Anthropometric determinants of high blood pressure in elementary schoolchildren
DOI:
https://doi.org/10.5712/rbmfc16(43)2779Keywords:
Child, Overweight, Pediatric obesity, Hypertension, Cardiovascular diseases.Abstract
Introduction: Pediatric hypertension has received special attention from pediatricians, as increased blood pressure in childhood contributes to the early onset of essential hypertension in adulthood and mortality from cardiovascular diseases. Anthropometric measurements have been useful in diagnosing childhood overweight and obesity, considered risk conditions for hypertension in adulthood. The earlier the identification of these risk factors, whether in the school environment or in health services, the higher the number of preventive actions that can be developed to reduce this problem. Objective: To identify the incidence of high blood pressure and its association with anthropometric measurements in elementary schoolchildren. Methods: This is a longitudinal study with 1,116 schoolchildren, 133 of whom participated in three assessments from 2017 to 2019. Demographic information, anthropometric measures (weight, height, waist circumference, body mass index), and blood pressure values (systolic and diastolic adjusted for sex and age according to parameters from the Centers for Disease Control and Prevention) were recorded in a form. The association of variables with high blood pressure was analyzed using Poisson regression, with robust variance adjustment. Results: A total of 51.6% of students were boys with a mean age of 7.9 years, and 45.4% had high blood pressure according to criteria from the Centers for Disease Control and Prevention. Among those who presented high waist circumference, 19.4% progressed from normal to high systolic blood pressure, and 35.5% from normal to high diastolic blood pressure over the three years of follow-up. In overweight and obese schoolchildren, normal systolic blood pressure progressed to high in 20.7 and 21.2% of cases, respectively, and normal diastolic blood pressure progressed to high in 24.1 and 42.4%, respectively. Schoolchildren with high waist circumference (relative risk – RR 1.51; confidence interval – 95%CI 1.20–1.91; RR 1.58; 95%CI 1.25–2.00), weight (RR 1.37; 95%CI 1.08–1.74; RR 1.34; 95%CI 1.05–1.71), and body mass index (RR 1.51; 95%CI 1.21–1.87; RR 1.50; 95%CI 1.20–1.88) presented a greater risk for systolic and diastolic hypertension, respectively. Conclusions: Waist circumference, weight, and body mass index were associated with increased systolic and diastolic blood pressure in schoolchildren, and the risk was greater among those with higher waist circumference.
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(1) Olson M, Chambers M, Shaibi G. Pediatric markers of adult cardiovascular disease. Curr Pediatr Rev 2017;13(4):255-9. https://doi.org/10.2174/1573396314666180117092010 DOI: https://doi.org/10.2174/1573396314666180117092010
(2) Falkner B. The childhood role in development of primary hypertension. Am J Hypertens 2018;31(7):762-9. https://doi.org/10.1093/ajh/hpy058 DOI: https://doi.org/10.1093/ajh/hpy058
(3) Gupta-Malhotra M, Hamzeh RK, Poffenbarger T, McNiece-Redwine K, Hashmi SS. Myocardial performance index in childhood onset essential hypertension and white coat hypertension. Am J Hypertens 2016;29(3):379-87. https://doi.org/10.1093/ajh/hpv123 DOI: https://doi.org/10.1093/ajh/hpv123
(4) Wühl E. Hypertension in childhood obesity. Acta Paediatr 2019;108(1):37-43. https://doi.org/10.1111/apa.14551 DOI: https://doi.org/10.1111/apa.14551
(5) Noubiap JJ, Essouma M, Bigna JJ, Jingi AM, Aminde LN, Nansseu JR. Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis. Lancet Public Health 2017;2(8):e375-e386. https://doi.org/10.1016/S2468-2667(17)30123-8 DOI: https://doi.org/10.1016/S2468-2667(17)30123-8
(6) Kaelber DC, Liu W, Ross M, Localio AR, Leon JB, Pace WD, et al. Diagnosis and medication treatment of pediatric hypertension: a retrospective cohort study. Pediatrics 2016;138(6):e20162195. https://doi.org/10.1542/peds.2016-2195 DOI: https://doi.org/10.1542/peds.2016-2195
