Home blood pressure normalcy in children and adolescents: the Arsakeion School study

OBJECTIVE: There is evidence that home blood pressure (BP) is being used in clinical practice for the assessment of out-of-office blood pressure in children. However, there is no information on the normal range of home BP in this population. This prospective school-based study was designed to investigate the normal range of home BP in children and adolescents. SUBJECTS AND METHODS: A total of 778 healthy subjects (358 boys) with mean age 12.3 +/- 3.3 (SD) years (range 6-18 years), height 157 +/- 18 cm (113-198 cm) and weight 50 +/- 18 kg (16-135 kg) were included. Home BP was monitored for 3 days using validated electronic devices (Omron 705IT). RESULTS: Reliable home BP readings provided by 767 subjects (98%) were analysed. Strong correlations were found between systolic home BP and body height (r = 0.49) and age (r = 0.41), whereas for diastolic BP these correlations were poor (r = 0.11 and 0.08, respectively). The 50th (midpoint of distribution) and the 95th percentile (suggested upper normal limit) for systolic and diastolic home BP in children are provided by body height. There was a marked increase in the estimated 95th percentile for systolic home BP with increasing height in boys (from 119 to 134 mmHg) and less so in girls (from 119 to 128 cm). Regarding diastolic home BP, there was little change with increasing height (from 75 to 80 cm) and no difference between boys and girls. CONCLUSIONS: These data suggest that home BP monitoring in children and adolescents is feasible. Reference values for home BP in the paediatric population are provided.     

Prevalence of arterial hypertension in children aged 9-14 years, residents of the city of Łódź

BACKGROUND: Hypertension is one of the most common disorders in adults. Although it may be already present in children and adolescents, it is usually undetected. There is a lack of data on the prevalence of hypertension in this age-group in Poland. AIM: To assess the prevalence of hypertension in children and adolescents, residents of the city of ?ód?. METHODS: Children and adolescents aged 9-14 years, attending one primary and one secondary school, were examined. Blood pressure (BP) was measured three times with the use of a mercury sphygmomanometer. Systolic BP was determined by the first Korotkoff sound, and diastolic BP - by the fifth Korotkoff sound. Hypertension was diagnosed when the value of systolic and/or diastolic BP exceeded the 95th percentile of normal values, taking into account height, gender and age. RESULTS: In total, 637 children and adolescents (349 girls and 288 boys) were examined. The first BP measurements revealed abnormal values in 13.2% of examined subjects, slightly more often in girls than in boys (14.6% vs 11.4%, NS). Triple BP measurements revealed the presence of hypertension in 3.3% of examined subjects (2.9% of girls and 3.8% of boys, NS). Hypertension was diagnosed by triple measurement in a significantly lower proportion of subjects than by a single screening examination (p<0.05). CONCLUSIONS: Hypertension is present in a significant proportion of children and adolescents who live in the city of ?ód?, which shows the need for a systematic screening. A proper detection of hypertension requires repeated BP measurements.     

Blood pressure in childhood and adolescence: the Italian normal standards. Study Group on Hypertension' of the Italian Society of Pediatrics'.

OBJECTIVES: To develop a national standard level of blood pressure (BP) for Italian children on the basis of a large sample of the population. DESIGN: We analyzed data available from 21 Italian studies conducted according to the recommendations of the American Task Force between 1988 and 1994. Percentile curves of systolic and diastolic BP were constructed by fitting a third-order polynomial model of BP on age and height using multiple regression analysis. PARTICIPANTS: BP was measured in 11 519 healthy individuals (6258 boys and 5261 girls) aged 5-17 years in various locations throughout Italy. All measurements were performed at school. RESULTS: Percentile curves (5th, 10th, 25th, 50th, 75th, 90th and 95th) of systolic and diastolic BP are reported by age and by height for males and females. CONCLUSIONS: With respect to the American standards, the levels in Italy for the 90th and 95th percentiles were 3-8 mmHg higher for systolic and diastolic BP in both sexes between 5 and 12 years of age, and 2-3 mmHg higher in older males. With respect to Northern Europe, in the lower ages, levels in Italy were quite similar, although slightly higher, whereas in late adolescence, the Northern European levels were much higher, especially in males, with differences of 4-5 mmHg for the mean values and 8-12 mmHg for the 95th percentile.     

