Assessing levels of uric acid and other cardiovascular markers in prehypertensive and hypertensive adults.

INTRODUCTION: Although some studies have reported the association between uric acid (UA) and hypertension, evidence on prehypertension is still lacking. Therefore, the objective of this study was to determine the levels of UA and other cardiovascular markers among prehypertensive and hypertensive patients and assess their risk for developing arterial hypertension. METHODS: 157 individuals were recruited: 67 normotensive, 23 pre-hypertensive and 67 hypertensive. Blood samples were collected to measure biochemical parameters and anthropometric measurements and blood pressure were evaluated. We calculated the product of lipid accumulation and the visceral adiposity index to assess cardiovascular risk. RESULTS: Our data showed an increase in UA levels in normotensives (4.9±1.3mg/dL), prehypertensives (5.2±1.3mg/dL) and hypertensives (5.9±1.6mg/dL) (p=0.004). We found a higher frequency of hyperuricemia in the hypertensive group (34.3%) than in the normotensive group (13.4%, p<0.05). Hypertensive volunteers had lower levels of HDL-C (p=0.004 and p=0.003) and higher body mass indexes (p<0.001 and p=0.007), glucose (p<0.001 and p=0.033), triglycerides (p=0.001 and p=0.005), visceral adiposity index (p<0.001 and p=0.002) and lipid accumulation product (p<0.001 and p=0.007) than normotensive and prehypertensive participants. We also observed that individuals with UA≥6.2mg/dL had an increased risk of hypertension of 4.77 (p=0.003) compared to individuals with levels≤4.3mg/dL. CONCLUSION: Our results showed that UA is associated with increased blood pressure and unfavorable changes in anthropometric and biochemical parameters, which represent risk factors for hypertension and cardiovascular diseases.

Reclassification of Adolescent Ambulatory Prehypertension and Unclassified Blood Pressures by 2022 American Heart Association Pediatric Ambulatory Blood Pressure Monitoring Guidelines.

OBJECTIVE: To describe the epidemiology of reclassification of prehypertensive and unclassified adolescents by 2022 American Heart Association pediatric ambulatory blood pressure monitoring (ABPM) guidelines, and to evaluate the association of the new diagnostic categories with left ventricular hypertrophy (LVH). STUDY DESIGN: A single-center, retrospective review of ABPM reports from adolescents 13-21 years old, from 2015 through 2022, was performed. Adolescents with prehypertension or unclassified by 2014 guidelines were reclassified by 2022 definitions. Logistic regression models evaluated the association of reclassification phenotypes with LVH. RESULTS: A majority of prehypertensive adolescents reclassified to hypertension (70%, n = 49/70). More than one-half (57%, n = 28/49) of the hypertension was isolated nocturnal hypertension, and 80% was systolic hypertension. Reclassification to hypertension was more common in males. The majority (55.6%) of unclassified adolescents were reclassified to normotension. No demographic or clinical variables were associated with reclassification categories. LVH was not associated with hypertension in the reclassified prehypertensive or unclassified groups. CONCLUSIONS: The 2022 ABPM guidelines clearly define blood pressure phenotypes. However, reclassification to hypertension was not associated with an increased odds of LVH. Because most prehypertensive adolescents reclassified as hypertensive by nighttime BPs alone, this study highlights the lowered threshold for nocturnal hypertension. Prospective studies in larger, well-defined cohorts are needed to describe better the predictive value of 2022 BP phenotypes for target organ damage.

Changes in Ambulatory Blood Pressure Phenotype over Time in Children and Adolescents with Elevated Blood Pressures.

