / m 3 increase in second-trimester PM 2.5 . PM 2.5 averaged over the prenatal period was only significantly associated with higher DBP percentiles [β = 11.6 (95% CI: 2.9, 20.2)]. Positive associations of second-trimester PM 2.5 with SBP and DBP percentiles were stronger in children with maternal folate concentrations in the lowest quartile (p interaction = 0.05 and 0.07, respectively) and associations with DBP percentiles were stronger in female children (p interaction = 0.05). We did not detect significant association of NO 2 , road proximity, and postnatal PM 2.5 with any outcomes. CONCLUSIONS The findings suggest that higher prenatal PM 2.5 exposure, particularly in the second trimester, is associated with elevated early childhood blood pressure. This adverse association could be modified by pregnancy folate concentrations. https://doi.org/10.1289/EHP7486.
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Affiliation(s)
- Yu Ni
- Department of Epidemiology, School of Public Health, University of Washington (UW), Seattle, Washington, USA
| | - Adam A. Szpiro
- Department of Biostatistics, School of Public Health, UW, Seattle, Washington, USA
| | - Michael T. Young
- Department of Environmental and Occupational Health Sciences, School of Public Health, UW, Seattle, Washington, USA
| | - Christine T. Loftus
- Department of Environmental and Occupational Health Sciences, School of Public Health, UW, Seattle, Washington, USA
| | - Nicole R. Bush
- Department of Psychiatry, School of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
- Department of Pediatrics, School of Medicine, UCSF, San Francisco, California, USA
| | - Kaja Z. LeWinn
- Department of Psychiatry, School of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Sheela Sathyanarayana
- Department of Environmental and Occupational Health Sciences, School of Public Health, UW, Seattle, Washington, USA
- Department of Pediatrics, School of Medicine, UW, Seattle, Washington, USA
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Daniel A. Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington (UW), Seattle, Washington, USA
- Department of Health Services, School of Public Health, UW, Seattle, Washington, USA
| | - Robert L. Davis
- Center for Biomedical Informatics, University of Tennessee Health Science Center (UTHSC), Memphis, Tennessee, USA
- Department of Pediatrics, UTHSC, Memphis, Tennessee, USA
| | - Mario Kratz
- Department of Epidemiology, School of Public Health, University of Washington (UW), Seattle, Washington, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Annette L. Fitzpatrick
- Department of Epidemiology, School of Public Health, University of Washington (UW), Seattle, Washington, USA
- Department of Family Medicine, School of Medicine, UW, Seattle, Washington, USA
- Department of Global Health, School of Public Health, UW, Seattle, Washington, USA
| | - Jennifer T. Sonney
- Department of Child, Family, and Population Health Nursing, School of Nursing, UW, Seattle, Washington, USA
| | | | - Catherine J. Karr
- Department of Epidemiology, School of Public Health, University of Washington (UW), Seattle, Washington, USA
- Department of Environmental and Occupational Health Sciences, School of Public Health, UW, Seattle, Washington, USA
- Department of Pediatrics, School of Medicine, UW, Seattle, Washington, USA
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Placide Kambola K, Emmanuel Kiyana M, Clarence Kaut M, Jaques Mbaz M, Jeef Paul B, Christian Ngama K, Dophra Ngoy N, Olivier M. Prevalence and associated factors of elevated blood pressure in adolescents in schools in Lubumbashi, Democratic Republic of Congo. ARCHIVES OF CLINICAL HYPERTENSION 2021:001-006. [DOI: 10.17352/ach.000029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Al Salloum AA, El Mouzan MI, Al Sharqawi AH, Al Omar AA, Alqurashi MM, Al Herbish AS. Blood pressure standards for pre-school children in Saudi Arabia. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2021; 31:1281-1293. [PMID: 33565440 DOI: 10.4103/1319-2442.308337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The prevalence of hypertension (HTN) in children is increasing. Early detection of HTN in childhood may prevent the occurrence of complications in adult age. Blood pressure (BP) varies between populations according to ethnic and environmental factors. Based on these variations, reference norms developed for one particular population may not be applicable to others. Thus, this study aimed to provide age-, gender-, and height-related BP reference standards using oscillometric techniques for pre-school children in Saudi Arabia. A sub-sample of preschool children aged from 2 to 6 years was selected by multi-stage probability sampling of Saudi population. The samples represented Saudi children from the whole country. Data were collected through a house-to-house survey of all selected households in all 13 regions in the country. Oscillometric devices were used to measure the BP. Data were analyzed to study the distribution pattern of systolic (SBP) and diastolic BP (DBP) and to develop reference values based on age, gender, and height. The values for each age and height percentile were compared with the recent (2017) values of the North American children. A total of 2553 Saudi Arabian children (1299 boys and 1254 girls) aged 2-6 years with complete data on age, gender, height, SBP, and DBP were considered for analysis. Values for SBP and DBP were significantly higher in Saudi children than in the North American children. This study adds evidence to the BP variations between populations with influences such as genetic and environmental factors. The need of every population to define its normal BP standards is essential to avoid unnecessary investigations and anxiety in patients and their parents.
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Affiliation(s)
- Abdullah A Al Salloum
- Department of Pediatrics, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed I El Mouzan
- Department of Pediatrics, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad H Al Sharqawi
- Department of Biostatistics, Prince Naif Health Research Center, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad A Al Omar
- King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
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Al-Riyami H, Nadar SK. The mercury sphygmomanometer: soon a museum piece! J Hum Hypertens 2020; 35:490-491. [PMID: 33288858 DOI: 10.1038/s41371-020-00462-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/09/2020] [Accepted: 11/25/2020] [Indexed: 11/09/2022]
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Varney EJ, Van Drunen AM, Moore EF, Carlin K, Thomas K. Blood Pressure Measurement Error in Children: Lessons in Measurement Reliability. J Nurs Meas 2020; 27:114-125. [PMID: 31068495 DOI: 10.1891/1061-3749.27.1.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Blood pressure measurement represents the pressure exerted during heart ejection and filling. There are several ways to measure blood pressure and a valid measure is essential. The purpose of this study was to evaluate the approach to noninvasive blood pressure measurement in children. METHODS Blood pressure measurements were taken using the automatic Phillips MP30 monitor and compared against Welch Allyn blood pressure cuffs with Medline manual sphygmomanometers. RESULTS A total of 492 measurements were taken on 82 subjects, and they demonstrated comparability between automatic and manual devices. CONCLUSIONS Although our study indicated acceptable agreement between automatic and manual blood pressure measurement, it also revealed measurement error remains a concern, with sample size, study protocol, training, and environment all playing a role.
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Li Z, Yan C, Zhao W, Hu J, Jia D, Wang H, You T. A Novel Method for Calibration-Based Cuff-Less Blood Pressure Estimation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:4266-4269. [PMID: 31946811 DOI: 10.1109/embc.2019.8857373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cuff-less blood pressure estimation technology is useful for cardiovascular disease monitoring. However, without calibration, cuff-less blood pressure estimation is hard to achieve clinical acceptable performance. The traditional methods are always calibrated with retraining. With the increases of the parameters number, the cost of model retraining increases several times. So we propose a novel blood pressure estimation method, which can be calibrated with reference inputs rather than with retraining. The experiment results suggest that the method we proposed can achieve clinical performance (SBP:-0.004 ± 5.869 mmHg, DBP:-0.004±4.511 mmHg) with low calibration cost.
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Hagedoorn NN, Zachariasse JM, Moll HA. A comparison of clinical paediatric guidelines for hypotension with population-based lower centiles: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:380. [PMID: 31775858 PMCID: PMC6882047 DOI: 10.1186/s13054-019-2653-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/21/2019] [Indexed: 12/29/2022]
Abstract
Background Different definitions exist for hypotension in children. In this study, we aim to identify evidence-based reference values for low blood pressure and to compare these with existing definitions for systolic hypotension. Methods We searched online databases until February 2019 (including MEDLINE, EMBASE, Web of Science) using a comprehensive search strategy to identify studies that defined age-related centiles (first to fifth centile) for non-invasive systolic blood pressure in healthy children < 18 years. Existing cut-offs for hypotension were identified in international guidelines and textbooks. The age-related centiles and clinical cut-offs were compared and visualized using step charts. Results Fourteen studies with population-based centiles were selected, of which 2 addressed children < 1 year. Values for the fifth centile differed 8 to 17 mmHg for age. We identified 13 clinical cut-offs of which only 5 reported accurate references. Age-related cut-offs for hypotension showed large variability (ranging from 15 to 30 mmHg). The clinical cut-offs varied in agreement with the low centiles. The definition from Paediatric Advanced Life Support agreed well for children < 12 years but was below the fifth centiles for children > 12 years. For children > 12 years, the definition of Parshuram’s early warning score agreed well, but the Advanced Paediatric Life Support definition was above the fifth centiles. Conclusions The different clinical guidelines for low blood pressure show large variability and low to moderate agreement with population-based lower centiles. For children < 12 years, the Paediatric Advanced Life Support definition fits best but it underestimates hypotension in older children. For children > 12 years, the Advanced Paediatric Life Support overestimates hypotension but Parshuram’s cut-off for hypotension in the early warning score agrees well. Future studies should focus on developing reference values for hypotension for acutely ill children.
