Search

In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk.

Context No universal waist circumference (WC) percentile cutoffs used have been proposed for screening central obesity in children and adolescents. Objective To develop international WC percentile cutoffs for children and adolescents with normal weight based on data from 8 countries in different global regions and to examine the relation with cardiovascular risk. Design and Setting We used pooled data on WC in 113,453 children and adolescents (males 50.2%) aged 4 to 20 years from 8 countries in different regions (Bulgaria, China, Iran, Korea, Malaysia, Poland, Seychelles, and Switzerland). We calculated WC percentile cutoffs in samples including or excluding children with obesity, overweight, or underweight. WC percentiles were generated using the general additive model for location, scale, and shape (GAMLSS). We also estimated the predictive power of the WC 90th percentile cutoffs to predict cardiovascular risk using receiver operator characteristics curve analysis based on data from 3 countries that had available data (China, Iran, and Korea). We also examined which WC percentiles linked with WC cutoffs for central obesity in adults (at age of 18 years). Main Outcome Measure WC measured based on recommendation by the World Health Organization. Results We validated the performance of the age- and sex-specific 90th percentile WC cutoffs calculated in children and adolescents (6-18 years of age) with normal weight (excluding youth with obesity, overweight, or underweight) by linking the percentile with cardiovascular risk (area under the curve [AUC]: 0.69 for boys; 0.63 for girls). In addition, WC percentile among normal weight children linked relatively well with established WC cutoffs for central obesity in adults (eg, AUC in US adolescents: 0.71 for boys; 0.68 for girls). Conclusion The international WC cutoffs developed in this study could be useful to screen central obesity in children and adolescents aged 6 to 18 years and allow direct comparison of WC distributions between populations and over time.

Introduction Despite considerable progress in diagnostic methods and treatment options, cardiovascular diseases constitute a serious health issue in Poland, and hypertension is considered one of the main risk factors in the incidence of the diseases. Objectives The aim of this study is to assess the values of arterial blood pressure among adolescents in the context of urban and rural environments. Material and Methods The study was carried out on a representative, randomly selected group of youths aged 10–18 years, participating in the ADOPOLNOR project. Prior to blood pressure measurement, each pupil was assessed according to anthropomorphic principles. The BP measurements strictly followed the guidelines of the Fourth Protocol of the American Working Group of High Blood pressure in Children and Adolescents. Results Mean values of systolic blood pressure (SBP) in boys in rural areas were higher in every age group than in the boys in urban areas. Higher values of systolic and diastolic blood pressure were observed also in girls in rural areas. BP values sufficiently high for the diagnosis of hypertension were observed in 12.8% of the rural boy population but only in 6.7% of the boys from the urban environment. The difference is statistically significant. The girls in rural areas (13.3%) had twice the incidence of elevated BP values in comparison with the girls in urban areas (7.2%) and, as in boys, the difference is statistically significant. Conclusions The high proportion of pupils with elevated arterial blood pressure observed in the rural areas of Wielkopolska calls for regularly performed BP assessment and monitoring in this populatio

The ever increasing epidemics of overweight and obesity in school children may be one of the reasons of the growing numbers of children with incorrect body posture. The purpose of the study was the assessment of the prevalence of incorrect body posture in children and adolescents with overweight and obesity in Poznań, Poland. The population subject to study consisted of 2732 boys and girls aged 3–18 with obesity, overweight, and standard body mass. The assessment of body mass was performed based on BMI, adopting Cole’s cutoff values. The evaluation of body posture was performed according to the postural error chart based on criteria complied by professor Dega. The prevalence rates of postural errors were significantly higher among children and adolescents with overweight and obesity than among the group with standard body mass. In the overweight group, it amounted to 69.2% and in the obese group to 78.6%. Conclusion: The most common postural deviations in obese children and adolescents were valgus knees and flat feet. Overweight and obesity in children and adolescents, predisposing to higher incidence of some types of postural errors, call for prevention programs addressing both health problems. What is Known: • The increase in the prevalence of overweight and obesity among children and adolescents has drawn attention to additional health complications which may occur in this population such as occurrence of incorrect body posture. What is New: • The modified chart of postural errors proved to be an effective tool in the assessment of incorrect body posture.• This chart may be used in the assessment of posture during screening tests and prevention actions at school.

It is well established that obesity is associated with an increased risk of elevated and high blood pressure (BP) in children and adolescents. However, it is uncertain whether there is an increase in the risk of elevated and high BP associated with an increase of body mass index (BMI) among children and adolescents whose BMI is in the accepted normal range. Data were available for 58 899 children and adolescents aged 6-17 years from seven national cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. The subjects were divided into eight percentile subgroups according to their BMI levels based on the World Health Organization recommendations. Elevated BP and high BP were defined using the 2016 international child BP criteria. Compared with the reference subgroup of the 5th-24th percentiles, the odds ratios (ORs) for high BP were 1.27 (95% confidence interval [CI], 1.14-1.41; P 0.001) in the 25th-49th percentile subgroup, 1.55 (95% CI, 1.39-1.73; P 0.001) in the 50th-74th percentile subgroup, and 2.17 (95% CI, 1.92-2.46; P 0.001) in the 75th-84th percentile subgroup, respectively, after adjustment for sex, age, race/ethnicity, height and country. Additionally, the corresponding ORs for elevated BP were 1.21 (95% CI, 1.10-1.32; P 0.001), 1.55 (95% CI, 1.42-1.69; P 0.001), and 1.80 (95% CI, 1.62-2.01; P 0.001), respectively. In conclusion, a BMI in the 25th-84th percentiles, within the accepted normal weight range, was associated with an increased risk of elevated and high BP among children and adolescents. It is important for children and adolescents to keep a BMI at a low level in order to prevent and control hypertension.