Changes in the blood pressure during an exercise test in children and adolescents. Results with reference to height

The variations of blood pressure (BP) during exercise are important when there is a doubt about the normality of the values or a possibility of future abnormality. This is particularly true in children and adolescents with borderline or variable values, whose capacity of cardiovascular adaptation to sport is to be evaluated or who have a family history of hypertension. This study was undertaken to establish the profile of blood pressure on exercise during bicycle ergometry with reference to the height of the child or adolescent. BP and heart rate were measured in 651 healthy children aged 5 to 18 years during stress testing by bicycle ergometry. The sample was divided according to sex and height (120-139, 140-159, 160-180 cm), and according to resting BP values. During simple progressive exercise, the work required is increased by 10 watts every 2 minutes for children less than 140 cm tall, and by 20 watts when over 140 cm tall. BP and heart rate were measured during the last 30 seconds of each stage. Heart rate and systolic BP increased progressively with work load; on the other hand, the diastolic pressure did not change on exercise. The regression equation and the slope of systolic BP with respect to heart rate are reported, and allow comparison of different groups according to height, sex and resting systolic BP. The increase in systolic BP was the same in all groups except for boys taller than 160 cm in whom it was significantly greater (p less than 0,01). Sex and resting BP had no significant effect on the slope of systolic BP on exercise. The same applied to exercise lasting more than 6 minutes. The mean values and standard deviation of systolic BP at a heart rate of 150/min were, for each height group in ascending order: 121.5 +/- 19, 129 +/- 22 and 151 +/- 26 mmHg for boys, and 118.5 +/- 26, 126 +/- 21 and 137 +/- 26 mmHg for girls. In order to simplify the interpretation of the results obtained individually, charts in the form of an ellipse were plotted containing the usual values (95% of a healthy population) of systolic BP on exercise at the heart rate of 150/min, for each sex. They were established with reference to resting systolic BP and height. The diagnostic and prognostic value of this test will have to be evaluated by comparison with values obtained in hypertensive children.     

Blood pressure and its influencing factors in a national representative sample of Iranian children and adolescents: the CASPIAN Study.

BACKGROUND: This study was performed to determine the blood pressure (BP) percentile curves by height, as well as to assess the prevalence of high BP and its influencing factors among children in the first national survey in this field in Iran. DESIGN: A multicentre national cross-sectional survey. METHODS: This study was performed in 23 provinces among a representative sample of 21,111 students aged 6-18 years. RESULTS: Age and sex-specific percentile curves of systolic and diastolic BP were obtained by height. A comparison of the values obtained corresponding to the 90th percentiles with the Second Task Force cut-offs showed that the BP values and trends were relatively similar in both studies. The overall prevalence of systolic, diastolic as well as systolic or diastolic hypertension according to the Second Task Force study 95th percentile cut-off points were 4.2, 5.4 and 7.7%, respectively, without a significant sex difference. A history of low birthweight, overweight, taller height, the consumption of solid hydrogenated fat, as well as the frequency of fast food consumption increased the risk of both systolic and diastolic hypertension. Male sex, large waist, and low education of the mother were the risks for systolic hypertension, whereas the risk of diastolic hypertension rose with living in an urban area, attending public school, low physical activity level, having a housewife mother, and a positive family history of obesity, especially in the parents. CONCLUSION: Considering the effect of modifiable environmental factors on the childrens' BP, encouraging breast feeding and a healthy lifestyle may have an important effect on public health.     