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Affiliation(s)
- Nienke N Hagedoorn
- Department of Paediatrics, Room Sp 1540, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, PO Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - Joany M Zachariasse
- Department of Paediatrics, Room Sp 1540, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, PO Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - Henriette A Moll
- Department of Paediatrics, Room Sp 1540, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, PO Box 2060, 3000 CB, Rotterdam, The Netherlands.
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16
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Evaluation and management of elevated blood pressures in hospitalized children. Pediatr Nephrol 2019; 34:1671-1681. [PMID: 30171355 DOI: 10.1007/s00467-018-4070-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/14/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
Elevated blood pressures (BP) are common among hospitalized children and, if not recognized and treated promptly, can lead to potentially significant consequences. Even though we have normative BP data and well-developed guidelines for the diagnosis and management of hypertension (HTN) in the ambulatory setting, our understanding of elevated BPs and their relationship to HTN in hospitalized children is limited. Several issues have hampered our ability to diagnose and manage HTN in the inpatient setting including the common presence of physiologic conditions, which are associated with transient BP elevations (i.e., pain or anxiety), non-standard approaches to BP measurement, a lack of clarity regarding appropriate diagnostic and therapeutic thresholds, and marginal outcome data. The purpose of this review is to highlight the issues and challenges surrounding BP monitoring, assessment of elevated BPs, and the diagnosis of HTN in hospitalized children. Extrapolating from currently available clinical practice guidelines and utilizing the best data available, we aim to provide guidelines regarding evaluation and treatment of elevated BP in hospitalized children.
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17
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Kim SH, Park Y, Song YH, An HS, Shin JI, Oh JH, Lee JW, Kim SH, Kim HS, Shin HJ, Lee HK, Park YB, Lee HY, Kim NS, Ha IS, Ahn S, Lee W, Hong YM. Blood Pressure Reference Values for Normal Weight Korean Children and Adolescents: Data from The Korea National Health and Nutrition Examination Survey 1998-2016: The Korean Working Group of Pediatric Hypertension. Korean Circ J 2019; 49:1167-1180. [PMID: 31456368 PMCID: PMC6875600 DOI: 10.4070/kcj.2019.0075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/21/2019] [Accepted: 07/10/2019] [Indexed: 01/30/2023] Open
Abstract
Background and Objectives Hypertension is becoming one of the most common health conditions in children and adolescents due to increasing childhood obesity. We aimed to provide the auscultatory blood pressure (BP) normative reference values for Korean non-overweight children and adolescents. Methods BP measurements in children and adolescents aged 10 to 18 years were performed in the Korean National Health and Nutrition Examination Survey (KNHANES) from 1998 to 2016. BP was measured using a mercury sphygmomanometer. Sex-, age- and height-specific systolic BP (SBP) and diastolic BP (DBP) percentiles were calculated in the non-overweight children (n=10,442). We used the General Additive Model for Location Scale and Shape method to calculate BP percentiles. Results The 50th, 90th, 95th, and 99th percentiles of SBP and DBP tables and graphs of non-overweight children and adolescents aged 10 to 18 years were presented by age and height percentiles. We found that the SBP and DBP at the 95th percentile were well correlated with height. The BP tables presented by height contained BP values from 124 cm to 190 cm for boys and from 120 cm to 178 cm for girls. Boys had higher SBP and DBP. Conclusions We provided the sex-, age- and height-specific auscultatory BP values using the KNHANES big data. These may be useful in diagnosis and treatment of hypertension in Korean children and adolescents.
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Affiliation(s)
- Sung Hye Kim
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea.,The Korean Working Group of Pediatric Hypertension, Seoul, Korea
| | - Youngmi Park
- Medical Research Collaborating Center, Seongnam, Korea
| | - Young Hwan Song
- The Korean Working Group of Pediatric Hypertension, Seoul, Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Hyo Soon An
- The Korean Working Group of Pediatric Hypertension, Seoul, Korea.,Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jae Il Shin
- The Korean Working Group of Pediatric Hypertension, Seoul, Korea.,Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Hee Oh
- The Korean Working Group of Pediatric Hypertension, Seoul, Korea.,Department of Pediatrics, The Catholic University of Korea, St.Vincent's Hospital, Suwon, Korea
| | - Jung Won Lee
- The Korean Working Group of Pediatric Hypertension, Seoul, Korea.,Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
| | - Seong Heon Kim
- The Korean Working Group of Pediatric Hypertension, Seoul, Korea.,Department of Pediatrics, Pusan National University Children's Hospital, Pusan, Korea
| | - Hae Soon Kim
- The Korean Working Group of Pediatric Hypertension, Seoul, Korea.,Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hye Jung Shin
- The Korean Working Group of Pediatric Hypertension, Seoul, Korea.,Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Hae Kyoung Lee
- The Korean Working Group of Pediatric Hypertension, Seoul, Korea.,Department of Pediatrics, VHS Medical Center, Seoul, Korea
| | - Yeong Bong Park
- The Korean Working Group of Pediatric Hypertension, Seoul, Korea.,Department of Pediatrics, Chosun University School of Medicine, Gwangju, Korea
| | - Hae Yong Lee
- The Korean Working Group of Pediatric Hypertension, Seoul, Korea.,Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Nam Su Kim
- The Korean Working Group of Pediatric Hypertension, Seoul, Korea.,Department of Pediatrics, Hanyang University Hospital, Seoul, Korea
| | - Il Soo Ha
- The Korean Working Group of Pediatric Hypertension, Seoul, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woojoo Lee
- Department of Statistics, Inha University, Incheon, Korea
| | - Young Mi Hong
- The Korean Working Group of Pediatric Hypertension, Seoul, Korea.,Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
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18
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Choi S, Kim YM, Shin J, Lim YH, Choi SY, Choi BY, Oh KW, Lee HM, Woo KJ. Comparison of the accuracy and errors of blood pressure measured by 2 types of non-mercury sphygmomanometers in an epidemiological survey. Medicine (Baltimore) 2018; 97:e10851. [PMID: 29923975 PMCID: PMC6023853 DOI: 10.1097/md.0000000000010851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A few studies have compared auscultation and oscillometric devices with the mercury sphygmomanometer (MS) reference values for blood pressure (BP) measurement in an epidemiologic survey.Four trained observers recorded BP measurements from 766 subjects from general Korean population in 2014 and 2015. Measurements were repeated 3 times for each device, alternately using an MS and 2 electronic devices (EDs; Greenlight 300 vs Omron HEM-907), together with a randomized device sequence. The BP measurement difference was defined as BP measured by MS minus BP obtained by ED, and the absolute error as the absolute value of the difference.Mean differences in systolic BP (SBP) were -0.52 and -0.62 mmHg and those of diastolic BP (DBP) were -0.78 and 6.23 mmHg (P < .01) in the Greenlight and Omron device group, respectively. The concordance correlation coefficients were 0.97 and 0.94 for SBP and 0.95 and 0.76 for DBP in the Greenlight and Omron group, respectively (P < .05). Kappa values for the Joint National Committee 7 BP classification were 0.84 and 0.74 for Greenlight and Omron group, respectively. The prevalence of normotension, prehypertension and hypertension were 53.5%, 33.9%, and 12.5% with the MS and 59.8%, 29.0%, and 11.2% with the ED in the Omron group (P = .03, McNemar test), whereas they were insignificant in the Greenlight group.The Greenlight 300 may be a good alternative to the MS, and the Omron HEM-907 has good accuracy in SBP measurement. Due to the measurement error in DBP, Omron HEM-907 was inferior to the Greenlight device.