OBJECTIVE: To determine the stability of ambulatory blood pressure monitoring (ABPM) over time in children referred for evaluation of elevated BPs and assess for factors predicting change. STUDY DESIGN: This retrospective chart review conducted at Seattle Children's Hospital and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh identified 124 children referred for elevated BPs with 2 ABPM studies at least 6 months apart. All subjects received lifestyle counseling. Subjects with secondary hypertension (HTN) or on antihypertensive medication were excluded. ABPM phenotype was classified using American Heart Association guidelines as showing normal BP, prehypertension, and HTN. Generalized linear mixed effect regression models were used to regress stable, improving, or worsening HTN outcomes at study follow-up on baseline BP index and load variables. RESULTS: The median age of patients was 14.1 years (73% males) and the median interval between studies was 18 months. ABPM phenotype changed in 58 of 124 children, with 16% worsening and 31% improving. Older age was associated with persistence of HTN. Although not significant, decrease in body mass index z-score tracked with sustained normal ambulatory BPs. CONCLUSIONS: Although the sample size is small, our study suggests ABPM phenotype shows variability over time. Further study is required to identify factors supporting risk for progression of ABPM phenotype over time.

Stage I hypertension is associated with impaired systolic function by strain imaging compared with prehypertension: A report from the prever study.

High blood pressure (BP) is associated with higher rates of cardiovascular events, even in stage I hypertension (HTN) and prehypertension (preHTN). Lower left ventricular (LV) systolic function, assessed by global longitudinal strain (GLS), has been demonstrated in individuals with HTN compared to individuals with normal BP, but a comparison of individuals with preHTN and stage I HTN was not described to date. The PREVER study includes two randomized double-blind controlled trials, performed in volunteers with preHTN (PREVER-prevention trial) or stage I HTN (PREVER-treatment trial), aged 30-70 years. A subsample of patients of both trials had GLS measured from 2D echocardiograms performed at baseline and after 18 months of follow-up. We compared baseline data from both studies and, among stage I HTN patients, clinical and echocardiographic correlates of GLS were determined. Participants with preHTN (n = 91;53% female; 55 ± 9 yo) and stage I HTN (n = 105; 44% female; 55 ± 8 yo) had similar clinical parameters beyond the expected differences in BP levels. Participants with stage I HTN had lower GLS (-17.5 ± 2.5% vs -18.2 ± 2.4%, P = .03) compared with those with preHTN. In stage I HTN, lower GLS was associated with lower e' and lower LV ejection fraction. In conclusion, patients in Stage I HTN may already express changes in GLS compared with individuals with preHTN, suggesting that even mildly difference in BP can be impact in subclinical systolic function.

Ecocardiografia na pré-hipertensão e hipertensão estágio I / Echocardiography in pre-hypertension and hypertension stage I

Fundamento: A pré-hipertensão e a hipertensão estágio I estão associadas ao remodelamento do ventrículo esquerdo (VE). No presente estudo, comparamos os parâmetros ecocardiográficos de lesão de órgãos-alvo pré-clínicos da hiper-tensão arterial em indivíduos com pré hipertensão e hipertensão estágio I selecionados a partir da mesma população. Métodos: Comparou-se as medidas ecocardiográficas basais dos participantes incluídos no estudo PREVER com pré-hi-pertensão (PREVER-prevention; n = 106) ou hipertensão estágio I (PREVER-treatment; n = 128). Investigou-se também as diferenças relacionadas ao sexo, verificadas nos parâmetros ecocardiográficos. Resultados: A pressão arterial sistólica e diastólica média mostrou-se significativamente maior no grupo hipertensão estágio I (141,0/90,4 mmHg) quando comparada com o grupo pré-hipertensão (129,3/81,5 mmHg, P<0,001 para ambos os grupos). A média de idade foi de 55 anos (30 a 70), com um número quase igual de homens e mulheres, dos quais 80% eram brancos e 7% tinham diabetes. A maioria dos parâmetros de massa do VE, dimensão do AE e função diastólica mostrou-se semelhante entre os grupos pré-hipertensão e hipertensão estágio I. Os indivíduos hipertensos apresentavam AE com maior diâmetro e maior espessura da parede posterior, além de menores velocidades laterais e, mesmo após ajuste para idade, sexo e índice de massa corporal. A análise em relação ao sexo mostrou VE com maior massa na hipertensão estágio I em comparação à pré-hipertensão apenas em mulheres (141,1 ± 34,1 gvs. 126,1 ± 29,1 g, P<0,05). Conclusões: Em indivíduos de meia-idade com baixo risco cardiovascular, as diferenças nos parâmetros ecocardiográficos relacionadas à lesão de órgãos-alvo são sutis entre a pré-hipertensão e a hipertensão estágio I, embora mulheres com hipertensão estágio I tenham VE com massa significativamente maior, o que pode indicar resposta adaptativa específica do sexo à pressão arterial em estágios iniciais de hipertensão