Blood pressure in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children study

To characterize the distribution of blood pressure (BP), prevalence, and risk factors for hypertension in pediatric chronic kidney disease, we conducted a cross-sectional analysis of baseline BPs in 432 children (mean age 11 years; 60% male; mean glomerular filtration rate 44 mL/min per 1.73 m(2)) enrolled in the Chronic Kidney Disease in Children cohort study. BPs were obtained using an aneroid sphygmomanometer. Glomerular filtration rate was measured by iohexol disappearance. Elevated BP was defined as BP >or=90th percentile for age, gender, and height. Hypertension was defined as BP >or=95th percentile or as self-reported hypertension plus current treatment with antihypertensive medications. For systolic BP, 14% were hypertensive and 11% were prehypertensive (BP 90th to 95th percentile); 68% of subjects with elevated systolic BP were taking antihypertensive medications. For diastolic BP, 14% were hypertensive and 9% were prehypertensive; 53% of subjects with elevated diastolic BP were taking antihypertensive medications. Fifty-four percent of subjects had either systolic or diastolic BP >or=95th percentile or a history of hypertension plus current antihypertensive use. Characteristics associated with elevated BP included black race, shorter duration of chronic kidney disease, absence of antihypertensive medication use, and elevated serum potassium. Among subjects receiving antihypertensive treatment, uncontrolled BP was associated with male sex, shorter chronic kidney disease duration, and absence of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use. Thirty-seven percent of children with chronic kidney disease had either elevated systolic or diastolic BP, and 39% of these were not receiving antihypertensives, indicating that hypertension in pediatric chronic kidney disease may be frequently under- or even untreated. Treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may improve BP control in these patients.     

Gender-related differences in the relationships between blood pressure, age, and body size in prepubertal children

BackgroundThe blood pressure (BP) increase with age is well documented in adults and children. However, in the pediatric age group, body size is the most important determinant of age-related BP increases. The aim of the present analysis was to investigate the relationships between age, gender, and body size and BP in children.MethodsTo this purpose, data were analyzed from 4,514 prepubertal children, aged 6-11 years (71% of the eligible sample; boys = 2,283, girls = 2,231) from the ARCA Project, a screening of childhood obesity carried out in southern Italy. Girls who reported the occurrence of menarche were excluded from the analysis. The sample constituted roughly 20% of all the children attending the primary schools in the area. Weight, height, waist circumference, and BP were measured according to standardized procedures.ResultsAs expected, both systolic and diastolic BP significantly increased (P < 0.001) with age in boys and girls. However, after adjustment for waist circumference (as index of adiposity) and height (as index of body size), BP significantly increased with age only in girls (systolic BP: F = 4.380, P = 0.002; diastolic BP: F = 3.093, P = 0.01) but not in boys (systolic BP: F = 0.711, P = 0.55; diastolic BP: F = 2.180, P = 0.07). The association, however, was no longer apparent after the exclusion of children aged >10 years.ConclusionsIn prepubertal girls in the age range 6-11 years, but not in boys, age is significantly associated with BP independently of body size and adiposity.American Journal of Hypertension 2008; doi:10.1038/ajh.2008.228American Journal of Hypertension (2008); 21, 9, 1007-1010. doi 10.1038/ajh.2008.228.     

Blood pressure tracking in Japanese adolescents. Five-year follow-up in Hisayama, Japan

Blood pressures (BPs) were measured with standardized sphygmomanometers in 434 Japanese boys and girls living in the town of Hisayama. Simultaneously, data on pulse rate, weight and height were obtained. Out of the original 434 subjects, data were obtained repeatedly for 5 years in 280 subjects. BP levels were significantly correlated with weight in those aged 14-15 and also 19-20 years, but correlation coefficients were small. During the 5-year period, the mean systolic and diastolic blood pressure (SBP & DBP) increased significantly in both sexes, but the increments were greater in boys. Both SBP and DBP at 14-15 years of age were significantly correlated with data taken 5 years later for both sexes, and subjects with a higher initial BP (more than 90th percentile of the distribution) tended to have a higher BP after 5 years. SBPs after 5 years were independently correlated with initial SBP levels and changes in QI (D-QI) in both sexes. On the other hand, DBPs after 5 years were independently correlated with initial DBP levels and height for boys, and initial DBP levels and D-QI for girls.     