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Affiliation(s)
- SeongIl Choi
- Department of Cardiology, Hanyang University Hanmaeum Changwon Hospital, Changwon
| | - Yu-Mi Kim
- Department of Preventive Medicine, Dong-A University College of Medicine, Busan
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine
| | - Sung-Yong Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul
| | - Bo-Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul
| | - Kyung-Won Oh
- Division of Health and Nutrition Survey, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Hyung-Min Lee
- Division of Health and Nutrition Survey, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Kyung-Ji Woo
- Division of Health and Nutrition Survey, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
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19
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The Prevalence of Elevated Blood Pressure in a Sample of Slovene Children and Adolescents: a Pilot Study. Zdr Varst 2018; 57:72-80. [PMID: 29651318 PMCID: PMC5894461 DOI: 10.2478/sjph-2018-0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/18/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction The aim of our study was to determine the prevalence of prehypertensive and elevated blood pressure in the hypertensive range (elevated BP) and obtain some anthropometric measures in Slovene children and adolescents. Methods In the cross-sectional study lasting one year, we measured BP using mercury sphygmomanometers, as well as height, weight, waist, and hip circumferences in schools. Data from regular check-ups (oscillometric measurements) were also added to increase the sample size. Participants were 2-19 years old. For statistical analysis, we used two-sided multivariate analysis of variance, Pearson’s r, and chi-squared test. Results From altogether 1594 participants, 723 (45.4%) were boys and 871 (54.6%) girls. The prevalence of elevated BP on a single oscillometric blood-pressure measurement was 12.0% (95% CI: 10.3 to 13.9), and an additional 13.9% (95% CI: 12.0 to 15.9) had prehypertensive BP. In Riva-Rocci measurements, elevated BP was present in only 7.1% (95% CI: 4.9 to 10.1) and prehypertensive BP additionally in 3.9% (95% CI: 2.4 to 6.4) in comparison to oscillometric measurements, which showed higher prevalence. Importantly, overweight participants had a 1.75 times greater relative risk for prehypertensive BP (95% CI: 1.22 to 2.53; p<0.01). Obesity carried a 1.79 times greater relative risk (95% CI: 1.22 to 2.63; p<0.01) for BP outside of the normotensive BP range. Conclusion Arterial hypertension is becoming an important public health problem, especially due to the childhood obesity. It seems to concern also Slovene young population with prevalence of elevated BP at around 7.1% after a single auscultatory BP measurement.
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20
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Evidence on the accuracy of automated blood pressure monitors in children: quantity versus quality. J Hypertens 2018; 35:896-897. [PMID: 28248907 DOI: 10.1097/hjh.0000000000001281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Xu J, Jiang J, Zhou H, Yan Z. A novel Blood Pressure estimation method combing Pulse Wave Transit Time model and neural network model. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2130-2133. [PMID: 29060318 DOI: 10.1109/embc.2017.8037275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Blood Pressure (BP) measurement can assist doctors to assess patients' cardiovascular status and diagnose heart diseases. Pulse Wave Transit Time (PWTT) model is one frequently used BP estimation method to monitor BP continuously in clinics. However, individual variations may influence the measurement accuracy of PWTT model. Focusing on above promble, this paper proposes a novel BP estimation method combining a classical PWTT model and a neural network model. The novel method is composed of five steps: signal pre-processing, feature extraction, initial PWTT model selection, model correction by neural network model, and final PWTT model identification. A validation experiment based on 10 patients from Multiparameter Intelligent Monitoring in Intensive Care (MIMIC) database showed that the BP estimation results by our method had a minimum mean of error readout value 5 mmHg with a standard deviation of error readout value ±8mmHg. As a result, both the diastolic blood pressure and systolic blood pressure estimation by our method can meet clinical requirements.
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22
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Molinero A, Cervero M, Magro MC, Partearroyo T, Zuluaga P, Martín A. [Blood pressure values in adolescents in the Community of Madrid: Tables based on the MEPAFAC Study]. HIPERTENSION Y RIESGO VASCULAR 2017; 34:157-164. [PMID: 28576401 DOI: 10.1016/j.hipert.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/17/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION High blood pressure (HBP) is a modifiable cardiovascular risk factor and its detection at early ages may allow strategies to be designed to reduce cardiovascular risk in adulthood. OBJECTIVES To provide blood pressure (BP) values in a sample of adolescents using an electronic oscillometric device. MATERIAL AND METHODS BP was measured according the European Society of Hypertension guidelines using an oscillometric device. Height and weight were also measured. Four height groups were used in order to associate the 90, 95, and 99 percentiles with systolic BP (pSBP) and diastolic BP percentiles (pDBP) for sex and age: H150 (≤ 150cm), H160(151-160cm), H170(161-170cm), and H180(≥171cm). RESULTS Data from 2,758 students aged 12-17 years were included in the analysis. BP increases with age, with differences of up to 11mmHg in boys vs. 3mmHg in girls for SBP and 3mmHg vs. 1mmHg for DBP. In high SBP, for the younger adolescents, the difference related to height was 15mmHg in boys vs. 8mmHg in girls, with no significant increase in the older ones in either gender. The high BDP varied depending on the height, 10mmHg in younger boys and 3mmHg in older ones, while in girls the variation was 3mmHg for all ages. CONCLUSIONS SBP/DBP in adolescents increases with age and also with height, giving similar figures in the taller ones, regardless of age.
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Affiliation(s)
- A Molinero
- Grupo de trabajo en Hipertensión y Riesgo Vascular, Sociedad Española de Farmacia Familiar y Comunitaria (SEFAC); Departamento de Ciencias Biomédicas, Universidad Alcalá de Henares, Alcalá de Henares, España.
| | - M Cervero
- Grupo de trabajo en Hipertensión y Riesgo Vascular, Sociedad Española de Farmacia Familiar y Comunitaria (SEFAC); Farmacia comunitaria en Madrid, Madrid, España
| | - M C Magro
- Grupo de trabajo en Hipertensión y Riesgo Vascular, Sociedad Española de Farmacia Familiar y Comunitaria (SEFAC); Farmacia comunitaria en Torrejón de Ardoz, Torrejón de Ardoz, España
| | - T Partearroyo
- Departamento de Ciencias Farmacéuticas y de la Salud, Universidad CEU-San Pablo, Madrid, España
| | - P Zuluaga
- Departamento de Estadística e Investigación Operativa, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - A Martín
- Grupo de trabajo en Hipertensión y Riesgo Vascular, Sociedad Española de Farmacia Familiar y Comunitaria (SEFAC); Farmacia comunitaria en Córdoba, Córdoba, España
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23
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Šuláková T, Šuláková A, Strnadel J, Pavlíček J, Obermannová B, Feber J. Can auscultatory blood pressure normative values be used for evaluation of oscillometric blood pressure in children? J Clin Hypertens (Greenwich) 2017; 19:381-387. [PMID: 28383188 DOI: 10.1111/jch.12943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/26/2016] [Accepted: 09/02/2016] [Indexed: 11/28/2022]
Abstract
The aim of the study was to analyze whether auscultatory normative values (Fourth Task Force [4TF]) can be applied to blood pressure (BP) obtained by oscillometric devices. The authors performed a retrospective analysis of oscillometric office BP and ambulatory BP monitoring in 229 children (116 boys), median age 15.31 years. Office systolic BP (SBP) and diastolic BP (DBP) values were converted into Z scores using 4TF and oscillometric (German Health Interview and Examination Survey for Children and Adolescent [KiGGS]) reference values. There was good correlation between the two normative methods (r=0.9773 for SBP, r=0.9627 for DBP). Results from Bland-Altman test revealed only minimal differences in Z scores between 4TF and KiGGS for SBP, but a significant proportional error for DBP. 4TF and KiGGS Z scores were equally predictive of ambulatory hypertension. In conclusion, auscultatory and oscillometric normative data are interchangeable for SBP but not for DBP.
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Affiliation(s)
- Terezie Šuláková
- Department of Pediatrics, University Hospital Ostrava and Medical Faculty University of Ostrava, Ostrava, Czech Republic
| | - Astrida Šuláková
- Department of Pediatrics, University Hospital Ostrava and Medical Faculty University of Ostrava, Ostrava, Czech Republic
| | - Jiří Strnadel
- Department of Pediatrics, University Hospital Ostrava and Medical Faculty University of Ostrava, Ostrava, Czech Republic
| | - Jan Pavlíček
- Department of Pediatrics, University Hospital Ostrava and Medical Faculty University of Ostrava, Ostrava, Czech Republic
| | - Barbora Obermannová
- Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Janusz Feber
- Children Hospital of Eastern Ontario Ottawa and University of Ottawa, Ottawa, ON, Canada
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24
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Jardim TV, Gaziano TA, Nascente FM, Carneiro CDS, Morais P, Roriz V, Mendonça KL, Póvoa TIR, Barroso WKS, Sousa ALL, Jardim PCV. Office blood pressure measurements with oscillometric devices in adolescents: a comparison with home blood pressure. Blood Press 2017; 26:272-278. [PMID: 28376650 DOI: 10.1080/08037051.2017.1312279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Compare multiple in office BP measurements in adolescents using an oscillometric device with out-of-office blood pressure measurements (home blood pressure monitoring - HBPM). MATERIALS AND METHODS Office measurements were performed with validated semi-automatic devices twice (3 minutes interval) in two different moments (1 week apart), with a total of four readings. These BP readings were named R1, R2, R3 and R4 (following the sequence they were performed), FDM (mean of two readings on first day) and SDM (mean of two readings on second day) and SRM (R2-R4 means). The HBPM protocol included two day-time and two evening-time measurements over 6 days. RESULTS A total of 1024 students between 12 and 17 years were included (mean age 14.68 years; 52.4% females). The mean systolic blood pressure (SBP) values of R2, SDM and SRM were similar to HBPM values. Regarding diastolic blood pressure (DBP) HBPM value was different than R4. High SBP and DBP correlation coefficients with HBPM values were found for R2, SDM and SRM values. CONCLUSION The second office BP measurement performed with an oscilometric device in adolescents was comparable to HBPM values, suggesting that two office readings might be suitable to rule out hypertension in this age group.