Indicators of accumulated fat are stronger associated with prehypertension compared with indicators of circulating fat: A cross-sectional study.

Recently, prehypertension has been considered as a risk factor for cardiovascular disease because it can progress to hypertension. The association between obesity and dyslipidemia with raised blood pressure has been reported in some studies; however, the ability of indicators of such conditions to predict prehypertension has been scarcely explored. In this cross-sectional study, we compared the ability of indicators of accumulated and circulating fat to discriminate between prehypertensive and normotensive Mexico City residents (n = 1377). The indicators were classified based on the parameters needed for their calculation: including only circulating fat (IOCFi) (e.g., Castelli risk indexes), including only accumulated fat (IOAFi) (e.g., waist circumference [WC]), and mixed (e.g., lipid accumulation product [LAP]). We compared the areas under the receiving operating characteristic curves (AURCs) and estimated the cutoff points for each indicator and their associated risk of prehypertension. The IOAFi had the greatest AURCs, followed by mixed and IOCFi; the AURCs for WC were the highest (AURC = 0.688 and 0.666 for women and men, respectively). The highest odds ratios for prehypertension were those associated with the cutoff points for IOAFi and LAP (e.g., OR = 2.8 for women with WC > 83.5 cm and OR = 2.6 for men with WC > 87.5 cm). Early detecting people at risk of cardiovascular disease is a necessity and given that WC had a better performance than the other indexes and it is relatively easy to measure, it has the potential of being used as a complementary measure in routine clinical examinations and by the general population as an auto-screening measurement to detect prehypertension.

[Risk of high blood pressure in hyperreactive cardiovascular individuals.] / Riesgo de hipertensión arterial en individuos hiperreactivos cardiovasculares.

OBJECTIVE: To determine the risk of high blood pressure in cardiovascular hyperreactive individuals identified by the isometric hand-held weight test. MATERIALS AND METHODS: A prospective cohort study was conducted for 5 years, including a total of 419 individuals. Of them, 215 were normoreactive and 204 hyperreactive. The relative risk of hypertension in the hyperreactive individuals and the contribution of cardiovascular hyperreactivity to the development of high blood pressure were determined. The significance level was 0.05. RESULTS: The frequency of new hypertension cases after five years was twice as high in the cohort of hyperreactive subjects compared to the cohort of normoreactive subjects (RR 2.23, 95%CI 1.42, 3.51). The cardiovascular hyperreactivity was the most important variable for predicting of the high blood pressure (OR: 2.73; 95%CI 1.59, 4.54). CONCLUSIONS: Conclusions. Cardiovascular hyperreactive individuals have a higher risk of high blood pressure than normorreactive individuals.

OBJETIVO: Determinar el riesgo de padecer hipertensión arterial en individuos normotensos con hiperreactividad cardiovascular, identificados mediante la ergometría isométrica. MATERIAL Y MÉTODOS: Se desarrolló un estudio de cohorte, de cinco años de evolución, con un total de 419 personas; de ellas, 215 normorreactivos cardiovasculares y 204 hiperreactivos cardiovasculares. Se determinó el riesgo relativo que tienen los individuos hiperreactivos cardiovasculares de ser hipertensos y el peso de la hiperreactividad cardiovascular en la aparición de hipertensión arterial; se fijó un nivel de significación estadística de p igual 0.05. RESULTADOS: La frecuencia de nuevos hipertensos en la cohorte de hiperreactivos cardiovasculares respecto a los normorreactivos cardiovasculares fue dos veces superior (RR:2.23 IC95% 1.42;3.51). La hiperreactividad cardiovascular fue la variable de mayor influencia. CONCLUSIONES: Los individuos normotensos hiperreactivos cardiovasculares tienen mayor riesgo de hipertensión arteria que los normotensos normorreactivos cardiovasculares.