An epidemiological study of blood pressure in school children (5-14 years) in Delhi.

Distribution patterns of blood pressure were studied in a randomised sample of 10,215 school children (5,709 boys 4,506 girls) in the age group 5-14 years in Delhi. The mean values of systolic and diastolic blood pressure (SBP and DBP) increased with age in both sexes. The cut-off points for high blood pressure were based on average SBP and/or DBP values of 95th percentile or greater for each age. The values for SBP ranged from 70 mm Hg to 140 mm Hg and for DBP from 36 mm Hg to 100 mm Hg for the age group 5-9 years. In the age group 10-14 years, the values for SBP and DBP ranged from 72 mm Hg to 160 mm Hg and from 46 mm Hg to 120 mm Hg, respectively. The prevalence of hypertension (systolic, diastolic or both) was 11.9 percent in boys and 11.4 percent in girls, an insignificant difference. Anthropometric variables like height, weight and body mass index showed positive correlation with systolic as well as diastolic blood pressure but the waist-hip ratio showed negative correlation coefficient with blood pressure. Family history of hypertension in one or both the parents was present in 20.4 percent children with high blood pressure compared to 6.8 percent in normotensives. Family history or diabetes was also significantly higher in hypertensive children (5.4%) than in normotensives (3.1%).     

Predicting the dynamics of elevated arterial pressure in 12--13-year-old children of Kaunas and Berlin

The increased arterial blood pressure (BP) variation between 12-13 and 15-16 years of age was examined in 119 schoolchildren of Kaunas and 169 schoolchildren of Berlin. The 90th percentile for systolic and/or diastolic BP was used as a criterion of increased arterial BP. The data were treated by multivariate logistical regression analysis. Independent samples were used to construct and test the model. The reproducibility of increased arterial BP was shown to be affected by physical developmental status as well as baseline systolic and diastolic BP, the influence being more pronounced in girls, as compared to boys. The derived formulas are presented as a nomogram to facilitate their practical application.     

Blood pressure and Turner syndrome

INTRODUCTION: Elevated blood pressure (BP) is an important predictor of morbidity and mortality from cardiovascular disease. Patients with Turner syndrome (TS) have a higher morbidity and mortality in middle age than the normal population. As BP in childhood or early adulthood is predictive of BP later in adult life, we assessed manual and 24 h ambulatory BP in patients with TS to determine whether the BP pattern is altered at an early stage in these patients who are known to be at risk of cardiovascular disease. PATIENTS AND METHODS: We studied manual and 24 h ambulatory BP profiles in 75 girls with Turner syndrome, age range 5.4-22.4 years. A monitor with an oscillometric device (SpaceLabs model 90207) and an appropriate sized cuff was used. BP was measured during the day-time (0800-2000 h) and the night-time periods (2200-0800 h). The BP measured were compared with population standards. The effect of different growth promoting agents on BP was also evaluated. RESULTS: Mean manual and 24 h ambulatory BP measurements were 118/77 mmHg (range 95/60-140/102) and 115/70 mmHg (range 93/57-154/99), respectively. There was minimal difference between the two methods with a positive bias of 2.4 mmHg for diastolic BP and a negative bias of 2.1 mmHg for systolic BP. The mean standard deviation scores (SDS) corresponding to the mean BP recordings were 24 h systolic + 0. 81 (range - 1.26 to + 4.45), 24 h diastolic + 0.43 (range - 0.85 to + 3.42), day-time systolic + 1.08 (range - 0.95 to + 4.72), day-time diastolic + 0.70 (range - 0.94 to + 3.71), night-time systolic + 0. 22 (range -2.2 to + 3.64) and night-time diastolic - 0.18 (range -2. 0 to + 2.43). The SDS for both the mean 24 h and day-time systolic and diastolic BP were shifted to the right of the normal distribution. 57% of the girls had less than the normal 10% reduction in nocturnal systolic blood pressure. 17% had diastolic and 21% had systolic blood pressure above the 95th percentile for age and sex. There was no significant difference in the BP SDS between girls on no treatment and those receiving treatment. CONCLUSION: Over 50% of girls with Turner syndrome have an abnormal BP circadian rhythm, which is similar to adult patients with secondary hypertension. Patients with Turner syndrome have higher blood pressure measurements compared to published population standards, as evidenced by the shift to the right of both the systolic and diastolic BP SDS. These findings suggest that girls with Turner syndrome should be carefully monitored in childhood and adulthood for blood pressure and other cardiovascular risk factors.     

