Abstract
Obesity is related to office blood pressure (OBP). Important discrepancies exist between OBP and home blood pressure (HBP), providing complementary information for the management of hypertension. The association between obesity and HBP has not been investigated in children. The evidence on the role of obesity in the predominance of systolic blood pressure (SBP) over diastolic (DBP) in paediatric hypertension is limited. A total of 778 healthy subjects aged 6–18 years were recruited in this study. OBP and HBP were measured using electronic devices validated in children. Anthropometric measurements were measured and expressed as z-scores for height or age. Among all indices of obesity (z-scores), body mass index (BMI) showed the best association with BP. The effect of obesity (BMI) was more pronounced on: (i) SBP than DBP and (ii) H-SBP than O-SBP (O-SBP: r2=0.09, O-DBP: r2=0.05, H-SBP: r2=0.12, H-DBP: r2=0.06). The prevalence of systolic hypertension was higher than that of diastolic hypertension. This difference was significant only in office readings and independent from obesity (normal weight: 6.3% systolic hypertension versus 1.2% diastolic; obese: 37.9% versus 6.9%, P<0.05 for both). These data imply that in children and adolescents the z-score of BMI is the most appropriate index of the association between BP and obesity. It also suggests that obesity is probably more closely associated with home than office BP. Finally, although obesity appears to affect SBP more than DBP, these results suggest that the predominance of systolic hypertension in children and adolescents might not be only related to obesity but also to the measurement setting (office).
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References
World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation presented at: the World Health Organization; 3–5 June 1997 WHO: Geneva, Switzerland, 1997. Publication WHO/NUT/NCD/98.1.
Lawlor DA, Leon DA . Association of body mass index and obesity measured in early childhood with risk of coronary heart disease and stroke in middle age: Findings from the Aberdeen children of the 1950s prospective cohort study. Circulation 2005; 111: 1891–1896.
Din-Dzietham R, Liu Y, Bielo M-V, Shamsa F . High blood pressure trends in children and adolescents in national surveys, 1963–2002. Circulation 2007; 116: 1392–1400.
Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004; 350: 2362–2374.
Paradis G, Lambert M, O'Loughlin J, Lavallee C, Aubin J, Delvin E et al. Blood pressure and adiposity in children and adolescents. Circulation 2004; 110: 1832–1838.
Sorof J, Daniels S . Obesity hypertension in children: a problem of epidemic proportions. Hypertension 2002; 40: 441–447.
Marcovecchio M, Patricelli L, Zito M, Capanna R, Ciampani M, Chiarelli F et al. Ambulatory blood pressure monitoring in obese children: role of insulin resistance. J Hypertens 2006; 24: 2431–2436.
Thompson D, Obarzanek E, Franko D, Barton B, Morrison J, Biro F et al. Childhood overweight and cardiovascular disease risk factors: The national heart, lung and blood institute growth and health study. J Pediatr 2007; 150: 18–25.
Papandreou D, Rousso I, Makedou A, Arvanitidou M, Mavromichalis I . Association of blood pressure, obesity and serum homocysteine levels in healthy children. Acta Pediatr 2007; 96: 1819–1823.
McGavock J, Torrance B, McGuire K, Wozny P, Lewanczuk R . The relationship between weight gain and blood pressure in children and adolescents. Am J Hypertens 2007; 20: 1038–1044.
Chiolero A, Cachat F, Burnier M, Paccaud F, Bovet P . Prevalence of hypertension in schoolchildren based on repeated measurements and association with overweight. J Hypertens 2007; 25: 2209–2217.
O'Quin M, Sharma BB, Miller KA, Tomsovic JP . Adolescent blood pressure survey: Tulsa, Oklahoma, 1987 to 1989. South Med J 1992; 85: 487–490.
Rosner B, Prineas R, Daniels SR, Logie J . Blood pressure differences between blacks and whites in relation to body size among US children and adolescents. Am J Epidemiol 2000; 151: 1007–1019.
Adrogue HE, Sinaiko AR . Prevalence of hypertension in junior high school-aged children: effect of new recommendations in the 1996 Updated Task Force Report. Am J Hypertens 2001; 14: 412–414.