Riesgo de hipertensión arterial en individuos hiperreactivos cardiovasculares / Risk of high blood pressure in hyperreactive cardiovascular individuals

Resumen Objetivo Determinar el riesgo de padecer hipertensión arterial en individuos normotensos con hiperreactividad cardiovascular, identificados mediante la ergometría isométrica. Material y métodos Se desarrolló un estudio de cohorte, de cinco años de evolución, con un total de 419 personas; de ellas, 215 normorreactivos cardiovasculares y 204 hiperreactivos cardiovasculares. Se determinó el riesgo relativo que tienen los individuos hiperreactivos cardiovasculares de ser hipertensos y el peso de la hiperreactividad cardiovascular en la aparición de hipertensión arterial; se fijó un nivel de significación estadística de p igual 0.05. Resultados La frecuencia de nuevos hipertensos en la cohorte de hiperreactivos cardiovasculares respecto a los normorreactivos cardiovasculares fue dos veces superior (RR: 2.23 IC95% 1.42;3.51). La hiperreactividad cardiovascular fue la variable de mayor influencia. Conclusiones Los individuos normotensos hiperreactivos cardiovasculares tienen mayor riesgo de hipertensión arterial que los normotensos normorreactivos cardiovasculares.

Abstract Objective To determine the risk of high blood pressure in cardiovascular hyperreactive individuals identified by the isometric hand-held weight test. Materials and methods A prospective cohort study was conducted for 5 years, including a total of 419 individuals. Of them, 215 were normoreactive and 204 hyperreactive. The relative risk of hypertension in the hyperreactive individuals and the contribution of cardiovascular hyperreactivity to the development of high blood pressure were determined. The significance level was 0.05. Results The frequency of new hypertension cases after five years was twice as high in the cohort of hyperreactive subjects compared to the cohort of normoreactive subjects (RR 2.23, 95%CI 1.42, 3.51). The cardiovascular hyperreactivity was the most important variable for predicting of the high blood pressure (OR: 2.73; 95%CI 1.59, 4.54). Conclusions Cardiovascular hyperreactive individuals have a higher risk of high blood pressure than normorreactive individuals.

Comparison of auscultatory and oscillometric BP measurements in children with obesity and their effect on the diagnosis of arterial hypertension / Comparación de la medición de PA auscultatoria y oscilométrica en niños con obesidad y su efecto en el diagnóstico de hipertensión arterial

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 4.2/10.2 mm Hg, 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. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma Mèxico S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Resumen: Objetivo: Para conocer el grado de concordancia entre 2 métodos de medición de presión arterial (PA), auscultatorio vs oscilométrico se utilizó un esfigmomanómetro de mercurio y un dispositivo electrónico en niños y adolescentes con diferentes grados de obesidad. Las lecturas fueron comparadas para conocer su impacto en el diagnóstico de prehipertensión/hipertensión. Método: Se midió la PA a niños con obesidad (percentil 95 del índice masa corporal) y obesidad severa (120% del percentil 95). Utilizamos análisis de Bland-Altman y Coeficiente de Correlación Intraclase (CCI) para conocer acuerdo entre mediciones. Resultados: Las lecturas con esfigmomanómetro de mercurio fueron más bajas que con el electrónico para la PA sistólica y diastólica (p = 0.01 y 0.001, respectivamente). El promedio de las diferencias en sistólica y diastólica entre oscilométrico vs. primera medición con mercurio fue de 4.2/10.2 mm Hg respectivamente. Se observó una gran diferencia de las mediciones entre los métodos de medición de PA. El CCI mostró una confiabilidad regular a moderada para la sistólica (0.595) pero pobre para la diastólica (0.330). El tamizaje con una medición mediante mercurio mostró que el 10.4% de los niños y adolescentes tenían PA en el rango de prehipertensión/hipertensión, pero se redujo a un 5.2% con el promedio de 3 mediciones. Conclusiones: Se observaron grandes discrepancias en la PA sistólica y diastólica. Tales diferencias no son clínicamente aceptables como para considerar equivalentes los 2 instrumentos. Las mediciones realizadas en este estudio con dispositivo electrónico fueron más altas y sobre estimaron el diagnóstico de hipertensión. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Hypertension and Diabetes Mellitus: Coprediction and Time Trajectories.