Lower bone mineral content in hypertensive compared with normotensive overweight Latino children and adolescents

BACKGROUND: In adults, hypertension has been shown to be inversely correlated with bone mineral content (BMC); however, the association between blood pressure (BP) and BMC has not been studied in pediatrics. METHODS: Total body BMC of 187 overweight (mean BMI = 28.7 kg/m(2)) Latino children and adolescents (mean age = 11.2 years) were measured using dual-energy x-ray absorptiometry. Seated systolic BP (SBP) and diastolic BP (DBP) were measured using a standard mercury sphygmomanometer. Hypertension was defined by SBP or DBP above the 90(th) percentile for height, age, and sex. RESULTS: Partial correlations revealed an inverse association between SBP and BMC (r = -0.24, P = 0.02) in boys (n = 105); results were nonsignificant (P = 0.27) in girls (n = 82). There were no significant correlations between DBP and BMC. When BMI and insulin sensitivity were adjusted for, hypertensive boys (n = 21) had lower BMC (1435 v 1636 g; P = 0.03) than normotensive boys (n = 84); similarly, hypertensive girls (n = 25) had lower BMC (1438 v 1618 g; P = 0.02) than normotensive girls (n = 57). In postpubertal adolescents (Tanner stage 4-5; n = 48), inverse correlations were stronger (r = -0.40, P = 0.007); results were nonsignificant in prepubertal and pubertal children (Tanner stage 1-3; n = 139, P = 0.57). In postpubertal girls (n = 37), there were no significant correlations (P = 0.14); inverse correlations in postpubertal boys (n = 11) became markedly stronger (r = -0.80, P = 0.02). CONCLUSION: Based on the study findings, SBP is inversely correlated with BMC in overweight adolescents; additionally, hypertensive subjects have lower adjusted means of BMC than normotensive subjects. These promising new findings suggest that hypertension may be a risk factor for osteopenia in overweight children and adolescents; this risk may be exacerbated in postpubertal boys.     

Obesity markers and blood pressure in a sample of Portuguese children and adolescents.

BACKGROUND: Little information exists regarding the effect of several obesity markers on blood pressure (BP) levels in youth. DESIGN: Transverse study including 2494 boys and 2589 girls. METHODS: Height, weight and waist were measured according to the international criteria and body fat (BF) by bioimpedance. BP was measured by an automated device. Hypertension was defined using sex-specific, age-specific and height-specific observation-points. RESULTS: Body mass index (BMI) and waist were positively related with systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate in both sexes, whereas the relationships with BF were less consistent. Stepwise linear regression analysis showed that BMI was positively related with SBP and DBP in both sexes, whereas BF was negatively related with SBP in both sexes and with heart rate in boys only; finally, waist was positively related with SBP in boys and heart rate in girls. Age and heart rate-adjusted values of SBP and DBP increased with BMI: for SBP, 117+/-1, 123+/-1 and 124+/-1 mmHg in normal, overweight and obese boys, respectively; corresponding values for girls were 111+/-1, 114+/-1 and 116+/-2 mmHg (mean+/-SE, P<0.001). Overweight and obese boys had an odds ratio for being hypertensive of 2.26 (95% confidence interval: 1.79-2.86) and 3.36 (2.32-4.87), respectively; corresponding values for girls were 1.58 (confidence interval 1.25-1.99) and 2.31 (1.53-3.50). CONCLUSION: BMI, not BF or waist, is consistently and independently related to BP levels in children; overweight and obesity considerably increase the risk of hypertension.     

