Original Article | Published:

Epidemiology of elevated blood pressure and associated risk factors in Chinese children: the SNEC study

Journal of Human Hypertension volume 30, pages 231236 (2016) | Download Citation

Abstract

Despite the association of childhood blood pressure (BP) with hypertension later in the life course, there remains dearth of information regarding the prevalence and emergence of hypertension in children, especially in China. To investigate the current status of BP, prevalence of elevated BP and related factors in Chinese children, a cross-sectional survey in a representative sample of 9354 Chinese children 5–17 years old was conducted in seven cities in Northeastern China during 2011 and 2012. BP measurements were taken by mercury sphygmomanometer. Elevated BP in children was defined as an average diastolic BP or systolic BP that is in the 95th percentile or higher for their gender, age and height. Overall, total prevalence of elevated BP was 13.8%, and no significant difference between males and females was identified. Multivariate analyses revealed that children having a higher area of residence had a lower of elevated BP. Increased odds for elevated BP were found for individuals who were lean (odds ratio (OR)=2.12; 95% confidence interval (CI): 1.67–2.69), overweight (OR=2.05; 95% CI: 1.74–2.42), obese (OR=3.15; 95% CI: 2.70–3.68), were born with low birth weight (OR=1.26; 95%CI: 1.01–1.63), premature birth (OR=1.46; 95%CI: 1.13–1.88), and were with home coal use (OR=1.24; 95%CI: 1.02–1.52). In conclusion, elevated BP was found to be prevalent in children in urban areas of Northeast China. These results underscore the importance of implementing a package of measures aimed at reducing malleable risk for this cardiovascular condition in school-aged children in Northeast China.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    , , , , , et al. The global cardiovascular risk transition: associations of four metabolic risk factors with national income, urbanization, and Western diet in 1980 and 2008. Circulation 2013; 127: 1493–1502.

  2. 2.

    , , , , , et al. National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 54 million participants. Lancet 2011; 377: 568–577.

  3. 3.

    , , , , , . Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365: 217–223.

  4. 4.

    , . Pediatric hypertension: a growing problem. Prim Care 2015; 42: 143–150.

  5. 5.

    , . Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation 2008; 117: 3171–3180.

  6. 6.

    , , . Underdiagnosis of hypertension in children and adolescents. JAMA 2007; 298: 874–879.

  7. 7.

    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.

  8. 8.

    , , , , , et al. Incidence of high blood pressure in children—effects of physical activity and sedentary behaviors: the IDEFICS Study: High blood pressure, lifestyle and children. Int J Cardiol 2015; 180: 165–170.

  9. 9.

    , , , , , . Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 2007; 150: 640–644.

  10. 10.

    , , , , . Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics 2004; 113: 475–482.

  11. 11.

    , , , , , et al. Air pollution associated hypertension and increased blood pressure may be reduced by breastfeeding in Chinese children: the Seven Northeastern Cities Chinese Children's Study. Int J Cardiol 2014; 176: 956–961.

  12. 12.

    , , , , . Prevalence of hypertension in schoolchildren based on repeated measurements and association with overweight. J Hypertens 2007; 25: 2209–2217.

  13. 13.

    World Health OrganizationPhysical Status: The Use and Interpretation of Anthropometry. WHO: Geneva, Switzerland, 1995.

  14. 14.

    National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionBMI: Body Mass Index. Centers for Disease Control and Prevention: Atlanta, GA, 2002. World Wide Web URL Accessed on January 27, 2012.

  15. 15.

    , , , , , et al. Children in South Asia have higher body mass-adjusted blood pressure levels than white children in the United States: a comparative study. Circulation 2005; 111: 1291–1297.

  16. 16.

    , , , , , et al. Blood pressure and its influencing factors in a national representative sample of Iranian children and adolescents: the CASPIAN Study. Eur J Cardiovasc Prev Rehabil 2006; 13: 956–963.

  17. 17.

    , , . The association of fat patterning with blood pressure in rural South African children: the Ellisras Longitudinal Growth and Health Study. Int J Epidemiol 2006; 35: 114–120.

  18. 18.

    , , , , , . Prevalence of elevated blood pressure and association with overweight in children of a rapidly developing country. J Hum Hypertens 2007; 21: 120–127.

  19. 19.

    , , , . Age- and gender-specific components of the metabolic syndrome in 2228 first graders: The PEP Family Heart Study. Scientifica 2013; 2013: 394807.

