Ambulatory blood pressure in 12-year-old children born small for gestational age

An association between low birth weight and subsequent elevated blood pressure has been demonstrated in a large number of studies, but the number of subjects born small for gestational age in these studies has been negligible. The inverse relationship between birth weight and blood pressure in children has been evaluated previously with an ambulatory blood pressure device, but only in children with normal birth weights. In this prospective case-control study from birth to the age of 12, we evaluated the ambulatory blood pressures in 50 children born at term but small for gestational age and in 50 full-term children born appropriate for gestational age. Children born small for gestational age had similar mean+/-SD systolic (117.5+/-8.5 mm Hg versus 115.3+/-7.4 mm Hg, P=0.221), and diastolic (69.2+/-5.3 mm Hg versus 67.3+/-4.4 mm Hg, P=0.075) 24-hour ambulatory blood pressure compared with the values of the children born appropriate for gestational age. However, 24-hour systolic blood pressure in the small-for-gestational-age children was higher (3.90 mm Hg; 95% confidence interval, 0.65 to 7.15) after adjusting for current body mass index. The difference in current body mass index was the only determinant for the difference in systolic blood pressure between the groups. Birth weight had no direct association with the blood pressure values. Impaired fetal growth may have a relationship with higher later blood pressure, but in 12-year-old children, blood pressure differences between small for gestational age and appropriate for gestational age children are much more dependent on current body size.     

Psychological correlates of elevated arterial pressure and smoking in adolescents

Psychological characteristics of adolescents with risk factors of cardiovascular disease (elevated arterial pressure - EAP - and smoking) were examined in Moscow secondary school pupils aged 12-14 years, using an abridged variant of the psychodiagnostic MMPI questionnaire. The following characteristics were found to differentiate these youngsters from a comparable control group of youngsters without the mentioned risk factors: increased anxiety, insufficient self-confidence, deficient understanding of the motives of their own behaviour, and a tendency to deny their own psychological problems. These characteristics are most pronounced in youngsters with neurocirculatory asthenia of hypertensive type. There were also found specific psychological characteristics differentiating youngsters with EAP from smokers without EAP. The authors point to the possibility of working out differentiated methods of psychological intervention in EAP and smoking in adolescents.     

Relation of the levels of thyroid hormones and cortisol and the degree of systolic arterial pressure in 11- and 12-year-old boys

An epidemiologic evaluation of relationships between arterial BP changes, and thyroid and adrenocortical hormones was carried out in eleven- and twelve-year-old boys. Different patterns of correlation were demonstrated between plasma thyrotropic hormone, thyroid hormones and cortisol levels, on one hand, and systolic BP variation, on the other. There was a correlation between thyroid hormones and cortisol in these groups. The results suggest that even slight changes in thyroid and adrenal function may promote disorders of BP regulation.     

Tuberculous peritonitis with infracarinal mass and elevated CA-125 in a 13-year-old girl

A 13-year-old girl with weight loss and ascites was admitted with suspicion of a malignant disease. Abdominal magnetic resonance imaging indicated extensive peritonitis and showed no evidence of a solid tumor. As a new imaging observation, thoracic computed tomography showed a lymphoma-like infracarinal mass and further enlarged lymph nodes in the pathway of draining lymph ducts. A tuberculin skin test and an interferon-gamma blood test were positive, and the tumor marker CA-125 was elevated. Histology of a peritoneal biopsy showed infectious granulomas with central necrosis, and Mycobacterium tuberculosis could be cultured, leading to the diagnosis of a tuberculous peritonitis. The girl received multi-drug anti-tuberculous treatment and subsequently recovered. At follow-up the peritonitis and the infracarinal mass had vanished. In conclusion, tuberculous peritonitis is a rare but relevant differential diagnosis in peritonitis of unknown origin. Its diagnosis is facilitated by imaging, by tuberculosis skin and blood tests, and by clinical interpretation.     

Comparison of Doppler-determined elevated pulmonary arterial pressure with pressure measured at cardiac catheterization

This study assesses use of pulsed Doppler echocardiography to measure pulmonary artery (PA) pressure. PA flow at the right ventricular (RV) outflow tract was analyzed in 51 patients. Attention was focused on PA flow morphologic pattern, RV systolic intervals, time to peak flow and acceleration time index. Correlation was made with PA pressure and total pulmonary resistance. Three morphologic patterns of PA flow were found: type I indicates normal PA pressure (sensitivity 85%, specificity 100%) and types II and III indicate PA hypertension (sensitivity 100%, specificity 85%). The RV preejection/RV ejection ratio, time to peak flow and acceleration time index show a good correlation coefficient improved when a logarithmic function was applied. The best correlation was achieved with time to peak flow (r = -0.77 with PA pressure, r = -0.79 with total pulmonary resistance), and especially with acceleration time index (r = -0.84 with PA pressure, r = -0.87 with total pulmonary resistance). Analysis of pulmonary flow is a reliable new tool for evaluating PA pressure and is even better for evaluating total pulmonary resistance. Acceleration time index is the parameter that correlates best with these 2 variables.     