24-hour blood pressure differences in hypertension and normotension in bed-confined subjects

This study investigates whether the degree of hypertension may be evaluated by information derived from the 24-h blood pressure (BP) curve unrelated to the pressure height. We performed 24-h BP intra-arterial monitoring in 52 bed-confined subjects (10 normotensives, 10 borderlines, and 32 hypertensives on WHO criteria). Computer analysis of 1152 BP values per subject per 24-h revealed the following: During the night hours, the percentage of the 1152 systolic BP values greater than or equal to 160 (in mmHg) increased (or did not change if 100%) in all subjects with mean 24-h systolic BP (24-h BP) greater than 170 and it decreased (or did not change if 0%) in all subjects with 24-h BP less than 150. The change in the percentage of the 1152 diastolic BP values greater than or equal to 95 during the night hours did not correlate to either the mean 24-h diastolic or systolic BP. The higher the mean 24-h systolic BP, the lower the skewness of the distribution of the 1152 systolic BP values (p less than 0.01). No such correlation existed between the skewness of the distribution of the 1152 diastolic BP values and either the mean 24-h diastolic or systolic BP. It is concluded that both the change in systolic BP during the night hours and the skewness of its distribution during the 24-h monitoring period are correlated to the severity of hypertension.     

Anthropometry and blood pressure differences in black Caribbean, African, South Asian and white adolescents: the MRC DASH study

OBJECTIVES: In this first large-scale study of ethnic differences in blood pressure (BP) among British adolescents, we examine the differences in BP levels in adolescence and the extent to which age, sex, body size and stage of maturation affect any observed differences. METHOD: A total of 6365 11-13 year olds (including 1189 white, 907 black Caribbeans and 1056 black Africans, 473 Indians, 605 Pakistanis and Bangladeshis, and 548 of mixed ethnicity) had systolic blood pressure (SBP) and diastolic blood pressure (DBP), anthropometry and pubertal stage measured in 2003. RESULTS: Compared with their white UK counterparts, black Caribbean and African boys were taller, and black Caribbean and African girls were taller, larger and matured earlier. Except for DBP among Indian girls, BP in minority groups was generally lower than in white UK children. Adjusted for age, height and body mass index, mean SBP was 109.1 mmHg (95% confidence interval 108.4, 109.8) and DBP 65.7 mmHg (65.2, 66.3) among white UK boys. Black Caribbean boys had lower SBP (-2.0; -3.2, -0.9 mmHg) and DBP (-1.5; -2.3, -0.6), and black African (-2.3; -3.4, -1.2) and mixed ethnicity (-1.6; -2.9, -0.3) boys had lower SBP. Adjusted SBP was 108.5 (107.8, 109.3) and DBP was 67.5 mmHg (66.9, 68.1) among white UK girls. Pakistani (-1.8; -3.2, -0.4) and black African (-1.1; -1.9, -0.3) girls had lower SBP and Indian girls (1.2; 0.1, 2.4) had higher DBP. Unlike African American girls, late puberty was not associated with higher BP in minority groups. CONCLUSION: At these ages, the ethnic-specific patterns in BP in adulthood were not observed. Apart from higher DBP for Indian girls, BP in minority groups was generally lower than their white UK counterparts. Targeting intervention in adolescence may be a critical opportunity for preventing ethnic differences in BP in later life.     