  20. 20.

    , , , , , et al. Blood pressure and adiposity in children and adolescents. Circulation 2004; 110: 1832–1838.

  21. 21.

    , , , , , et al. Results of blood pressure screening in a population of school-aged children in the province of Milan: role of overweight. J Hypertens 2005; 23: 493–497.

  22. 22.

    , . Exploring determinants of secular decreases in childhood blood pressure and hypertension. Circulation 2011; 124: 397–405.

  23. 23.

    , , , , , . Prevalence of hypertension in school going children of Surat city, Western India. J Cardiovasc Dis Res 2011; 2: 228–232.

  24. 24.

    , . Tracking of blood pressure from adolescence to middle age: the Dormont High School Study. Prev Med 1994; 23: 418–426.

  25. 25.

    , . Childhood risk factors for high adult blood pressure: the Muscatine Study. Pediatrics 1989; 84: 633–641.

  26. 26.

    , , , , , et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med 2011; 365: 1876–1885.

  27. 27.

    , , , , , et al. Prevention and treatment of pediatric obesity: an Endocrine Society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab 2008; 93: 4576–4599.

  28. 28.

    , , , . Birth characteristics and risk of high systolic blood pressure in early adulthood: socioeconomic factors and familial effects. Epidemiology 2005; 16: 635–640.

  29. 29.

    , , , , . Associations of birth weight and postnatal weight gain with cardiometabolic risk parameters at 5 years of age. Hypertension 2014; 63: 1326–1332.

  30. 30.

    , , , , , et al. Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease. Lancet 2013; 382: 273–283.

  31. 31.

    , , , . Low birth weight and cardiovascular risk factors in Auckland adolescents: a retrospective cohort study. N Z Med J 2005; 118: U1612.

  32. 32.

    , , , , , et al. The effect of breastfeeding on weight gain in infants: results of a birth cohort study. Eur J Med Res 2005; 10: 36–42.

  33. 33.

    , , , . Exclusive breastfeeding of Swedish children and its possible influence on the development of obesity: a prospective cohort study. BMC Pediatr 2008; 8: 42.

  34. 34.

    , , , , , et al. Effects of prolonged and exclusive breastfeeding on child height, weight, adiposity, and blood pressure at age 6.5 y: evidence from a large randomized trial. Am J Clin Nutr 2007; 86: 1717–1721.

  35. 35.

    , , , , , et al. Indoor air pollution and blood pressure in adult women living in rural China. Environ Health Perspect 2011; 119: 1390–1395.

  36. 36.

    , , Indoor smoke from household solid fuels. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL (eds). Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. World Health Organization, Geneva, 2004, 1435–1493.

  37. 37.

    , , , , , et al. Differences in blood pressure and vascular responses associated with ambient fine particulate matter exposures measured at the personal versus community level. Occup Environ Med 2011; 68: 224–230.

Download references

Acknowledgements

We appreciate the cooperation from school principals, teachers and students and their parents in the seven cities. This work was supported by Grants from China Environmental Protection Foundation (CEPF2008–123–1–5), the Liaoning Province Science and Technology Foundation (2013225049), and the Guangdong Province Natural Science Foundation (2014A050503027). This research was supported by grants from China Environmental Protection Foundation (CEPF2008–123–1–5), the Liaoning Province Science and Technology Foundation (2013225049), and the Guangdong Province Natural Science Foundation (2014A030313021).

Author information

Affiliations

  1. Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, China

    • Y Zhou
    • , X-W Zeng
    • , R-Q Liu
    • , X-D Qin
    • , Y Zhu
    •  & G-H Dong
  2. Department of Epidemiology, College of Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA

    • Z Qian
    •  & B B Boutwell
  3. School of Social Work, College of Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA

    • M G Vaughn
    •  & B B Boutwell
  4. Department of Biostatistics and Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA, USA

    • M Yang

Authors

  1. Search for Y Zhou in:

  2. Search for Z Qian in:

  3. Search for M G Vaughn in:

  4. Search for B B Boutwell in:

  5. Search for M Yang in:

  6. Search for X-W Zeng in:

  7. Search for R-Q Liu in:

  8. Search for X-D Qin in:

  9. Search for Y Zhu in:

  10. Search for G-H Dong in:

Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to G-H Dong.

About this article

Publication history

Received

Revised

Accepted

Published

DOI

https://doi.org/10.1038/jhh.2015.104

Further reading