Type 2 diabetes mellitus and hypertension overlap in the population. In many subjects, development of diabetes mellitus is characterized by a relatively rapid increase in plasma glucose values. Whether a similar phenomenon occurs during the development of hypertension is not known. We analyzed the pattern of blood pressure (BP) changes during the development of hypertension in patients with or without diabetes mellitus using data from the MCDS (Mexico City Diabetes Study; a population-based study of diabetes mellitus in Hispanic whites) and in the FOS (Framingham Offspring Study, a community-based study in non-Hispanic whites) during a 7-year follow-up. Diabetes mellitus at baseline was a significant predictor of incident hypertension (in FOS, odds ratio, 3.14; 95% confidence interval, 2.17-4.54) independently of sex, age, body mass index, and familial diabetes mellitus. Conversely, hypertension at baseline was an independent predictor of incident diabetes mellitus (in FOS, odds ratio, 3.33; 95% CI, 2.50-4.44). In >60% of the converters, progression from normotension to hypertension was characterized by a steep increase in BP values, averaging 20 mm Hg for systolic BP within 3.5 years (in MCDS). In comparison with the nonconverters group, hypertension and diabetes mellitus converters shared a metabolic syndrome phenotype (hyperinsulinemia, higher body mass index, waist girth, BP, heart rate and pulse pressure, and dyslipidemia). Overall, results were similar in the 2 ethnic groups. We conclude that (1) development of hypertension and diabetes mellitus track each other over time, (2) transition from normotension to hypertension is characterized by a sharp increase in BP values, and (3) insulin resistance is one common feature of both prediabetes and prehypertension and an antecedent of progression to 2 respective disease states.

Comparison of auscultatory and oscillometric BP measurements in children with obesity and their effect on the diagnosis of arterial hypertension.

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.

[Prevalence of high blood pressure and their association with body mass index in children between 5 and 11 years of Nahbalam, Yucatan]. / Prevalencia de cifras tensionales elevadas y su asociación con el índice de masa corporal en niños de entre 5 y 11 años de Nahbalam, Yucatán.

OBJECTIVE: To determine the prevalence of high blood pressure in children aged between 5-11 years in the community of Nahbalam, Yucatan, and its association with the body mass index. MATERIAL AND METHODS: A transversal study with children of the primary school "Lazaro Cardenas del Rio" was performed, measuring blood pressure, height, and weight of 259 girls and boys; systolic and/or diastolic blood pressure equal or greater than percentile 95 for gender, age, and height at three measures was considered as hypertension; prehypertension was considered as blood pressure equal or greater than percentile 90 but lower than percentile 95. RESULTS: A prevalence of 11.9% prehypertension and 6.1% hypertension was found. There is an association between hypertension and overweight and obesity (p ≤ 0.001). CONCLUSIONS: The prevalence of high blood pressure in children of the community of Nahbalam, Yucatan, is 18%. The children with overweight and obesity have an almost tenfold greater risk of hypertension than the eutrophic children (OR: 9.896; 95% CI: 2.738-35.764).