(7) Rosner B, Cook NR, Daniels S, Falkner B. Childhood blood pressure trends and risk factors for high blood pressure: the NHANES experience 1988-2008. Hypertension 2013;62(2):247-54. https://doi.org/10.1161/HYPERTENSIONAHA.111.00831 DOI: https://doi.org/10.1161/HYPERTENSIONAHA.111.00831
(8) Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens 2016;34(10):1887-920. https://doi.org/10.1097/HJH.0000000000001039 DOI: https://doi.org/10.1097/HJH.0000000000001039
(9) Bloch KV, Klein CH, Szklo M, Kuschnir MCC, Abreu GA, Barufaldi LA, et al. ERICA: prevalences of hypertension and obesity in Brazilian adolescents. Rev Saude Publica 2016;50(Suppl 1):9s. https://doi.org/10.1590/S01518-8787.2016050006685 DOI: https://doi.org/10.1590/s01518-8787.2016050006685
(10) Li L, Hardy R, Kuh D, Power C. Life-course body mass index trajectories and blood pressure in mid life in two British birth cohorts: stronger associations in the later-born generation. Int J Epidemiol 2015;44(3):1018‐26. https://doi.org/10.1093/ije/dyv106 DOI: https://doi.org/10.1093/ije/dyv106
(11) Brasil. Ministério da Saúde. Sistema de Vigilância Alimentar e Nutricional. Relatórios de Acesso Público. Selecione o tipo de relatório [Internet] 2021. [acessado em 16 nov. 2021]. Disponível em: http://sisaps.saude.gov.br/sisvan/relatoriopublico/index
(12) Rosaneli CF, Baena CP, Auler F, Nakashima ATA, Netto-Oliveira ER, Oliveira AB, et al. Aumento da pressão arterial e obesidade na infância: uma avaliação transversal de 4.609 escolares. Arq Bras Cardiol 2014;103(3):238-44. https://doi.org/10.5935/abc.20140104 DOI: https://doi.org/10.5935/abc.20140104
(13) Kelly RK, Magnussen CG, Sabin MA, Cheung M, Juonala M. Development of hypertension in overweight adolescents: a review. Adolesc Health Med Ther 2015;6:171-87. https://doi.org/10.2147/AHMT.S55837 DOI: https://doi.org/10.2147/AHMT.S55837
(14) Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Norma Técnica do Sistema de Vigilância Alimentar e Nutricional. Orientações para a coleta e análise de dados antropométricos em serviços de saúde. Brasília: Ministério da Saúde; 2011. [acessado em 16 nov. 2021]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/orientacoes_coleta_analise_dados_antropometricos.pdf.
(15) Sardinha LB, Santos DA, Silva AM, Grøntved A, Andersen LB, Ekelund U. A comparison between BMI, waist circumference, and waist-to-height ratio for identifying cardio-metabolic risk in children and adolescents. PLoS One 2016;11(2):e0149351. https://doi.org/10.1371/journal.pone.0149351 DOI: https://doi.org/10.1371/journal.pone.0149351
(16) Wang Y, Howard AG, Adair LS, Wang H, Avery CL, Gordon-Larsen P. Waist circumference change is associated with blood pressure change independent of BMI change. Obesity (Silver Spring) 2020;28(1):146-53. https://doi.org/10.1002/oby.22638 DOI: https://doi.org/10.1002/oby.22638
(17) Cruz NRC, Cardoso PC, Frossard TNSV, Ferreira FO, Brener S, Gomides AFF, et al. Waist circumference as high blood pressure predictor in school age children. Cien Saude Colet 2019;24(5):1885-93. https://doi.org/10.1590/1413-81232018245.18012017 DOI: https://doi.org/10.1590/1413-81232018245.18012017
(18) Zhang YX, Zhao JS, Chu ZH. Children and adolescents with low body mass index but large waist circumference remain high risk of elevated blood pressure. Int J Cardiol 2016;215:23-5. https://doi.org/10.1016/j.ijcard.2016.04.040 DOI: https://doi.org/10.1016/j.ijcard.2016.04.040
(19) Parker ED, Sinaiko AR, Kharbanda EO, Margolis KL, Daley MF, Trower NK, et al. Change in weight status and development of Hypertension. Pediatrics 2016;137(3):e20151662. https://doi.org/10.1542/peds.2015-1662 DOI: https://doi.org/10.1542/peds.2015-1662
(20) Freedman DS, Serdula MK, Srinivasan SR, Berenson GS. Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 1999;69(2):308-17. https://doi.org/10.1093/ajcn/69.2.308 DOI: https://doi.org/10.1093/ajcn/69.2.308
(21) National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114(2 Suppl 4th Report):555-76. PMID: 15286277 DOI: https://doi.org/10.1542/peds.114.2.S2.555