Environmental temperature and blood pressure in 9-year-old Australian children

Relationships between blood pressure (BP) and environmental temperature were investigated as part of a broader study of constitutional and environmental determinants of BP in a sample of 1037 9-year-old Australian children. A Dinamap semi-automatic device was used to obtain three BP readings for each child. Average systolic blood pressure (SBP) and diastolic blood pressure (DBP) differed according to month of examination, with higher levels in the colder months. Negative relationships were observed between BP and temperature on the measurement day; computed regression equations indicated that a rise in maximum daily temperature of 10 degrees C was associated with falls of 5-7 mmHg in SBP and DBP. The relationships were independent of age, weight, height, socio-economic status and heart rate (HR). The results emphasize the importance of taking environmental temperatures into account in epidemiological studies of BP.     

Association between pubertal development and elevated blood pressure in children

Blood pressure (BP) increased with age and height development, but little was known about the effect of pubertal development on blood pressure in children. A cross‐sectional study was performed among 4146 children aged 7–12 years old in China. Pubertal development was assessed based on breast stages and testicular volume. The associations of pubertal development with BP levels and the rate of elevated blood pressure (EBP) were quantified using multiple linear and logistic regressions. We found that pubertal developmental level was positively correlated with BP, and children who experienced puberty onset and early pubertal timing had higher BP levels and prevalence of EBP. After adjusting for covariates, children experienced puberty onset had 3.84 and 2.24 mmHg increase in systolic blood pressure and diastolic blood pressure, and 70%, 53%, and 62% increased odds of EBP, ESBP, and EDBP, respectively, compared with those without puberty onset. Similar results were observed for children who had early pubertal timing. The change of BP in puberty is greater and the association between pubertal development and BP is stronger in girls than boys. These findings suggested that pubertal development could be an important independent factor and one critical period for the EBP progress. Monitoring and management of pubertal development are necessary particularly among girls.     

Endogenous melanocortin system activity contributes to the elevated arterial pressure in spontaneously hypertensive rats

Previous studies suggest that activation of the CNS melanocortin system reduces appetite while increasing sympathetic activity and arterial pressure. The present study tested whether endogenous activity of the CNS melanocortin 3/4 receptors (MC3/4-R) contributes to elevated arterial pressure in the spontaneously hypertensive rat (SHR), a model of hypertension with increased sympathetic activity. A cannula was placed in the lateral ventricle of male SHR and Wistar (WKY) rats for chronic intracerebroventricular (ICV) infusions (0.5 muL/h). Mean arterial pressure (MAP) and heart rate (HR) were recorded 24 hour/d using telemetry. After 5-day control period, rats were infused with MC3/4-R antagonist (SHU-9119, 1 nmol/h-ICV) for 12 days, followed by 5-day posttreatment period. MC3/4-R antagonism increased food intake in SHR by 90% and in WKY by 125%, resulting in marked weight gain, insulin resistance, and hyperleptinemia in SHR and WKY. Despite weight gain, MC3/4-R antagonism reduced HR in SHR and WKY ( approximately 40 bpm), while lowering MAP to a greater extent in SHR (-22+/-4 mm Hg) than WKY (-4+/-3 mm Hg). SHU9119 treatment failed to cause further reductions in MAP during chronic adrenergic blockade with propranolol and terazosin. These results suggest that endogenous activity of the CNS melanocortin system contributes to the maintenance of adrenergic tone and elevated arterial pressure in SHR even though mRNA levels for POMC and MC4R in the mediobasal hypothalamus were not increased compared to WKY. These results also support the hypothesis that weight gain does not raise arterial pressure in the absence of a functional MC3/4-R.     

Thyroid gland volume and echo structure in 13-year-old children in northern Finland

The purpose of this work was to determine by ultrasound the volume and echo structure of the thyroid gland in 13-year-old schoolchildren in northern Finland. 76 healthy schoolchildren underwent cervical ultrasound examinations during the period of Jan-Feb 1990, performed with a real-time scanner using a 7.5 MHz linear transducer and direct contact method. The volume of each lobe was calculated according to the formula for a volume of rotation ellipsoid by multiplication of maximal thickness, width and height of the lobe by the correction factor 0.479. Any focal lesion that could be distinguished in the homogenous thyroid parenchyma was assessed for echogenicity as compared with the normal thyroid gland and was measured with electronic calipers. The mean thyroid volume was 6.5 +/- 1.6 ml (mean +/- SD), being 6.3 +/- 1.8 ml in the boys and 6.7 +/- 1.4 ml in the girls. The sex difference was not significant. The right lobe was significantly larger than the left one (mean 3.7 and 2.8 ml, respectively). Thyroid volume was correlated with body weight and body surface area in both sexes. Abnormal lesions in terms of echo structure were noted in one subject (1.3%). Comparing the results with the findings reported from other countries, it can be concluded that the thyroid volume in these 13-year-old Finnish schoolchildren was about 30% less than that reported for the same age group in the FRG (with insufficient iodine intake) and about 35% more than in 13-year-old schoolchildren in Sweden (with sufficient iodine intake).     