Serum Uric Acid and Prehypertension Among Adults Free of Cardiovascular Diseases and Diabetes: Baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

The association between serum uric acid (SUA) and prehypertension was evaluated in a racially admixed sample of civil servants aged 35 to 74 years, enrolled (2008-2010) in the Brazilian Longitudinal Study of Health (ELSA-Brasil). Of the 15 105 patients who enrolled in the study, we analyzed 3412 after excluding those who reported previous cardiovascular diseases, diabetes, or hypertension; were heavy drinkers; or had a body mass index (BMI) ≥ 35 kg/m(2). Among the men, logistic regression, adjusted for age, race, income, birth weight, salt intake, insulin resistance, BMI, and renal function revealed odds ratios (ORs) and 95% confidence intervals (CIs) of prehypertension from the bottom quartile (referent) to the top quartile of SUA levels as follows: 0.84 (95% CI, 0.61-1.38), 0.97 (0.71-1.34) and 1.44 (1.04-2.0; P for trend .01). Analyzing for 1-standard deviation of change in SUA, the ORs were 1.19 (1.06-1.32). This association persisted in the subgroup analysis consisting of patients who were white, overweight, with a high salt intake but with normal renal function, and without metabolic syndrome. No association was found among women. In conclusion, SUA levels were associated with prehypertension among men.

Comparison of different screening methods for blood pressure disorders in children and adolescents / Comparação entre diferentes métodos de rastreamento para distúrbios da pressão arterial em crianças e adolescentes

OBJECTIVE: To compare different methods of screening for blood pressure disorders in children and adolescents. METHOD: A database with 17,083 medical records of patients from a pediatric cardiology clinic was used. After analyzing the inclusion and exclusion criteria, 5,650 were selected. These were divided into two age groups: between 5 and 13 years and between 13 and 18 years. The blood pressure measurement was classified as normal, pre-hypertensive, or hypertensive, consistent with recent guidelines and the selected screening methods. Sensitivity, specificity, and accuracy were then calculated according to gender and age range. RESULTS: The formulas proposed by Somu and Ardissino's table showed low sensitivity in identifying pre-hypertension in all age groups, whereas the table proposed by Kaelber showed the best results. The ratio between blood pressure and height showed low specificity in the younger age group, but showed good performance in adolescents. CONCLUSION: Screening tools used for the assessment of blood pressure disorders in children and adolescents may be useful to decrease the current rate of underdiagnosis of this condition. The table proposed by Kaelber showed the best results; however, the ratio between BP and height demonstrated specific advantages, as it does not require tables. .

OBJETIVO: Comparar diferentes métodos de rastreamento para distúrbios da pressão arterial em crianças e adolescentes. MÉTODO: Foi usado um banco de dados com 17.083 prontuários de pacientes de uma clínica de cardiologia pediátrica. Após análise dos critérios de inclusão e exclusão, 5.650 foram selecionados. Esses foram divididos em duas faixas etárias: entre cinco e 13 anos e entre 13 e 18 anos De acordo com a aferição, a pressão arterial era classificada como normal, pré-hipertensiva ou hipertensiva de acordo com guidelines recentes e os métodos de rastreamento selecionados. Posteriormente, foram calculadas a sensibilidade, especificidade e acurácia de cada um de acordo com o gênero e faixa etária. RESULTADOS: As fórmulas de Somu e a tabela proposta por Ardissino apresentaram baixa sensibilidade na identificação de pré-hipertensão em todas as faixas etárias, enquanto a tabela proposta por Kaelber apresentou os melhores resultados. A razão entre pressão arterial e altura apresentou baixa especificidade na faixa etária menor, mas apresentou bom desempenho em adolescentes. CONCLUSÃO: As ferramentas de rastreamento para distúrbios da pressão arterial em crianças e adolescentes podem ser úteis para diminuir o subdiagnóstico que ocorre atualmente nessa condição. A tabela proposta por Kaelber apresentou os melhores resultados, entretanto a razão entre PA e altura apresenta vantagens específicas, como a não necessidade de tabelas. .