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Affiliation(s)
- Thiago Veiga Jardim
- a Hypertension League - Federal University of Goias , Goiânia , GO , Brazil.,b Brigham & Women's Hospital - Division of Cardiovascular Medicine , Boston , MA , USA.,c Harvard TH Chan School of Public Health - Department of Health Policy and Management , Center for Health Decision Science , Boston , MA , USA
| | - Thomas A Gaziano
- b Brigham & Women's Hospital - Division of Cardiovascular Medicine , Boston , MA , USA.,c Harvard TH Chan School of Public Health - Department of Health Policy and Management , Center for Health Decision Science , Boston , MA , USA
| | | | | | - Polyana Morais
- a Hypertension League - Federal University of Goias , Goiânia , GO , Brazil
| | - Vanessa Roriz
- a Hypertension League - Federal University of Goias , Goiânia , GO , Brazil
| | | | - Thaís Inácio Rolim Póvoa
- a Hypertension League - Federal University of Goias , Goiânia , GO , Brazil.,d School of Physical Education and Therapy (ESEFFEGO) , State University of Goiás (UEG) , Goiânia , GO , Brazil
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25
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Fonseca-Reyes S, Romero-Velarde E, Torres-Gudiño E, Illescas-Zarate D, Forsyth-MacQuarrie AM. Comparison of auscultatory and oscillometric BP measurements in children with obesity and their effect on the diagnosis of arterial hypertension. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 88:16-24. [PMID: 28238543 DOI: 10.1016/j.acmx.2017.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The level of agreement between two blood pressure (BP) reading methods, auscultatory vs oscillometric, was examined using a mercury sphygmomanometer and an electronic device in children and adolescents with different levels of obesity. The readings were compared to determine their impact on the diagnosis of pre-hypertension/hypertension. METHODS Blood pressure readings were taken in children with obesity (body mass index ≥ 95th percentile) and severe obesity (≥120% 95th percentile). Bland-Altman analysis and Intraclass Correlation Coefficient were used to determine the agreement between measurements. RESULTS The mercury sphygmomanometer readings were lower than those obtained with the electronic device for both systolic and diastolic BP (P=.01 and P=.001, respectively). The mean systolic and diastolic BP differences between the oscillometric vs first mercury reading were 4.2/10.2mmHg, respectively. A large difference was observed between the BP measurement methods. The ICC showed regular to moderate reliability for the systolic BP (.595), but poor for the diastolic BP (.330). Screening using the first of three mercury measurements showed that 10.4% of the children and adolescents had BPs within the pre-hypertension/hypertension range. This was reduced to 5.2% when the mean of three mercury readings was used. CONCLUSIONS Large discrepancies were observed in both the systolic and diastolic BP. These differences are not clinically acceptable as to consider the two instruments interchangeable. The electronic device readings were higher, and they overestimated the diagnosis of hypertension.
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Affiliation(s)
- Salvador Fonseca-Reyes
- Instituto de Investigación Cardiovascular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Nuevo Hospital Civil de Guadalajara, Mexico.
| | - Enrique Romero-Velarde
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Nuevo Hospital Civil de Guadalajara, Mexico
| | - Edith Torres-Gudiño
- Instituto de Investigación Cardiovascular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Nuevo Hospital Civil de Guadalajara, Mexico
| | - Daniel Illescas-Zarate
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Nuevo Hospital Civil de Guadalajara, Mexico
| | - Avril M Forsyth-MacQuarrie
- Instituto de Investigación Cardiovascular, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Nuevo Hospital Civil de Guadalajara, Mexico
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27
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Marlais M, Lyttle MD, Inwald D. Ten concerns about blood pressure measurement and targets in paediatric sepsis. Intensive Care Med 2016; 43:433-435. [DOI: 10.1007/s00134-016-4642-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/01/2016] [Indexed: 11/25/2022]
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28
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Olgun G, John E. Hypertension in the Pediatric Intensive Care Unit. J Pediatr Intensive Care 2016; 5:50-58. [PMID: 31110885 PMCID: PMC6512408 DOI: 10.1055/s-0035-1564796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 11/01/2014] [Indexed: 10/22/2022] Open
Abstract
Hypertension in the pediatric intensive care unit (PICU) is common and it contributes to the overall morbidity and mortality. Patients may present with hypertensive emergencies or hypertension can manifest itself later in PICU course. Although hypertension can be seen in most patients during hospitalization, patients with some specific diseases and conditions are more prone to hypertension. Hypertension should be recognized promptly and treated accordingly. Different pathophysiologic mechanisms can be responsible for the hypertension and management differs based on the underlying etiology. Any patient with a hypertensive emergency must be admitted to PICU, and treatment and diagnostic workup should be initiated immediately.
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Affiliation(s)
- Gokhan Olgun
- Department of Pediatric Critical Care Medicine, University of Chicago, Chicago, Illinois, United States
| | - Eunice John
- Department of Pediatric Nephrology, University of Illinois at Chicago, Illinois, United States
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Abstract
Hypertension in children is common, and the prevalence of primary hypertension is increasing with the obesity epidemic and changing dietary choices. Careful measurement of blood pressure is important to correctly diagnose hypertension, as many factors can lead to inaccurate blood pressure measurement. Hypertension is diagnosed based on comparison of age-, sex-, and height-based norms with the average systolic and diastolic blood pressures on three separate occasions. In the absence of hypertensive target organ damage (TOD), stage I hypertension is managed first by diet and exercise, with the addition of drug therapy if this fails. First-line treatment of stage I hypertension with TOD and stage II hypertension includes both lifestyle changes and medications. First-line agents include angiotensin-converting enzyme (ACE) inhibitors, thiazide diuretics, and calcium-channel blockers. Hypertensive emergency with end-organ effects requires immediate modest blood pressure reduction to alleviate symptoms. This is usually accomplished with IV medications. Long-term reduction in blood pressure to normal levels is accomplished gradually. Specific medication choice for outpatient hypertension management is determined by the underlying cause of hypertension and the comparative adverse effect profiles, along with practical considerations such as cost and frequency of administration. Antihypertensive medication is initiated at a starting dose and can be gradually increased to effect. If ineffective at the recommended maximum dose, an additional medication with a complementary mechanism of action can be added.
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Affiliation(s)
- Jason Misurac
- Department of Pediatrics, Section of Pediatric Nephrology, Indiana University School of Medicine, 699 Riley Hospital Dr., Room 230, Indianapolis, IN, 46202, USA.
| | - Kristen R Nichols
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN, USA
- Department of Pharmacy, Riley Hospital for Children, Indiana University Health, Indianapolis, IN, USA
| | - Amy C Wilson
- Department of Pediatrics, Section of Pediatric Nephrology, Indiana University School of Medicine, 699 Riley Hospital Dr., Room 230, Indianapolis, IN, 46202, USA
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Urbina EM, Khoury PR, McCoy CE, Daniels SR, Dolan LM, Kimball TR. Comparison of mercury sphygmomanometry blood pressure readings with oscillometric and central blood pressure in predicting target organ damage in youth. Blood Press Monit 2016; 20:150-6. [PMID: 25647284 DOI: 10.1097/mbp.0000000000000110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Hypertension (HT) is an important risk factor for target organ damage (TOD). New methods for measuring BP are replacing mercury sphygmomanometry in many clinics. We examined the utility of different BP measurement techniques in predicting subclinical TOD in adolescents and young adults. METHODS Participants in a study of the cardiovascular effects of obesity and type 2 diabetes were evaluated (N=677, 18±3.3 years, 35% male, 60% non-White, 30% with type 2 diabetes). We measured adiposity, laboratory data, left ventricular mass, carotid intima-media thickness, and pulse wave velocity. BP was measured three times by mercury sphygmomanometry (BPm), using an oscillometric device (BPo), and by arterial tonometry to measure central aortic BP (BPc). Participants were stratified as normotensive, prehypertensive, or hypertensive. RESULTS The prevalence of HT in this cohort with a mean BMI of 31 was the highest on BPo measurement (16%), followed by BPm (11%) and BPc (9%; P≤0.001) measurements. BPm was the most consistent in differentiating left ventricular mass and pulse wave velocity among participants in the prehypertensive group as compared with the normotensive and hypertensive groups. Mercury BP measurement was also more sensitive and specific at predicting greater left ventricular mass, pulse wave velocity, and carotid thickness compared with other BP measurement techniques in logistic regression. CONCLUSION We conclude that mercury sphygmomanometry should remain the gold standard for evaluation of HT and the risk for TOD in adolescents and young adults.