Univariate genetic analysis of blood pressure in children (the Medical College of Virginia Twin Study)

The relative contributions of genetic, individual environmental and shared environmental effects on resting blood pressure (BP) and heart rate (HR) were studied in prepubescent twins. The study population consisted of 251 caucasian 11-year-old twin pairs. Correlations were higher for all variables in monozygotic twins compared to dizygotic twins; this is consistent with a significant genetic effect. Path analysis revealed that the model of additive genetic and individual environmental effects fit systolic BP, diastolic BP and HR. In boys and girls, sex-specific genetic effects controlled systolic BP. The magnitudes of the sex-specific genetic effects on systolic BP were similar in both boys and girls and accounted for 66% of the variance. In boys, for diastolic BP, genetic effects accounted for 64% of the variance while in girls they accounted for 51%. These results provide no evidence for different genetic effects on HR in boys or girls. No shared environmental effects were detected. The large sample size and design, using different-sex dizygotic twins of the same age, establish that genes play an important role in the influence of resting BP and HR and that there are sex-specific genetic contributions in early pubertal children.     

Effects of early growth on blood pressure of infants of British European and South Asian origin at one year of age: the Manchester children's growth and vascular health study

OBJECTIVE: The objective of this study was to investigate early influences of postnatal growth on blood pressure (BP) in healthy, British-born South Asian and European origin infants. We tested the hypotheses that South Asian infants would be smaller in all body dimensions (length and weight) with higher relative truncal skinfold thickness at birth, and that increased (central) adiposity and accelerated growth up to 1 year would be associated with higher BP in both ethnic groups. PATIENTS AND METHODS: Five hundred and sixty infants were followed prospectively from birth to 3 and/or 12 months with measures of anthropometry and resting BP, compared against a UK 1990 growth reference, and analysed using regression methods. RESULTS: Marked differences in birth size persisted, as expected, between European and South Asian babies, but with a sexual dichotomy: South Asian boys were smaller in all anthropometric parameters (P < 0.001), including skinfolds (P < 0.05), than European boys, but South Asian girls, although smaller in length and weight, had similar skinfolds to European girls and thus a slightly larger subscapular skinfold thickness relative to birth weight [1.3 versus 1.2, mean difference 0.07, 95% confidence interval (CI) 0.0009-0.14, P = 0.047]. The dichotomy persisted postnatally; South Asian boys showed a striking early increase in weight and length compared with European boys, associated with significant accrual of subscapular fat (6.1 versus 5.3 mm, mean difference 0.8, 95% CI 0.3-1.3, P = 0.003). In gender and ethnicity adjusted regression models, infants with the largest weight standard deviation score (SDS) increases in the first 3 months had the highest 12-month systolic BP (beta = 2.4, 95% CI 0.5-4.2, P = 0.01), while those with the greatest birth length (beta = 0.7, 95% CI 0.05-1.4, P = 0.04) but the smallest changes in length over 3-12 months (beta = -0.57, 95% CI -0.95 to -0.19, P = 0.004) had the highest diastolic BP. CONCLUSIONS: Ethnic and gender differences in growth and adiposity present in early infancy include truncal fat preservation in South Asian girls from birth, which in boys is related to rapid early weight gain. Weight gain during the first 3 months appears to drive the rise in systolic BP to 1 year, itself a likely driver of later BP.     

Nycthemeral blood pressure monitoring in the diagnosis of borderline arterial hypertension in young adults

PURPOSE: Evaluating Blood Pressure Monitoring contribution at rest to the diagnosis and pathophysiology of borderline (BL) hypertension in the twenties. METHOD: a nycthemeral blood pressure recording each 15 minute has been performed during the 48 first hours of hospitalisation on two groups of white twenties males with a Dinamap: 143 Controls. Mean age: 21.1 +/- 2 yrs, mean height: 177 +/- 7 cm, mean weight: 71 +/- 11 kg; 104 BL hypertensive patients. Mean age: 21 +/- 2 yrs, mean height: 178 +/- 7 cm, mean weight: 78 +/- 12 kg. Mean BP recording levels are smaller than casual measurements in two groups: Controls (Casual BP: 125/71, BP recording on 24 hours: 117/60, day time: 121/63, nighttime: 110/54 mmHg). BL hypertensives (Casual BP: 144/83, BP recording on 24 h: 132/69, daytime: 137/73, nighttime: 121/60 mmHg). Nycthemeral BP variability measured by the standard deviation of mean pressure is not different in two groups for systolic variability, it significantly differs for diastolic variability (BL: 7.6/Controls: 5.5, p less than 0.01). Correlations between casual BP and diurnal records are stronger in controls than in BL patients showing a lower predictive value of clinical assessment in BL patients. Though the same heart rate at sleep, BP is significantly higher in BL than in controls. It probably means that factors different from sympathetic activity are involved in pathophysiology of borderline hypertension. The whole measurement study on 24 hours of two groups show an important overlap (the 65th percentile in BL systolic BP correspond with the 95th of controls, the 74th percentile in BL diastolic BP correspond with the 95th in controls). That make difficult the recording evaluation for a given patient.     