Comparison of different screening methods for blood pressure disorders in children and adolescents.

OBJECTIVE: To compare different methods of screening for blood pressure disorders in children and adolescents. METHOD: A database with 17,083 medical records of patients from a pediatric cardiology clinic was used. After analyzing the inclusion and exclusion criteria, 5,650 were selected. These were divided into two age groups: between 5 and 13 years and between 13 and 18 years. The blood pressure measurement was classified as normal, pre-hypertensive, or hypertensive, consistent with recent guidelines and the selected screening methods. Sensitivity, specificity, and accuracy were then calculated according to gender and age range. RESULTS: The formulas proposed by Somu and Ardissino's table showed low sensitivity in identifying pre-hypertension in all age groups, whereas the table proposed by Kaelber showed the best results. The ratio between blood pressure and height showed low specificity in the younger age group, but showed good performance in adolescents. CONCLUSION: Screening tools used for the assessment of blood pressure disorders in children and adolescents may be useful to decrease the current rate of underdiagnosis of this condition. The table proposed by Kaelber showed the best results; however, the ratio between BP and height demonstrated specific advantages, as it does not require tables.

Intervention for prehypertension and its cardiovascular risk factors in Inner Mongolia.

Blood pressure levels were evaluated among prehypertension patients with associated cardiovascular risk factors to determine the effect of different interventions with respect to new endpoint events. A total of 1112 patients were equally and randomly divided into control, lifestyle, drug, and lifestyle + drug groups, and were followed-up for 12 months. We collected the age, height, weight, blood pressure, heart rate, blood lipid levels, blood glucose levels, and other clinical data from all subjects at the baseline and at the end of the follow-up period. The average systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the intervention groups were significantly reduced after the intervention (lifestyle + drug > drug > lifestyle). SBP and DBP were higher in the control group than before intervention (P < 0.05). Age, gender, heart rate, triglyceride (TG) levels, body mass index (BMI), alcohol consumption, and family history were the major factors affecting blood pressure. Increased BMI, TG, high-sensitivity C-reactive protein, alcohol consumption, family history, SBP, and DBP were major risk factors of hypertension. At the end of the follow-up period, there were 67 cases of hypertension, 32 cases of diabetes, and 12 cases of the endpoint events. Hypertension and diabetes events were reduced in the intervention groups relative to the control group (P < 0.05). The number of cases with incident cardiovascular endpoints did not differ among the three intervention groups (P > 0.05). Therefore, hypertension and related cardiovascular events can be controlled with different interventions.

First report on simplified diagnostic criteria for pre-hypertension and hypertension in a national sample of adolescents from the Middle East and North Africa: the CASPIAN-III study / Primeiro relatório sobre critérios de diagnóstico simplificado para pré-hipertensão e hipertensão em uma amostra nacional de adolescentes do Oriente Médio e da África do Norte: o estudo CASPIAN-III

OBJECTIVE: This study aimed to simplify the diagnostic criteria of pre-hypertension (pre-HTN) and hypertension (HTN) in the pediatric age group, and to determine the accuracy of these simple indexes in a nationally-representative sample of Iranian children and adolescents. METHOD: The diagnostic accuracy of the indexes of systolic blood pressure-to-height ratio (SBPHR) and diastolic BPHR (DBPHR) to define pre-HTN and HTN was determined by the area under the curve of the receiver operator characteristic curves. RESULTS: The study population consisted of 5,738 Iranian students (2,875 females) with mean (SD) age of 14.7 (2.4) years. The prevalences of pre-HTN and HTN were 6.9% and 5.6%. The optimal thresholds for defining pre-HTN were 0.73 in males and 0.71 in females for SBPHR, and 0.47 in males and 0.45 in females for DBPHR, respectively. The corresponding figures for HTNwere 0.73, 0.71, 0.48, and 0.46, respectively. In both genders, the accuracies of SBPHR and DBPHR in diagnosing pre-HTN and HTN were approximately 80%. CONCLUSIONS: BPHR is a valid, simple, inexpensive, and accurate tool to diagnose pre-HTN and HTN in adolescents. The optimal thresholds of SBPHR and DBPHR were consistent with the corresponding figures in other populations of children and adolescents with different racial and ethnic backgrounds. Thus, it is suggested that the use of these indexes can be generalized in programs aiming to screen elevated blood pressure in the pediatric age group. .