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Affiliation(s)
- Elaine M Urbina
- aCincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio bDepartment of Pediatrics, University of Colorado, Aurora, Colorado, USA
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Benmira A, Perez-Martin A, Schuster I, Aichoun I, Coudray S, Bereksi-Reguig F, Dauzat M. From Korotkoff and Marey to automatic non-invasive oscillometric blood pressure measurement: does easiness come with reliability? Expert Rev Med Devices 2016; 13:179-89. [DOI: 10.1586/17434440.2016.1128821] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Differences in mean arterial pressure of young and elderly people measured by oscilometry during inflation and deflation of the arm cuff. ACTA ACUST UNITED AC 2016; 61:611-621. [DOI: 10.1515/bmt-2015-0098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 02/02/2016] [Indexed: 11/15/2022]
Abstract
AbstractSystemic arterial blood pressure (BP) is one of the most important parameters of the cardiovascular system. An oscillometric NIBP monitor was specifically designed to measure oscillometric pulsations and mean arterial pressure (MAP) during inflation and deflation of the cuff. Nineteen healthy young (age 23.1±1.7 years; mean±SD) and 35 elderly (83.9±7.9 years; mean±SD) subjects were studied. Differential analysis of MAP during inflation and deflation show mean |ΔMAP|=2.9±2.6 mm Hg in the young group (mean±SD) and |ΔMAP|=6.3±5.2 mm Hg for seniors (mean±SD). There was a significant difference (p<0.05) in means of |ΔMAP| measured during cuff inflation and cuff deflation between both groups. In about 50% of elderly subjects |ΔMAP| was higher than 5 mm Hg. Potential clinical relevance of the method needs to be further evaluated.
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Negroni-Balasquide X, Bell CS, Samuel J, Samuels JA. Is one measurement enough to evaluate blood pressure among adolescents? A blood pressure screening experience in more than 9000 children with a subset comparison of auscultatory to mercury measurements. ACTA ACUST UNITED AC 2015; 10:95-100. [PMID: 26875474 DOI: 10.1016/j.jash.2015.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/02/2015] [Accepted: 12/01/2015] [Indexed: 02/04/2023]
Abstract
Evaluation of blood pressure is recommended in all children older than 3 years. Auscultatory devices are the recommended method to assess blood pressure in pediatrics, but automated oscillometric devices are increasingly common. A retrospective analysis of our school-based blood pressure screening was performed to determine if multiple oscillometric blood pressure measurements are needed to approach true blood pressure. All children had 4 oscillometric measurements of blood pressures and a random subset of 287 had an additional auscultatory measurement. Among 9870 participants, we observed a nonlinear decrease in blood pressure over time. The largest decrease in systolic blood pressure was between first and second (-3.8 mm Hg) and in diastolic from second to third (-3.3 mm Hg) measurement. For systolic blood pressure, the second oscillometric measurement, the average of second to third and the average of first to third were statistically similar to a single auscultatory measurement. We conclude that assessment of blood pressure using oscillometric devices should include at least 3 measurements in the same sitting to avoid inaccurate assessment.
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Affiliation(s)
- Xamayta Negroni-Balasquide
- Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, University of Texas Health Science Center, Houston, TX, USA.
| | - Cynthia S Bell
- Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, University of Texas Health Science Center, Houston, TX, USA
| | - Joyce Samuel
- Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, University of Texas Health Science Center, Houston, TX, USA
| | - Joshua A Samuels
- Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, University of Texas Health Science Center, Houston, TX, USA
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Abstract
Hypertension has become a serious global public health burden because of its high incidence and concomitant risk of cardiovascular disease. Many studies have verified that risk factors, such as hypertension and obesity which are responsible for cardiovascular disease, start in early childhood. In Asian countries, the prevalence of hypertension in the pediatric age group has become more prevalent than ever before with the increasing obesity epidemic. To tackle the epidemic of cardiovascular disease, a leading cause of death and disability of non-communicable diseases in Asian countries, population-based measures aiming at reducing harmful environmental factors to blood pressure and body weight must be applied to individuals in their early childhood, as early as the fetal stage. This review focused on the prevalence of pediatric hypertension in Asian countries and outlined several considerations for accurate blood pressure (BP) measurement and evaluation, along with an overview of pathophysiology of fetal programming and obesity related with childhood hypertension.
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Sharma AP, Mohammed J, Thomas B, Singh RN, Filler G. Using simplified blood pressure tables to avoid underdiagnosing childhood hypertension. Paediatr Child Health 2015; 20:297-301. [PMID: 26435668 PMCID: PMC4578468 DOI: 10.1093/pch/20.6.297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent studies have revealed that hypertension remains underdiagnosed in a significant number of children despite their recorded office blood pressure (OBP) exceeding the recommended fourth report OBP thresholds. Simplified OBP thresholds have been proposed to reduce this underdiagnosis of hypertension in children. In clinical practice, OBP screened as elevated according to the fourth report OBP thresholds are referred for ambulatory blood pressure (ABP) monitoring to rule out 'white coat' hypertension. OBJECTIVES The present study tested the usefulness of simplified OBP thresholds to screen abnormal OBP for ABP monitoring referral. METHODS A total of 155 subjects were retrospectively analyzed with paired OBP and ABP recordings obtained from an outpatient referral clinic. OBP recordings were classified as abnormal according to the simplified and fourth report OBP thresholds. ABP measurements were classified as abnormal according to the ABP reference tables. RESULTS Simplified blood pressure (BP) tables correctly identified all OBP classified as abnormal according to fourth report BP thresholds (kappa [κ] 0.72 [95% CI 0.61 to 0.83]) for systolic OBP; κ 0.92 [95% CI 0.86 to 0.99] for diastolic OBP). OBP classified as abnormal by the simplified BP thresholds and by the fourth report BP thresholds performed similarly for correctly identifying abnormal ABP measurements as per ABP references (overlapping 95% CIs of the sensitivity, specificity and predictive values and likelihood ratios). CONCLUSIONS Simplified BP tables, proposed to reduce the underdiagnosis of hypertension in children, can serve as a useful screening tool to decide a referral for ABP monitoring. Future prospective studies are needed to establish these findings.
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Affiliation(s)
- Ajay P Sharma
- Division of Nephrology, Western University, Children’s Hospital, London Health Sciences Centre, London, Ontario
- Department of Pediatrics, Western University, Children’s Hospital, London Health Sciences Centre, London, Ontario
| | - Javed Mohammed
- Department of Pediatrics, Western University, Children’s Hospital, London Health Sciences Centre, London, Ontario
| | - Benson Thomas
- Department of Pediatrics, Western University, Children’s Hospital, London Health Sciences Centre, London, Ontario
| | - Ram N Singh
- Department of Pediatrics, Western University, Children’s Hospital, London Health Sciences Centre, London, Ontario
- Division of Critical Care Medicine, Western University, Children’s Hospital, London Health Sciences Centre, London, Ontario
| | - Guido Filler
- Division of Nephrology, Western University, Children’s Hospital, London Health Sciences Centre, London, Ontario
- Department of Pediatrics, Western University, Children’s Hospital, London Health Sciences Centre, London, Ontario
- Department of Medicine, Western University, Children’s Hospital, London Health Sciences Centre, London, Ontario
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Schwandt P, Scholze JE, Bertsch T, Liepold E, Haas GM. Blood pressure percentiles in 22,051 German children and adolescents: The PEP Family Heart Study. Am J Hypertens 2015; 28:672-9. [PMID: 25413840 DOI: 10.1093/ajh/hpu208] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/01/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Strong associations between blood pressure (BP) and overweight raise the question whether overweight children (body mass index (BMI) ≥85th percentile) should be included in the normative database. METHODS Using the LMS (Lamda-Mu-Sigma) method, we developed age-, gender-, and height-adjusted percentile curves for systolic blood pressure (SBP) and diastolic blood pressure (DBP) at the 50th, 85th, 90th, 95th, and 97th percentiles in 22,051 German youths (18,917 normal-weight, 1,938 overweight, and 1,196 obese) aged 3-18 years from yearly cross-sectional surveys of the PEP Family Heart Study Nuremberg. RESULTS Among children, we found no gender differences for BP and BMI. Male adolescents are taller and heavier. The mean prevalence of hypertension and obesity is 7.3% and 5.2% among children and 7.2% and 5.8% among adolescents, respectively. The prevalence of elevated BP increased substantially by weight groups achieving 24.4% in obese females and 21.9% in obese males with odds ratios of 5.9 (95% confidence interval (CI): 5.1-7.5) and 4.3 (95% CI: 3.5-5.2), respectively. The shapes of the 10 LMS-smoothed SBP and DBP percentile curves differ substantially between gender and weight group. The normal-weight percentiles are nearly identical with the overall growth charts, but separate percentiles for overweight and obese youths provide considerably higher values, such as 148/91 vs. 136/86 mm Hg for a 17-year-old male and 136/91 vs. 123/81 mm Hg for female, respectively, at the 90th percentile. CONCLUSIONS Because of substantially higher BP percentiles, separate databases for overweight and obese children and adolescents are strongly recommended.
