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      Prenatal and postnatal mercury exposure and blood pressure in childhood

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          Abstract

          Elevated blood pressure in childhood is an important risk factor for hypertension in adulthood. Environmental exposures have been associated with elevated blood pressure over the life course and exposure to mercury (Hg) has been linked to cardiovascular effects in adults. As subclinical vascular changes begin early in life, Hg may play a role in altered blood pressure in children. However, the evidence linking early life Hg exposure to altered blood pressure in childhood has been largely inconsistent. In the ongoing New Hampshire Birth Cohort Study, we investigated prenatal and childhood Hg exposure at multiple time points and associations with blood pressure measurements in 395 young children (mean age 5.5 years, SD 0.4). Hg exposure was measured in children’s toenail clippings at age 3 and in urine at age 5–6 years, as well as in maternal toenail samples collected at ~28 weeks gestation and 6 weeks postpartum, the latter two samples reflecting early prenatal and mid-gestation exposures, respectively. Five measurements of systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were averaged for each child using a standardized technique. In covariate-adjusted linear regression analyses, we observed that a 0.1 µg/g increase in child toenail Hg at age 3 or a 0.1 µg/L urine Hg at age 5–6 were individually associated with greater DBP (toenail β: 0.53 mmHg; 95% CI: −0.02, 1.07; urine β: 0.48 mmHg; 95% CI: 0.10, 0.86) and MAP (toenail β: 0.67 mmHg; 95% CI: 0.002, 1.33; urine β: 0.55 mmHg; 95% CI: 0.10, 1.01). Neither early prenatal nor mid-gestation Hg exposure, as measured by maternal toenails, were related to any changes to child BP. Simultaneous inclusion of both child urine Hg and child toenail Hg in models suggested a potentially stronger relationship of urine Hg at age 5–6 with DBP and MAP, as compared to toenail Hg at age 3. Our findings suggest that Hg exposure during childhood is associated with alterations in BP. Childhood may be an important window of opportunity to reduce the impacts of Hg exposure on children’s blood pressure, and in turn, long-term health.

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          Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

          These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.
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            Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study.

            In adults, cardiovascular risk factors reinforce each other in their effect on cardiovascular events. However, information is scant on the relation of multiple risk factors to the extent of asymptomatic atherosclerosis in young people. We performed autopsies on 204 young persons 2 to 39 years of age, who had died from various causes, principally trauma. Data on antemortem risk factors were available for 93 of these persons, who were the focus of this study. We correlated risk factors with the extent of atherosclerosis in the aorta and coronary arteries. The extent of fatty streaks and fibrous plaques in the aorta and coronary arteries increased with age. The association between fatty streaks and fibrous plaques was much stronger in the coronary arteries (r=0.60, P<0.001) than in the aorta (r=0.23, P=0.03). Among the cardiovascular risk factors, body-mass index, systolic and diastolic blood pressure, and serum concentrations of total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, as a group, were strongly associated with the extent of lesions in the aorta and coronary arteries (canonical correlation [a measure of the association between groups of variables]: r=0.70; P<0.001). In addition, cigarette smoking increased the percentage of the intimal surface involved with fibrous plaques in the aorta (1.22 percent in smokers vs. 0.12 percent in nonsmokers, P=0.02) and fatty streaks in the coronary vessels (8.27 percent vs. 2.89 percent, P=0.04). The effect of multiple risk factors on the extent of atherosclerosis was quite evident. Subjects with 0, 1, 2, and 3 or 4 risk factors had, respectively, 19.1 percent, 30.3 percent, 37.9 percent, and 35.0 percent of the intimal surface covered with fatty streaks in the aorta (P for trend=0.01). The comparable figures for the coronary arteries were 1.3 percent, 2.5 percent, 7.9 percent, and 11.0 percent, respectively, for fatty streaks (P for trend=0.01) and 0.6 percent, 0.7 percent, 2.4 percent, and 7.2 percent for collagenous fibrous plaques (P for trend=0.003). These findings indicate that as the number of cardiovascular risk factors increases, so does the severity of asymptomatic coronary and aortic atherosclerosis in young people.
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              Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis.

              A large number of studies have examined the tracking of blood pressure (BP) from childhood to adulthood, but the reported findings are inconsistent and few systematic analyses have been conducted. We conducted a systematic search of PubMed for studies that examined the tracking of BP from childhood to adulthood published between January 1970 and July 2006. From 301 retrieved papers, 50 cohort studies met our inclusion criteria and provided 617 data points (Pearson/Spearman correlation coefficients) for systolic BP (SBP) and 547 data points for diastolic BP (DBP) for our meta-analysis. Information on sample characteristics and BP measurement protocols was extracted. Fisher z transformation and random-effects meta-regression analysis were conducted. The reported BP tracking correlation coefficients varied from -0.12 to 0.80 for SBP and from -0.16 to 0.70 for DBP, with an average of 0.38 for SBP and 0.28 for DBP. BP tracking varied significantly by baseline age and length of follow-up. The strength of BP tracking increased with baseline age by 0.012 for SBP (P<0.001) and 0.009 for DBP (P<0.001) and decreased with follow-up length by 0.008 for SBP (P<0.001) and 0.005 for DBP (P<0.001). BP tracking did not vary markedly across the number of BP measurements or race/population groups. Data from diverse populations show that the evidence for BP tracking from childhood into adulthood is strong. Childhood BP is associated with BP in later life, and early intervention is important.
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                Author and article information

                Journal
                7807270
                22115
                Environ Int
                Environ Int
                Environment international
                0160-4120
                1873-6750
                8 November 2020
                28 October 2020
                January 2021
                02 January 2021
                : 146
                : 106201
                Affiliations
                [a ]Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
                [b ]Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
                [c ]Department of Population Health, New York University School of Medicine, New York, NY, USA
                [d ]Children’s Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH, USA
                [e ]Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
                [f ]Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
                [g ]Department of Earth Sciences, Dartmouth College, Hanover, NH, USA
                [h ]Department of Medical Education and Pediatrics, Geisel School of Medicine, Hanover, NH, USA
                Author notes

                CRediT authorship contribution statement

                Shohreh F. Farzan: Conceptualization, Investigation, Methodology, Formal analysis, Funding acquisition, Writing - original draft. Caitlin G. Howe: Formal analysis, Writing - review & editing. Yu Chen: Writing - original draft, Writing - review & editing. Diane Gilbert-Diamond: Methodology, Writing - review & editing. Susan Korrick: Methodology, Writing - review & editing. Brian P. Jackson: Investigation, Writing - review & editing. Adam R. Weinstein: Methodology, Writing – review & editing. Margaret R. Karagas: Writing - original draft, Methodology, Supervision, Resources, Funding acquisition, Writing - review & editing.

                [* ]Corresponding author at: Division of Environmental Health, Department of Preventive Medicine, Keck School of Medicine of University of Southern California, 2001 N. Soto Street, MC 9237, Los Angeles, CA 90089, USA. sffarzan@ 123456usc.edu (S.F. Farzan).
                Article
                NIHMS1638455
                10.1016/j.envint.2020.106201
                7775884
                33129000
                803bad19-e329-4412-a463-c415cc21ae79

                This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Categories
                Article

                mercury,children’s health,blood pressure,cohort,new hampshire

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