(22) Kuciene R, Dulskiene V. Associations between body mass index, waist circumference, waist-to-height ratio, and high blood pressure among adolescents: a cross-sectional study. Sci Rep. 2019;9(1):9493. https://doi.org/10.1038/s41598-019-45956-9 DOI: https://doi.org/10.1038/s41598-019-45956-9
(23) Choy CS, Chan WY, Chen TL, Shih CC, Wu LC, Liao CC. Waist circumference and risk of elevated blood pressure in children: a cross-sectional study. BMC Public Health 2011;11:613. https://doi.org/10.1186/1471-2458-11-613 DOI: https://doi.org/10.1186/1471-2458-11-613
(24) Pazin DC, Rosaneli CF, Olandoski M, Oliveira ERN, Baena CP, Figueredo AS, et al. Waist circumference is associated with blood pressure in children with normal body mass index: a cross-sectional analysis of 3,417 school children. Arq Bras Cardiol 2017;109(6):509-15. https://doi.org/10.5935/abc.20170162 DOI: https://doi.org/10.5935/abc.20170162
(25) Kuwahara E, Asakura K, Nishiwaki Y, Komatsu H, Nakazawa A, Ushiku H, et al. Steeper increases in body mass index during childhood correlate with blood pressure elevation in adolescence: a long-term follow-up study in a Japanese community. Hypertens Res 2014;37(2):179-84. https://doi.org/10.1038/hr.2013.109 DOI: https://doi.org/10.1038/hr.2013.109
(26) Sabo RT, Lu Z, Daniels S, Sun SS. Serial childhood BMI and associations with adult hypertension and obesity: the Fels Longitudinal Study. Obesity (Silver Spring) 2012;20(8):1741-3. https://doi.org/10.1038/oby.2012.58 DOI: https://doi.org/10.1038/oby.2012.58
(27) Fonseca MJ, Oliveira A, Azevedo I, Nunes J, Santos AC. Association of pubertal development with adiposity and cardiometabolic health in girls and boys-findings from the generation XXI birth cohort. J Adolesc Health 2019;65(4):558-63. https://doi.org/10.1016/j.jadohealth.2019.05.014 DOI: https://doi.org/10.1016/j.jadohealth.2019.05.014
(28) Chan NPT, Choi KC, Nelson EAS, Chan JC, Kong APS. Associations of pubertal stage and body mass index with cardiometabolic risk in Hong Kong Chinese children: a cross-sectional study. BMC Pediatr 2015;15:136. https://doi.org/10.1186/s12887-015-0446-0 DOI: https://doi.org/10.1186/s12887-015-0446-0
(29) Kelishadi R, Mirmoghtadaee P, Najafi H, Keikha M. Systematic review on the association of abdominal obesity in children and adolescents with cardio-metabolic risk factors. J Res Med Sci 2015;20(3):294-307. PMID: 26109978
(30) Kelly AS, Steinberger J, Jacobs DR, Hong CP, Moran A, Sinaiko AR. Predicting cardiovascular risk in young adulthood from the metabolic syndrome, its component risk factors, and a cluster score in childhood. Int J Pediatr Obes 2011;6(2-2):e283-9. https://doi.org/10.3109/17477166.2010.528765 DOI: https://doi.org/10.3109/17477166.2010.528765
(31) Freedman DS, Goodman A, Contreras OA, DasMahapatra P, Srinivasan SR, Berenson GS. Secular trends in BMI and blood pressure among children and adolescents: the Bogalusa Heart Study. Pediatrics 2012;130(1):159-66. https://doi.org/10.1542/peds.2011-3302 DOI: https://doi.org/10.1542/peds.2011-3302
(32) Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;140(3):e20171904. https://doi.org/10.1542/peds.2017-1904 DOI: https://doi.org/10.1542/peds.2017-3035
(33) Malachias MVB, Souza WKSB, Plavnik FL, Rodrigues CIS, Brandão AA, Neves MFT, et al. Capítulo 10 – Hipertensão na Criança e no Adolescente. In: Malachias MVB, Souza WKSB, Plavnik FL, Rodrigues CIS, Brandão AA, Neves MFT, et al. 7a Diretriz Brasileira de Hipertensão Arterial. Arq Bras Cardiol. 2016;107(Suppl.3):53-63. Disponível em: https://www.scielo.br/j/abc/a/9fCp7wjFQhRYmqDbSTRvn3L/?format=pdf&lang=pt DOI: https://doi.org/10.5935/abc.20160160
(34) Sociedade Brasileira de Pediatria. Manual de Orientação. Hipertensão arterial na infância e adolescência. Rio de Janeiro: Departamento Científico de Nefrologia; 2019. Disponível em: https://www.sbp.com.br/fileadmin/user_upload/21635c-MO_-_Hipertensao_Arterial_Infanc_e_Adolesc.pdf
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Copyright (c) 2021 Laiza Santos Pimentel Haddad, Kiscila Araújo Fernandes , Guilherme Burini Lopes, Francielle Bosi Rodrigues Veloso, Sheila Cristina Caniçali, Wanêssa Lacerda Poton
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