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Affiliation(s)
- Peter Schwandt
- Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany; Ludwig-Maximilians University of Munich, Munich, Germany;
| | - Juergen E Scholze
- Outpatient Clinic-Hypertension Excellence Centre ESH, Universitätsmedizin Berlin, Charité CCM, Berlin, Germany
| | - Thomas Bertsch
- Central Laboratory, Paracelsus Medical University, Nuremberg, Germany
| | - Evelyn Liepold
- Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany
| | - Gerda M Haas
- Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany
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Krmar RT, Holtbäck U, Bergh A, Svensson E, Wühl E. Oscillometric casual blood pressure normative standards for Swedish children using ABPM to exclude casual hypertension. Am J Hypertens 2015; 28:459-68. [PMID: 25384408 DOI: 10.1093/ajh/hpu182] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Casual blood pressure (CBP) is considered a reliable proxy for cardiovascular health. Although the auscultatory technique is the reference standard method for measuring CBP, oscillometric devices are increasingly being used in children. We sought to establish oscillometric CBP normative standards for Swedish children. METHODS Cross-sectional oscillometric CBP readings were obtained by the Welch Allyn Spot Vital Signs 420 monitor and measured according to the International Guidelines' recommendations. Participants with elevated oscillometric CBP levels underwent verification by the auscultatory method. Ambulatory blood pressure monitoring (ABPM) was used to exclude casual hypertension. Data on 1,470 (772 males) apparently healthy Swedish schoolchildren aged 6-16 years were analyzed and sex-specific reference charts normalized to age or height were constructed. RESULTS Systolic and diastolic CBP values were significantly higher with age, height, height standard deviation score (SDS), body mass index (BMI), and BMI SDS. Gender differences for systolic CBP were present starting from age of 15 years and revealed significantly higher values in boys than in girls, whereas for diastolic CBP, the differences were apparent at the age of 12 years, with higher values in girls. Increased BMI and BMI SDS were positively associated with CBP levels. Positive parental history of hypertension turned out to be a risk factor for higher systolic and diastolic CBP across all ages. CONCLUSIONS Our normative standard for CBP can be used for blood pressure screening and control programs in Swedish children. The use of ABPM should be considered to confirm the diagnosis of casual hypertension.
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Affiliation(s)
- Rafael T Krmar
- Karolinska Institutet, Department for Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska University Hospital, Huddinge, Sweden
| | - Ulla Holtbäck
- Karolinska Institutet, Department for Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska University Hospital, Huddinge, Sweden
| | - Anita Bergh
- Karolinska Institutet, Department for Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska University Hospital, Huddinge, Sweden
| | - Eva Svensson
- Karolinska Institutet, Department for Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska University Hospital, Huddinge, Sweden
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
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Ghaffari S, Malaki M, Rezaeifar A, Abdollahi Fakhim S. Effect of peripheral edema on oscillometric blood pressure measurement. J Cardiovasc Thorac Res 2014; 6:217-21. [PMID: 25610552 PMCID: PMC4291599 DOI: 10.15171/jcvtr.2014.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/12/2014] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Blood pressure (BP) measurement is essential for epidemiological studies and clinical decisions. It seems that tissue characteristics can affect BP results and we try to find edema effect on BP results taken by different methods. METHODS BP of 55 children before open heart surgery were measured and compared according to three methods: Arterial as standard and reference, oscillometric and auscultatory methods. Peripheral edema as a tissue characteristic was defined in higher than +2 as marked edema and in equal or lower than +2 as no edema. STATISTICAL ANALYSES data was expressed as Mean and 95% of confidence interval (CI 95%). Comparison of two groups was performed by T independent test and of more than two groups by ANOVA test. Mann-Whitney U and paired T-test were used for serially comparisons of changes. P less than 0.05 was considered significant. RESULTS Fifty five children aged 29.4±3.9 months were divided into two groups: 10 children with peripheral edema beyond +2 and 45 cases without edema. Oscillometric method overestimated systolic BP and the Mean (CI 95%) difference of oscillometric to arterial was 4.8 (8/-1, P=0.02) in edematous and 4.2 (7/1, p=0.004) in non edematous. Oscillometric method underestimated diastolic BP as -9 (-1.8/-16.5, P=0.03) in edematous group and 2.6 (-0.7/+5, P= 0.2) in non edematous compared to arterial method. CONCLUSION Oscillometric device standards cannot cover all specific clinical conditions. It underestimates diastolic BP significantly in edematous children, which was 9.2 mmHg in average beyond the acceptable standards.
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Affiliation(s)
- Shamsi Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Malaki
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afshin Rezaeifar
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Bassareo PP, Mercuro G. Pediatric hypertension: An update on a burning problem. World J Cardiol 2014; 6:253-259. [PMID: 24944755 PMCID: PMC4062118 DOI: 10.4330/wjc.v6.i5.253] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/25/2014] [Accepted: 04/17/2014] [Indexed: 02/06/2023] Open
Abstract
A large number of adults worldwide suffer from essential hypertension, and because blood pressures (BPs) tend to remain within the same percentiles throughout life, it has been postulated that hypertensive pressures can be tracked from childhood to adulthood. Thus, children with higher BPs are more likely to become hypertensive adults. These “pre-hypertensive” subjects can be identified by measuring arterial BP at a young age, and compared with age, gender and height-specific references. The majority of studies report that 1 to 5% of children and adolescents are hypertensive, defined as a BP > 95th percentile, with higher prevalence rates reported for some isolated geographic areas. However, the actual prevalence of hypertension in children and adolescents remains to be fully elucidated. In addition to these young “pre-hypertensive” subjects, there are also children and adolescents with a normal-high BP (90th-95th percentile). Early intervention may help prevent the development of essential hypertension as they age. An initial attempt should be made to lower their BP by non-pharmacologic measures, such as weight reduction, aerobic physical exercise, and lowered sodium intake. A pharmacological treatment is usually needed should these measures fail to lower BP. The majority of antihypertensive drugs are not formulated for pediatric patients, and have thus not been investigated in great detail. The purpose of this review is to provide an update concerning juvenile hypertension, and highlight recent developments in epidemiology, diagnostic methods, and relevant therapies.
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Markevych I, Thiering E, Fuertes E, Sugiri D, Berdel D, Koletzko S, von Berg A, Bauer CP, Heinrich J. A cross-sectional analysis of the effects of residential greenness on blood pressure in 10-year old children: results from the GINIplus and LISAplus studies. BMC Public Health 2014; 14:477. [PMID: 24886243 PMCID: PMC4035901 DOI: 10.1186/1471-2458-14-477] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/14/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND According to Ulrich's psychoevolutionary theory, contact with green environments mitigates stress by activating the parasympathetic system, (specifically, by decreasing blood pressure (BP)). Experimental studies have confirmed this biological effect. However, greenness effects on BP have not yet been explored using an observational study design. We assessed whether surrounding residential greenness is associated with BP in 10 year-old German children. METHODS Systolic and diastolic BPs were assessed in 10 year-old children residing in the Munich and Wesel study areas of the German GINIplus and LISAplus birth cohorts. Complete exposure, outcome and covariate data were available for 2,078 children. Residential surrounding greenness was defined as the mean of Normalized Difference Vegetation Index (NDVI) values, derived from Landsat 5 TM satellite images, in circular 500-m buffers around current home addresses of participants. Generalized additive models assessed pooled and area-specific associations between BP and residential greenness categorized into area-specific tertiles. RESULTS In the pooled adjusted model, the systolic BP of children living at residences with low and moderate greenness was 0.90 ± 0.50 mmHg (p-value = 0.073) and 1.23 ± 0.50 mmHg (p-value = 0.014) higher, respectively, than the systolic BP of children living in areas of high greenness. Similarly, the diastolic BP of children living in areas with low and moderate greenness was 0.80 ± 0.38 mmHg (p-value = 0.033) and 0.96 ± 0.38 mmHg (p-value = 0.011) higher, respectively, than children living in areas with high greenness. These associations were not influenced by environmental stressors (temperature, air pollution, noise annoyance, altitude and urbanisation level). When stratified by study area, associations were significant among children residing in the urbanised Munich area but null for those in the rural Wesel area. CONCLUSIONS Lower residential greenness was positively associated with higher BP in 10 year-old children living in an urbanised area. Further studies varying in participants' age, geographical area and urbanisation level are required.