OBJETIVO: Este estudo visa simplificar os critérios de diagnóstico da pré-hipertensão (pré-HTA) e hipertensão (HTA) na faixa etária pediátrica e determinar a precisão desses índices simple sem uma amostra nacionalmente representativa de crianças e adolescentes iranianos. MÉTODO: A precisão diagnóstica dos índices de relação pressão arterial sistólica/altura (RPASA) e RPAA diastólica (RPADA) para definir a pré-HTA e HTA foi determinada pela área sob as curvas de características de operação do receptor. RESULTADOS: A população estudada contou com 5738 alunos iranianos (2875 meninas) com idade média (DP) de 14,7 (2,4) anos. A prevalência de pré-HTA e HTA foi 6,9% e 5,6%. Os limites ideais para a definição de pré-HTA foram 0,73 em meninos e 0,71 em meninas com relação à RPASA e 0,47 em meninos e 0,45 em meninas com relação à RPADA, respectivamente. Os valores correspondentes com relação à HTA foram 0,73, 0,71, 0,48 e 0,46, respectivamente. Em ambos os gêneros, a precisão de RPASA e RPADA no diagnóstico de pré-HTA e HTA foi de aproximadamente 80%. CONCLUSÕES: A RPAA é uma ferramenta válida, simples, barata e precisa no diagnóstico da pré-HTA e HTA em adolescentes. Os limites ideais de RPASA e RPADA foram compatíveis comos números correspondentes em outra população de crianças e adolescentes com diferentes históricos raciais e étnicos, assim, sugerimos que a utilização desses índices possa ser generalizada em programas de triagem com relação à PA elevada na faixa etária pediátrica. .

First report on simplified diagnostic criteria for pre-hypertension and hypertension in a national sample of adolescents from the Middle East and North Africa: the CASPIAN-III study.

OBJECTIVE: This study aimed to simplify the diagnostic criteria of pre-hypertension (pre-HTN) and hypertension (HTN) in the pediatric age group, and to determine the accuracy of these simple indexes in a nationally-representative sample of Iranian children and adolescents. METHOD: The diagnostic accuracy of the indexes of systolic blood pressure-to-height ratio (SBPHR) and diastolic BPHR (DBPHR) to define pre-HTN and HTN was determined by the area under the curve of the receiver operator characteristic curves. RESULTS: The study population consisted of 5,738 Iranian students (2,875 females) with mean (SD) age of 14.7 (2.4) years. The prevalences of pre-HTN and HTN were 6.9% and 5.6%. The optimal thresholds for defining pre-HTN were 0.73 in males and 0.71 in females for SBPHR, and 0.47 in males and 0.45 in females for DBPHR, respectively. The corresponding figures for HTN were 0.73, 0.71, 0.48, and 0.46, respectively. In both genders, the accuracies of SBPHR and DBPHR in diagnosing pre-HTN and HTN were approximately 80%. CONCLUSIONS: BPHR is a valid, simple, inexpensive, and accurate tool to diagnose pre-HTN and HTN in adolescents. The optimal thresholds of SBPHR and DBPHR were consistent with the corresponding figures in other populations of children and adolescents with different racial and ethnic backgrounds. Thus, it is suggested that the use of these indexes can be generalized in programs aiming to screen elevated blood pressure in the pediatric age group.