Prognostic value of blood pressure in acute stroke

Manipulation of blood pressure (BP) in acute stroke may improve outcome. Despite various studies, data on the prognostic significance of early BP in stroke remain unclear. Therefore, we studied the relationship between various BP variables in the acute phase of stroke and functional outcome at 3 months. Blood pressures were collected by reviewing BP records of 817 patients who were admitted to our stroke unit between 1987 and 1992. Besides the first systolic and diastolic admission BP (SBP and DBP), we also used the mean of the daytime as well as the night-time systolic and diastolic BP values. Finally, we studied the relationship between the decrease in BP between day 0 and 4 and outcome. As dependent outcome variable we used the Rankin handicap score at 3 months dichotomized in a score >3 (poor outcome) vs a score 3 (good outcome). A total of 430 patients were admitted within 24 h following stroke onset. There was no significant relationship between the systolic and diastolic BP and the outcome at 3 months. Only night-time systolic BP 165 mm Hg (odds ratio (OR) 2.8; 95% CI 1.1-6.8), night-time diastolic BP 60 mm Hg (OR 8.1; 95% CI 1.1-58.3), and a decrease in daytime diastolic BP between day 0 and 4 of 10 mm Hg (OR 3.0; 95% CI 1.1-7.9) showed a significant relationship with poor outcome. Our findings suggest that admission BP values may not reliably reflect any impact of BP on stroke outcome. They also suggest a potential differential effect of BP manipulation: increasing or decreasing BP may be beneficial for patients with BP extremes in one direction, but detrimental for those with BP values in the opposite direction.     

Blood pressure is associated with body mass index in both normal and obese children

Obesity is associated with elevated blood pressure (BP) both in adults and children. Childhood obesity has become a severe health problem, especially during the last few decades. So far there has not been any large-scale study specifically focusing on the association between obesity and BP in early life. The aim of this study is to examine systematically the association between obesity and BP in preschool Chinese children in mainland China. In 1996, measurements of weight, height, and BP values were collected in a nationwide, case-control study of 748 boys and 574 girls who ranged in age from 0.1 to 6.9 years in 8 cities in mainland China. One obese child and 1 nonobese child were matched for gender and age. The BP differences of the mean-matched pair were approximately 5 mm Hg for systolic blood pressure (SBP) and approximately 4 mm Hg for diastolic blood pressure (DBP) (P<0.05); a higher value was noted in obese children. The BP value of 19.4% children in the obese group and 7.0% children in the nonobese group was higher than the 95th percentile value (P<0.0001), which is defined as high BP by the Task Force on Blood Pressure Control in Children. Both SBP and DBP were significantly (P<0.05) positively related to body mass index (BMI) values (P<0.05) for children in obese and nonobese groups after adjustment for age, gender, and height. To be specific, an increase of 1 BMI unit was associated with, on average, an increase of 0.56 mm Hg and 0.54 mm Hg in SBP and DBP, respectively, for obese children. In nonobese children, the increase in SBP and DBP was 1.22 mm Hg and 1.20 mm Hg, respectively. An increase in the BMI is conclusively associated with elevated SBP and DBP in nonobese children. Furthermore, an increase in the adjusted BMI was associated with an increase in SBP and DBP in obese and nonobese children.