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Affiliation(s)
- Iana Markevych
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstr, 1, 85764 Neuherberg, Germany
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstraße 4, 80337 Munich, Germany
| | - Elisabeth Thiering
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstr, 1, 85764 Neuherberg, Germany
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstraße 4, 80337 Munich, Germany
| | - Elaine Fuertes
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstr, 1, 85764 Neuherberg, Germany
- School of Population and Public Health, The University of British Columbia, 2206 East Mall, V6T 1Z3 Vancouver, Canada
| | - Dorothea Sugiri
- IUF – Leibniz Research Institute for Environmental Medicine, University of Düsseldorf, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany
| | - Dietrich Berdel
- Research Institute, Department of Paediatrics, Marien-Hospital Wesel, Pastor-Janßen-Straße 8, 46483 Wesel, Germany
| | - Sibylle Koletzko
- Division of Paediatric Gastroenterology and Hepatology, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstraße 4, 80337 Munich, Germany
| | - Andrea von Berg
- Research Institute, Department of Paediatrics, Marien-Hospital Wesel, Pastor-Janßen-Straße 8, 46483 Wesel, Germany
| | - Carl-Peter Bauer
- Department of Pediatrics, Technical University of Munich, Boltzmannstraße 15, 85748 Munich, Germany
| | - Joachim Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstr, 1, 85764 Neuherberg, Germany
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Regnault N, Kleinman KP, Rifas-Shiman SL, Langenberg C, Lipshultz SE, Gillman MW. Components of height and blood pressure in childhood. Int J Epidemiol 2014; 43:149-59. [PMID: 24413933 DOI: 10.1093/ije/dyt248] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In children being taller is associated with higher blood pressure (BP), but few studies have divided height into its components: trunk and leg length. We examined the associations of total height, trunk length and leg length with systolic BP (SBP), diastolic BP (DBP) and pulse pressure (PP) at early childhood and mid-childhood visits, as well as change between the two visits. METHODS We obtained five measures of SBP and DBP at the early childhood visit (N = 1153, follow-up rate = 54%) and at the mid-childhood visit (N = 1086, follow-up rate = 51%) respectively, in Project Viva, a US cohort study. We measured total height and sitting height (a measure of trunk length that includes head and neck) and calculated leg length as the difference between the two. Using mixed models, we adjusted the cross-sectional analyses for leg length when trunk length was the exposure of interest, and vice versa. We also adjusted for maternal race/ethnicity, child age, sex, overall adiposity and BP measurement conditions. RESULTS At the mid-childhood visit, total height was positively associated with SBP [0.34 (0.24; 0.45) mmHg/cm] but not with DBP [0.07 (-0.003; 0.15)]. In models examining trunk and leg length separately, each was positively associated with SBP [0.72 (0.52; 0.92) and 0.33 (0.16; 0.49) respectively]. In a fully adjusted model with both leg and trunk length, only trunk length remained associated with BP. For a given leg length, a 1-cm increment in trunk length was associated with a 0.63-mmHg (0.42; 0.83) higher SBP and a 0.17-mmHg (0.02; 0.31) higher DBP. For a given trunk length, however, the associations of leg length with SBP [0.13 (-0.03; 0.30)] and with DBP [0.002 (-0.11; 0.12)] were null. These patterns were similar at the early childhood visit. CONCLUSIONS Children with greater trunk lengths have higher BPs, perhaps because of the additional pressure needed to overcome gravity to perfuse the brain.
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Affiliation(s)
- Nolwenn Regnault
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA, MRC Epidemiology Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA and Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
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Eliasdottir SB, Steinthorsdottir SD, Indridason OS, Palsson R, Edvardsson VO. Comparison of aneroid and oscillometric blood pressure measurements in children. J Clin Hypertens (Greenwich) 2013; 15:776-83. [PMID: 24112661 PMCID: PMC8033818 DOI: 10.1111/jch.12196] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/12/2013] [Accepted: 07/21/2013] [Indexed: 11/28/2022]
Abstract
Limited data exist on the comparison of blood pressure (BP) measurements using aneroid and oscillometric devices. The purpose of the study was to investigate the difference in BP obtained using oscillometric and aneroid BP monitors in 9- to 10-year-old children. A total of 979 children were divided into group O, which underwent two oscillometric BP readings followed by two aneroid readings, and group A, which had BP measured in the reverse order. No significant difference was found between the mean (±standard deviation) of the two systolic BP readings obtained using the oscillometric and aneroid devices (111.5±8.6 vs 111.3±8.1 mm Hg; P=.39), whereas the mean diastolic BP was lower with the oscillometric monitor (61.5±8.0 vs 64.5±6.8 mm Hg; P<.001). A significant downward trend in BP was observed with each consecutive measurement, and agreement between the two monitors was limited. Multiple BP measurements are, therefore, recommended before the diagnosis of elevated BP or hypertension is made with either method.
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Affiliation(s)
| | | | - Olafur S. Indridason
- Division of NephrologyLandspitali – The National University Hospital of IcelandReykjavikIceland
| | - Runolfur Palsson
- Faculty of MedicineSchool of Health SciencesUniversity of IcelandReykjavikIceland
- Division of NephrologyLandspitali – The National University Hospital of IcelandReykjavikIceland
| | - Vidar O. Edvardsson
- Faculty of MedicineSchool of Health SciencesUniversity of IcelandReykjavikIceland
- Children′s Medical CenterLandspitali – The National University Hospital of IcelandReykjavikIceland
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Oscillometric blood pressure percentiles for Polish normal-weight school-aged children and adolescents. J Hypertens 2013; 30:1942-54. [PMID: 22828086 DOI: 10.1097/hjh.0b013e328356abad] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to construct blood pressure (BP) references with the use of a validated oscillometric device for normal-weight, school-aged children and adolescents and to study BP predictors. METHODS BP was measured in 14 266 randomly selected, normal-weight Polish children and adolescents aged 7-18 years, who were free of chronic disease, using a validated oscillometric device (Datascope Accutor Plus). Height, weight and waist circumference were measured. BP percentiles were constructed for age and height simultaneously with the use of a polynomial regression model. The normative values of BP were compared with the US normal-weight reference, German oscillometric reference, and Polish auscultatory reference. RESULTS Reference BP percentiles by sex, age and height are presented. At median height, the age-specific differences in the 90th BP percentiles compared with German oscillometric reference ranged in the case of boys from -3 to 2 mmHg and from -5 to -1 mmHg, SBP and DBP, respectively, and in the case of girls from 0 to 3 mmHg and from -5 to -1 mmHg, SBP and DBP, respectively. As compared to weight, waist circumference was stronger SBP predictor in low birth weight boys. CONCLUSION The study provides BP references for oscillmetric device, based on a current, nationally representative sample of normal-weight Polish children and adolescents. The normative values of BP were compared taking into consideration the height and BMI differences, the pubertal spurt, the methods of BP measurement and percentile construction.
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Kim HS, Park MJ, Oh MK, Hong YM. Auscultatory measured normative blood pressure of korean adolescents: using the korean national health and nutrition examination survey 2001-2007. Korean Circ J 2013; 42:809-15. [PMID: 23323118 PMCID: PMC3539046 DOI: 10.4070/kcj.2012.42.12.809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 06/21/2012] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives In Korea, there hasn't been any previous literature that describes auscultatory blood pressure (BP) normative tables for adolescents. Using BP data, from the Korean National Health and Nutrition Examination Survey (KNHANES), we created normative auscultatory BP percentile tables for Korean adolescents. Subjects and Methods A total of 3508 adolescents (boys 1852, girls 1656), aged 10-17 in 2001, 2005 and 2007 from the KNHANES database years, were included. Auscultatory BP measurement was performed, using a Baumanometer Mercury Gravity Sphygmomanometer. Results The mean systolic BP of boys was higher than that of girls in adolescents older than 13 years of age, and the mean diastolic BP of boys was higher than that of girls in those older than 15 years. Systolic and diastolic BP was correlated with weight, height and age. Age-specific normative auscultatory systolic and diastolic BP percentiles for boys and girls were completed. The graph that showed age-specific prehypertensive and hypertensive systolic and diastolic BP for boys and girls was presented. For adolescents, the height-specific auscultatory BP percentiles for boys and girls were completed. A graph that shows the height-specific prehypertensive and hypertensive BP for boys and girls was also made. Conclusion The auscultatory age-and height-specific BP percentiles for Korean adolescents are established. These can be useful in screening the prehypertension and hypertension of Korean adolescents in a clinical setting.
