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      High Blood Pressure in Overweight and Obese Youth: Implications for Screening

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          Abstract

          In the absence of evidence-based guidelines for high blood pressure screening in asymptomatic youth, a reasonable strategy is to screen those who are at high risk. The present study aimed to identify optimal body mass index (BMI) thresholds as a marker for high-risk youth to predict hypertension prevalence. In a cross-sectional study, youth aged 6 to 17 years (n=237,248) enrolled in an integrated prepaid health plan in 2007 to 2009 were classified according to their BMI and hypertension status. In moderately and extremely obese youth, the prevalence of hypertension was 3.8% and 9.2%, respectively, compared with 0.9% in normal weight youth. The adjusted prevalence ratios (95% confidence intervals) of hypertension for normal weight, overweight, moderate obesity, and extreme obesity were 1.00 (Reference), 2.27 (2.08–2.47), 4.43 (4.10–4.79), and 10.76 (9.99–11.59), respectively. The prevalence of hypertension was best predicted by a BMI-for-age ≥94th percentile. These results suggest that all obese youth should be screened for hypertension.

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          2000 CDC Growth Charts for the United States: methods and development.

          Robert J. Kuczmarski, Cynthia Ogden, Shumei S. Guo … (2002)
          This report provides detailed information on how the 2000 Centers for Disease Control and Prevention (CDC) growth charts for the United States were developed, expanding upon the report that accompanied the initial release of the charts in 2000. The growth charts were developed with data from five national health examination surveys and limited supplemental data. Smoothed percentile curves were developed in two stages. In the first stage, selected empirical percentiles were smoothed with a variety of parametric and nonparametric procedures. In the second stage, parameters were created to obtain the final curves, additional percentiles and z-scores. The revised charts were evaluated using statistical and graphical measures. The 1977 National Center for Health Statistics (NCHS) growth charts were revised for infants (birth to 36 months) and older children (2 to 20 years). New body mass index-for-age (BMI-for-age) charts were created. Use of national data improved the transition from the infant charts to those for older children. The evaluation of the charts found no large or systematic differences between the smoothed percentiles and the empirical data. The 2000 CDC growth charts were developed with improved data and statistical procedures. Health care providers now have an instrument for growth screening that better represents the racial-ethnic diversity and combination of breast- and formula-feeding in the United States. It is recommended that these charts replace the 1977 NCHS charts when assessing the size and growth patterns of infants, children, and adolescents.
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            Overweight, ethnicity, and the prevalence of hypertension in school-aged children.

            Jonathan Sorof, Dejian Lai, Jennifer Turner … (2004)
            To describe the current prevalence of pediatric hypertension and the relationships between gender, ethnicity, overweight, and blood pressure. School-based screening was performed in 5102 children (13.5 +/- 1.7 years) from May through November 2002. Age, gender, ethnicity, weight, and height were ascertained, and body mass index (BMI) was calculated as weight (kg)/height (m2). Overweight was defined as BMI > or =95th percentile. Students with blood pressure >95th percentile on the first screening underwent a second screening 1 to 2 weeks later, and then a third screening if blood pressure was >95th percentile at the second screening. Ethnicity distribution was 44% white, 25% Hispanic, 22% African American, and 7% Asian. Overall, overweight prevalence was 20%, which varied significantly by ethnicity (31% Hispanic, 20% African American, 15% white, and 11% Asian). The prevalence of elevated blood pressure after first, second, and third screenings was 19.4%, 9.5%, and 4.5%, respectively. Elevated blood pressure on first screening was highest among Hispanics (25%) and lowest among Asians (14%). Ethnic differences in the prevalence of hypertension (elevated blood pressure on 3 screenings) were not significant after controlling for overweight. The prevalence of hypertension increased progressively as the BMI percentile increased from or =95th percentile (11%). After adjustment for gender, ethnicity, overweight, and age, the relative risk of hypertension was significant for gender (relative risk: 1.50; confidence interval: 1.15, 1.95) and overweight (relative risk: 3.26; confidence interval: 2.50, 4.24). These results confirm an evolving epidemic of cardiovascular risk in youth, as evidenced by an increase in the prevalence of overweight and hypertension, notably among ethnic minority children.
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              Prevalence of hypertension and pre-hypertension among adolescents.

              Karen L McNiece, Timothy S Poffenbarger, Jennifer Turner … (2007)
              To determine the prevalence of hypertension and pre-hypertension on the basis of the 2004 National High Blood Pressure Education Program Working Group guidelines in an adolescent school-screening population. Cross-sectional assessment of blood pressure (BP) in 6790 adolescents (11-17 years) in Houston schools was conducted from 2003 to 2005. Initial measurements included height, weight, and 4 oscillometric BP readings. Repeat measurements were obtained on 2 subsequent occasions in students with persistently elevated BP. Final prevalence was adjusted for loss to follow-up and logistic regression used to assess risk factors. BP distribution at initial screen was 81.1% normal, 9.5% pre-hypertension, and 9.4% hypertension (8.4% Stage 1; 1% Stage 2). Prevalence after 3 screenings was 81.1% normal, 15.7% pre-hypertension, and 3.2% hypertension (2.6% Stage 1; 0.6% Stage 2). Hypertension and pre-hypertension increased with increasing body mass index. Sex, race, and classification as either at-risk for overweight or overweight were independently associated with pre-hypertension. Only classification as overweight was associated with hypertension. Application of new classification guidelines for adolescents with elevated BP reveals approximately 20% are at risk for hypertension. Further research determining the significance of each BP category and refining definitions to account for BP variability is warranted.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Clin Hypertens (Greenwich)
                Journal ID (iso-abbrev): J Clin Hypertens (Greenwich)
                Journal ID (publisher-id): jch
                Title: Journal of Clinical Hypertension (Greenwich, Conn.)
                Publisher: BlackWell Publishing Ltd (Oxford, UK )
                ISSN (Print): 1524-6175
                ISSN (Electronic): 1751-7176
                Publication date (Print): November 2013
                Publication date (Electronic): 10 October 2013
                Volume: 15
                Issue: 11
                Pages: 793-805
                Affiliations
                [1 ]Department of Research and Evaluation, Kaiser Permanente Southern California Pasadena, CA
                [2 ]Center for Health Research, Kaiser Permanente Northwest Portland, OR
                [3 ]Pediatric Nephrology, Kaiser Permanente Los Angeles Medical Center Los Angeles, CA
                [4 ]Department of Pediatrics, Kaiser Permanente Riverside Medical Center Riverside, CA
                Author notes
                Address for correspondence: Corinna Koebnick, PhD, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, 2nd Floor, Pasadena, CA 91101, E-mail: corinna.koebnick@ 123456kp.org
                Article
                DOI: 10.1111/jch.12199
                PMC ID: 3849231
                PubMed ID: 24119024
                SO-VID: 092dd8d3-193f-46f4-a05c-ef7a9804f7d9
                Copyright © ©2013 Wiley Periodicals, Inc.
                License:

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                Date received : 06 June 2013
                Date revision received : 09 August 2013
                Date accepted : 14 August 2013
                Categories
                Subject: Original Papers

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