Blood pressure levels in 7 to 14-year-old Belgrade children

The objective of the work was to study blood pressure and some anthropometric characteristics in children. The study design included the prevalence study at Belgrade, Serbia and Montenegro. The study comprised 1651 subjects (809 boys and 842 girls) aged 7-14 years, that is, 2.6% of all relevant population. The average levels of systolic and diastolic blood pressures (SBP and DBP) were 113.4/70.3 mmHg in boys and 114.6/71.1 mmHg in girls. High SBP was present in 4.7% of boys and in 5.3% of girls. High DBP was found in 5.6% of boys and in 4.8% of girls. According to multivariate regression analysis, in boys SBP and DBP were significantly associated with age, body mass index (BMI) and subscapular skinfold, SBP was also associated with body weight, and DBP with triceps skinfold. In girls, SBP was significantly related to BMI, suprailiac skinfold and body height, and DBP was significantly associated with BMI, suprailiac and subscapular skinfolds. The results of the present study support the opinion that BMI is a significant predictor of blood pressure in children and point out to suprailiac skinfold in girls as a possible predictor of blood pressure.     

Blood pressure,serum lipids,fasting insulin,and adrenal hormones in 12-year-old children born with maternal preeclampsia

Women with prior preeclamptic pregnancies have an increased risk for metabolic syndrome and cardiovascular diseases. Maternal preeclampsia has been associated with elevated blood pressure (BP) in offspring during childhood. The aim of our study was to determine whether elevated BP pressure and metabolic changes, such as dyslipidemia, insulin resistance, and increased adrenal hormonal activity, are found in 12-yr-old children of preeclamptic mothers. Sixty children born after preeclamptic pregnancy (PRE) and 60 matched control subjects born after normotensive pregnancy (non-PRE) were studied at the age of 12 yr. The case-control pairs were matched for sex, gestational age (+/-1 wk), and size at birth. We measured BP and concentrations of blood glucose, serum fasting insulin, total and high density lipoprotein cholesterol, triglycerides, cortisol, dehydroepiandrosterone sulfate, and plasma epinephrine (E) and norepinephrine (NE). Low density lipoprotein cholesterol was calculated according to the Friedewald-Fredrickson formula. The PRE children had significantly higher mean systolic (116.4 vs. 113.2 mm Hg; P = 0.021) and diastolic (73.9 vs. 70.3 mm Hg; P = 0.022) BP than the non-PRE children, even when adjusted by current weight and height. At 12 yr of age, systolic BP values correlated inversely with birth weight (r = -0.459; P < 0.001) and length SD scores (r = -0.429; P = 0.001) in the PRE children. The mean concentrations of serum total, low density lipoprotein, and high density lipoprotein cholesterol; triglycerides; fasting insulin; blood glucose; serum cortisol; and dehydroepiandrosterone sulfate did not differ between the PRE and non-PRE groups. However, the mean plasma E concentration was higher in the PRE than in the non-PRE children (0.32 vs. 0.28 nmol/liter; P = 0.042), whereas the mean NE concentration did not differ between these two groups. In conclusion, 12-yr-old children born with maternal preeclampsia had elevated systolic and diastolic BPs and slightly increased E levels in the circulation. It is not known whether these changes are caused by genetic factors or by preeclampsia itself.     

The Fuenlabrada study: arterial pressure in children and adolescents

Blood pressure was studied in 2,153 healthy children of both sexes, from 0 to 18 years of age; 1,115 were males and 1,038 females. Systolic and diastolic blood pressures were measured in the sitting position by the auscultatory method on the right arm with a mercury sphygmomanometer using an appropriate cuff size. Systolic blood pressure was measured on the first sound and diastolic blood pressure in the fourth phase of Korotkoff. In children younger than 3 years blood pressure was measured in the decubitus supine position using the Doppler technique. There were no significant differences in mean systolic and diastolic blood pressure in both sexes. But the percentage of systolic blood pressure greater than or equal to 130 mmHg was higher in males than females (p less than or equal to 0.01). 8.4% of the total population had systolic blood pressure greater than or equal to 130 mmHg, and 1.3% had diastolic blood pressure greater than or equal to 90 mmHg. The annual increase rates of systolic and diastolic blood pressure were 2.31/0.94 mmHg in males and 2/0.97 mmHg in females. Children with blood pressure greater than or equal to the 95th percentile had a higher prevalence of hypertriglyceridemia and obesity. 54% of the variation in systolic blood pressure was explained by the association of weight, subscapular skinfold, body mass index and C-HDL. 30% of the variation in diastolic blood pressure was explained by the association of weight, obesity index, subscapular skinfold and C-HDL.     