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Affiliation(s)
- Hae Soon Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
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Trends in blood pressure in 9 to 11-year-old children in the United Kingdom 1980-2008: the impact of obesity. J Hypertens 2012; 30:1708-17. [PMID: 22828085 DOI: 10.1097/hjh.0b013e3283562a6b] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES High blood pressure (BP) is a major public health issue, both in the United Kingdom and worldwide. Although BP levels in UK adults are declining, there is little published information on BP trends in children, a particular concern in the context of the rising levels of childhood adiposity. Our aims are to determine whether BP in children has changed over time and whether the change reflected trends in adiposity. METHODS We collated data from seven population-based BP studies conducted in the United Kingdom between 1980 and 2008. Children of white European origin were included (9-11 years, mean 10.3 years). Adjustments were made to account for differences in mean ages, BP devices and cuff sizes used in different studies. RESULTS Mean SBP increased over time both in boys and girls: annual increases were 0.45 mmHg (95% CI: 0.43, 0.48) for boys; 0.51 mmHg (0.49, 0.53) for girls. Mean BMI increased by 0.064 kg/m(2) (0.060, 0.068) per year for boys; 0.070 kg/m(2) (0.065, 0.074) for girls; the prevalence of overweight/obesity increased from 5.7 to 21.1% and from 9.7 to 24.1%, respectively. The SBP trends occurred both in children with low and high BMI, but were more marked in low BMI group; BMI explained only 15.3% (15.1%, 15.6%) of increases in SBP for boys and 14.9% (14.6%, 15.1%) for girls. The BMI/SBP association appeared to become weaker over time (P < 0.001 for negative interaction from 1984). There was only a modest annual increase in DBP (<0.1 mmHg). CONCLUSIONS SBP levels have increased with time, but the increase is not explained by increased BMI. Further research is needed to identify the factors responsible.
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Kamath N, Goud BR, Phadke KD, Iyengar A. Use of oscillometric devices for the measurement of blood pressure-comparison with the gold standard. Indian J Pediatr 2012; 79:1230-2. [PMID: 22057397 DOI: 10.1007/s12098-011-0600-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 10/13/2011] [Indexed: 11/28/2022]
Abstract
The study was done to validate the use of automated devices (Datascope Duo) as a screening tool for measuring blood pressure. A cross sectional study was conducted in school children from urban slums of Bangalore. Blood pressure was recorded according to standard guidelines using a mercury sphygmomanometer and an automated device (Datascope Duo). The readings obtained using the two instruments were compared. One thousand four hundred eighty nine school children, both males and females, aged 5-16 y were included in the study. Readings with the Datascope Duo varied significantly when compared to the gold standard. The blood pressure measurements using Datascope Duo cannot be recommended as an accurate substitute for manual readings.
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Affiliation(s)
- Nivedita Kamath
- Division of Pediatric Nephrology, Department of Pediatrics, St. John's Medical College, Sarjapur Road, Bangalore, 560034, India.
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van Dijk AE, van Eijsden M, Stronks K, Gemke RJBJ, Vrijkotte TGM. The association between prenatal psychosocial stress and blood pressure in the child at age 5-7 years. PLoS One 2012; 7:e43548. [PMID: 22927987 PMCID: PMC3424234 DOI: 10.1371/journal.pone.0043548] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 07/23/2012] [Indexed: 11/29/2022] Open
Abstract
Objective Prenatal maternal stress could have permanent effects on the offspring’s tissue structure and function, which may predispose to cardiovascular diseases. We investigated whether maternal psychosocial stress is a prenatal factor affecting the blood pressure (BP) of offspring. Study Design In the Amsterdam Born Children and their Development (ABCD) study, around gestational week 16, depressive symptoms, state-anxiety, pregnancy-related anxiety, parenting daily hassles and job strain were recorded by questionnaire. A cumulative stress score was also calculated (based on 80th percentiles). Systolic and diastolic BP and mean arterial pressure (MAP) were measured in the offspring at age 5–7 years. Inclusion criteria were: no use of antihypertensive medication during pregnancy; singleton birth; no reported cardiovascular problems in the child (N = 2968 included). Results After adjustment for confounders, the single stress scales were not associated with systolic and diastolic BP, MAP and hypertension (p>0.05). The presence of 3–4 psychosocial stressors prenatally (4%) was associated with 1.5 mmHg higher systolic and diastolic BP (p = 0.046; p = 0.04) and 1.5 mmHg higher MAP in the offspring (p = 0.02) compared to no stressors (46%). The presence of 3–4 stressors did not significantly increase the risk for hypertension (OR 1.8; 95% CI 0.93.4). Associations did not differ between sexes. Bonferroni correction for multiple testing rendered all associations non-significant. Conclusions The presence of multiple psychosocial stressors during pregnancy was associated with higher systolic and diastolic BP and MAP in the child at age 5–7. Further investigation of maternal prenatal stress may be valuable for later life cardiovascular health.
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Affiliation(s)
- Aimée E van Dijk
- Department of Public Health, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
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Acosta AA, Samuels JA, Portman RJ, Redwine KM. Prevalence of persistent prehypertension in adolescents. J Pediatr 2012; 160:757-61. [PMID: 22153679 DOI: 10.1016/j.jpeds.2011.10.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 09/30/2011] [Accepted: 10/24/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To measure the prevalence of persistent prehypertension in adolescents. STUDY DESIGN We collected demographic and anthropometric data and 4 oscillometric blood pressure (BP) measurements on 1020 students. The mean of the second, third, and fourth BP measurements determined each student's BP status per visit, with up to 3 total visits. Final BP status was classified as normal (BP <90th percentile and 120/80 mm Hg at the first visit), variable (BP ≥ 90th percentile or 120/80 mm Hg at the first visit and subsequently normal), abnormal (BP ≥ 90th percentile or 120/80 mm Hg at 3 visits but not hypertensive), or hypertensive (BP ≥ 95th percentile at 3 visits). The abnormal group included those with persistent prehypertension (BP ≥ 90th percentile or 120/80 mm Hg and <95th percentile on 3 visits). Statistical analysis allowed for comparison of groups and identification of characteristics associated with final BP classification. RESULTS Of 1010 students analyzed, 71.1% were classified as normal, 15.0% as variable, 11.5% as abnormal, and 2.5% as hypertensive. The prevalence of persistent prehypertension was 4.0%. Obesity similarly affected the odds for variable BP (OR, 3.9; 95% CI, 2.5-6.0) and abnormal BP (OR, 3.4; 95% CI, 2.0-5.9), and dramatically increased the odds for hypertension (OR, 38.4; 95% CI, 9.4-156.6). CONCLUSION Almost 30% of the students had at least one elevated BP measurement significantly influenced by obesity. Treating obesity may be essential to preventing prehypertension and/or hypertension.
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Affiliation(s)
- Alisa A Acosta
- Department of Pediatrics, Texas A&M University College of Medicine, Temple, TX, USA.
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Elevated Blood Pressure in ED Patients: Best Evidence on the Importance of Assessment, Recognition, and Referral. J Emerg Nurs 2012; 38:245-50. [DOI: 10.1016/j.jen.2010.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 12/18/2010] [Accepted: 12/20/2010] [Indexed: 11/20/2022]
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Nightingale CM, Krishnaveni GV, Rudnicka AR, Owen CG, Veena SR, Hill JC, Cook DG, Fall CHD, Whincup PH. Cardiometabolic risk markers in Indian children: comparison with UK Indian and white European children. PLoS One 2012; 7:e36236. [PMID: 22558399 PMCID: PMC3338673 DOI: 10.1371/journal.pone.0036236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 03/29/2012] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE UK Indian adults have higher risks of coronary heart disease and type 2 diabetes than Indian and UK European adults. With growing evidence that these diseases originate in early life, we compared cardiometabolic risk markers in Indian, UK Indian and white European children. METHODS Comparisons were based on the Mysore Parthenon Birth Cohort Study (MPBCS), India and the Child Heart Health Study in England (CHASE), which studied 9-10 year-old children (538 Indian, 483 UK Indian, 1375 white European) using similar methods. Analyses adjusted for study differences in age and sex. RESULTS Compared with Mysore Indians, UK Indians had markedly higher BMI (% difference 21%, 95%CI 18 to 24%), skinfold thickness (% difference 34%, 95%CI 26 to 42%), LDL-cholesterol (mean difference 0.48, 95%CI 0.38 to 0.57 mmol/L), systolic BP (mean difference 10.3, 95% CI 8.9 to 11.8 mmHg) and fasting insulin (% difference 145%, 95%CI 124 to 168%). These differences (similar in both sexes and little affected by adiposity adjustment) were larger than those between UK Indians and white Europeans. Compared with white Europeans, UK Indians had higher skinfold thickness (% difference 6.0%, 95%CI 1.5 to 10.7%), fasting insulin (% difference 31%, 95%CI 22 to 40%), triglyceride (% difference 13%, 95%CI 8 to 18%) and LDL-cholesterol (mean difference 0.12 mmol/L, 95%CI 0.04 to 0.19 mmol/L). CONCLUSIONS UK Indian children have an adverse cardiometabolic risk profile, especially compared to Indian children. These differences, not simply reflecting greater adiposity, emphasize the need for prevention strategies starting in childhood or earlier.
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Affiliation(s)
- Claire M Nightingale
- Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom.
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