Sorof JM, Urbina EM, Cunnigham RJ, Hogg RJ, Moxey-Mims M, Eissa MA et al. Screening for eligibility in the study of antihypertensive medication in children: experience from the Ziac Pediatric Hypertension Study. Am J Hypertens 2001; 14: 783–787.
Sorof JM, Poffenbarger T, France K, Bernard L, Portman RJ . Isolated systolic hypertension, obesity, and hyperkinetic hemodynamic states in children. J Pediatr 2002; 140: 660–666.
Mueller WH, Chan W, Meininger JC . Utility of different body composition indicators: demographic influences and associations with blood pressures and heart rates in adolescents (Heartfelt Study). Ann Hum Biol 2003; 30: 714–727.
Barba G, Troiano E, Russo P, Strazzullo P, Siani A . Body mass, fat distribution and blood pressure in Southern Italian children: results of the ARCA project. Nutr Metab Cardiovasc Dis 2006; 16: 239–248.
Moussa MA, Skaik MB, Selwanes SB, Yaghy OY, Bin-Othman SA . Contribution of body fat and fat pattern to blood pressure level in school children. Eur J Clin Nutr 1994; 48: 587–590.
Angelopoulos PD, Milionis HJ, Moschonis G, Manios Y . Relations between obesity and hypertension: preliminary data from a cross-sectional study in primary schoolchildren: the children study. Eur J Clin Nutr 2006; 60: 1226–1234.
Rebelo D, Teixeira J, Marques-Vidal P, Oliveira JM . Obesity markers and blood pressure in a sample of Portuguese children and adolescents. Eur J Cardiovasc Prev Rehabil 2008; 15: 73–77.
Stergiou GS, Yiannes NJ, Rarra VC . White coat hypertension and masked hypertension in children. Blood Press Monit 2005; 10: 297–300.
Stergiou GS, Nasothimiou E, Giovas P, Kapoyiannis A, Vazeou A . Diagnosis of hypertension in children and adolescents based on home versus ambulatory blood pressure monitoring. J Hypertens 2008; 26: 1556–1562.
Stergiou G, Yiannes N, Rarra V, Panagiotakos D . Home blood pressure normalcy in children and adolescents: the Arsakeion School study. J Hypertens 2007; 25: 1375–1379.
Stergiou GS, Yiannes NG, Rarra VC . Validation of the Omron 705 IT oscillometric device for home blood pressure measurement in children and adolescents: The Arsakeion School Study. Blood Press Monit 2006; 11: 229–234.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity: international survey. BMJ 2000; 320: 1240–1243.
Rocchini AP . Obesity hypertension. Am J Hypertens 2002; 15: 50S–52S.
Del-Rio-Navarro B, Velazquez-Monroy O, Lara-Esqueda A, Violante-Ortiz R, Fanghanel G, Perez-Sanchez L et al. Obesity and metabolic risks in children. Arch Med Res 2008; 39: 215–221.
Matsuoka S, Awazu M . Masked hypertension in children and young adults. Pediatr Nephrol 2004; 19: 651–654.
Lurbe E, Invitti C, Torro I, Maronatti A, Aguilar F, Sartotio G et al. The impact of the degree of obesity on the discrepancies between office and ambulatory blood pressure values in youth. J Hypertens 2006; 24: 1557–1564.
Stergiou G, Yiannes N, Rarra V, Alamara C . White coat hypertension and masked hypertension in children. Blood Press Monit 2005; 10: 297–300.
Franklin SS, Larson MG, Khan SA, Wong ND, Leip EP, Kannel WB et al. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation 2001; 103: 1245–1249.
O'Rourke MF, Vlachopoulos C, Graham RM . Spurious hypertension in youth. Vasc Med 2000; 5: 141–145.
Maple-Brown LJ, Piers LS, O'Rourke MF, Celermajer DS, O'Dea K . Central obesity is associated with reduced peripheral wave reflection in indigenous Australians irrespective of diabetes status. J Hypertens 2005; 23: 1403–1407.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555–576.
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Karatzi, K., Protogerou, A., Rarra, V. et al. Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion School Study. J Hum Hypertens 23, 512–520 (2009). https://doi.org/10.1038/jhh.2008.158
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DOI: https://doi.org/10.1038/jhh.2008.158
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