Severe obstructive sleep apnea in children with elevated blood pressure

The objective was to determine the prevalence of habitual snoring and obstructive sleep apnea (OSA) in a cohort of children referred for elevated blood pressure (BP), and to determine the association between OSA and BP elevation, learning difficulties, and behavioral problems. We performed a retrospective review of 446 consecutive new patients referred for elevated BP. One hundred four (23%) had habitual snoring. Patients with habitual snoring were more likely to be obese (86.5 vs. 55.6%, P < .001) and to have Medicaid insurance (52.4 vs. 36%, P = .004). Seventy-four patients had polysomnography, of which 57 (77%) had OSA; 21 (37%) had severe OSA. Severe OSA was associated with higher office systolic BP index after adjusting for body mass index, age, sex, and socioeconomic status (β = 0.07, P = .014). Fifty-two percent of patients with severe OSA had office systolic BP in the Stage 2 hypertension range. Children with habitual snoring or OSA were not at increased risk of receiving school services for a learning disability or receiving medications for inattention or mood problems. In summary, habitual snoring is common in children referred for elevated BP, and those with severe OSA are at higher risk of significantly increased BP.     

Prevalence of obstructive sleep apnea syndrome and associated symptoms in 3--11-year-old Turkish children

Our objective was to investigate the prevalence of sleep-disordered breathing (SDB) and obstructive sleep apnea syndrome (OSAS) in 3-11-year-old Turkish children. A cross-sectional study was conducted in Zonguldak, northwestern Turkey. Symptomatic children were identified by using a self-administered questionnaire and were classified into three groups: nonsnorers, occasional snorers, and habitual snorers. All habitual snoring children were invited to undergo polysomnography (PSG). Nine hundred fifty-four children (79.5%) were nonsnorers, 205 (17.2%) were occasional snorers, and 39 (3.3%) were habitual snorers. There was no significant relationship between gender and habitual snoring (male, 3.4%; female, 3.1%; P > 0.05; odds ratio (OR), 1.13; 95% confidence interval (CI), 0.59-2.14). There was a statistically significant relationship between habitual snoring and allergic rhinitis (OR, 4.23; 95% CI, 2.14-8.35). Four children who snored every night, and who had apnea spells and/or troubled sleep, underwent adenoidectomy and/or tonsillectomy before polysomnographic evaluation because of clinical detoriation. Twenty-eight of 39 children with habitual snoring participated in PSG evaluation. PSG revealed that 11 children (0.9% of the total population) had OSAS. When 4 operated children were added to these 28 children, we found the minimum prevalence of OSAS to be 1.3% in our study group. There was a significant correlation between OSAS and troubled sleeping (P <0.001; OR, 4.37; 95% CI, 1.33-14.3). We found the prevalence of habitual snoring to be 3.3% in Turkish children by using self-administered questionnaires. Allergic rhinitis was significantly correlated with habitual snoring. Minimum estimated prevalence of OSAS was found to be 1.3%.     

血压高升幅人群的肠道菌群组成和功能改变研究

目的 评估血压大幅升高患者的肠道微生物物种组成和潜在功能的变化情况。方法 本研究通过2年随访（2014年5月-2016年5月）,自开滦医院（课题合作单位）,纳入平均动脉压升幅高人群19例（△MAP≥10 mmHg）为研究组,平均动脉压升幅低人群33例（△MAP<10 mmHg）为对照组。利用该队列人群粪便DNA的Illumina HiSeq 2500高通量测序数据,对两组人群基线的肠道微生物物种组成和功能进行宏基因组分析,评价肠道菌群的组成和功能在血压上升人群中的特征。结果 研究组与对照组人群的肠道微生物在科、属和种级别,分别主要由Bacteroidaceae和Prevotellaceae、Bacteroides和Prevotella、Faecalibacterium prausnitzii和Prevotella copri组成。血压升幅高组人群肠道中微生物的丰度在基线时与对照组有显著不同,其中Bacteroidaceae、Bacteroide、Bacteroides vulgatus、Bacteroides dore等的相对丰度明显增加,而Planococcacea、Flavobacterium、Clostridium sp.等显著缺乏。基于京都基因与基因组百科全书 (Kyoto Encyclopedia of Genes and Genomes, KEGG) 数据库进行功能分析表明,血压升幅高组的肠道微生物潜在功能显著改变。结论 研究组人群基线时期的肠道微生物组成和功能与对照组不同,提示特定肠道微生物的改变可能参与宿主血压升高的病理过程。