Pediatric blood pressure (BP) reference tables are generally based on sex, age, and height and tend to be cumbersome to use in routine clinical practice. In this study, we aimed to develop a new, height-specific simple BP table according to the international child BP reference table based on sex, age and height and to evaluate its performance using international data. We validated the simple table in a derivation cohort that included 58,899 children and adolescents aged 6-17 years from surveys in 7 countries (China, India, Iran, Korea, Poland, Tunisia, and the United States) and in a validation cohort that included 70,072 participants from three other surveys (China, Poland and Seychelles). The BP cutoff values for the simple table were calculated for eight height categories for both the 90th ("elevated BP") and 95th ("high BP") percentiles of BP. The simple table had a high performance to predict high BP compared to the reference table, with high values (boys/girls) of area under the curve (0.94/0.91), sensitivity (88.5%/82.9%), specificity (99.3%/99.7%), positive predictive values (93.9%/97.3%), and negative predictive values (98.5%/97.8%) in the pooled data from 10 studies. The simple table performed similarly well for predicting elevated BP. A simple table based on height only predicts elevated BP and high BP in children and adolescents nearly as well as the international table based on sex, age, and height. This has important implications for simplifying the detection of pediatric high BP in clinical practice.

The identification of elevated blood pressure (BP) in children and adolescents relies on complex percentile tables. The present study compares the performance of 11 simplified methods for assessing elevated or high BP in children and adolescents using individual-level data from 7 countries. Data on BP were available for a total of 58 899 children and adolescents aged 6 to 17 years from 7 national surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. Performance of the simplified methods for screening elevated or high BP was assessed with receiver operating characteristic curve (area under the curve), sensitivity, specificity, positive predictive value, and negative predictive value. When pooling individual data from the 7 countries, all 11 simplified methods performed well in screening high BP, with high area under the curve values (0.84–0.98), high sensitivity (0.69–1.00), high specificity (0.87–1.00), and high negative predictive values (≥0.98). However, positive predictive value was low for most simplified methods, but reached ≈0.90 for each of the 3 methods, including sex- and age-specific BP references (at the 95th percentile of height), the formula for BP references (at the 95th percentile of height), and the simplified method relying on a child’s absolute height. These findings were found independently of sex, age, and geographical location. Similar results were found for simplified methods for screening elevated BP. In conclusion, all 11 simplified methods performed well for identifying high or elevated BP in children and adolescents, but 3 methods performed best and may be most useful for screening purposes.

The aim of the study was to develop waist circumference (WC) percentiles in Polish children and youth and to compare these with the results obtained in other countries. The study comprised a random group of 5663 Polish children aged 7-18 years. Smoothed WC percentile curves were computed using the LMS method. The curves displaying the values of the 50th (WC(50)) and the 90th (WC(90)) percentile were then compared with the results of similar studies carried out in children from the UK, Spain, Germany, Turkey, Cyprus, Canada and the USA. WC increased with age in both boys and girls and in all observed age periods the boys were seen to dominate. For 18-year-old Polish boys and girls the values of WC(90) were 86.5 and 78.2, respectively, and were lower than the current criteria developed by the International Diabetes Federation. Both WC(50) and WC(90) were higher in Polish boys and girls compared with their counterparts in the UK, Turkey and Canada and significantly lower than in children from the USA, Cyprus and Spain. The percentile curves for Polish children and youth, which were developed here for the first time, are base curves that can be applied in analysing trends as well as making comparisons with results of similar studies performed in other countries.

Background— Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (China, India, Iran, Korea, Poland, Tunisia, and the United States). Methods and Results— Data on BP for 52 636 nonoverweight children and adolescents aged 6 to 19 years were obtained from 7 large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. BP values were obtained with certified mercury sphygmomanometers in all 7 countries by using standard procedures for BP measurement. Smoothed BP percentiles (50th, 90th, 95th, and 99th) by age and height were estimated by using the Generalized Additive Model for Location Scale and Shape model. BP values were similar between males and females until the age of 13 years and were higher in males than females thereafter. In comparison with the BP levels of the 90th and 95th percentiles of the US Fourth Report at median height, systolic BP of the corresponding percentiles of these international references was lower, whereas diastolic BP was similar. Conclusions— These international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents and may help to identify hypertensive youths in diverse populations.

The aim of the study was to assess the prevalence of elevated blood pressure values and significant family history with respect to the incidence of cardiovascular diseases in overweight and obese adolescents.Our study encompassed 4904 adolescents from randomly selected schools from the Wielkopolska province of Poland. Measurements of body height and mass were performed in all the school pupils. The adolescents were qualified to be included in the overweight and obese groups based on the BMI value, using the cut-off points according to Cole's method. Blood pressure measurements were conducted according to the methodology and recommendations of the Fourth Report, with the application of the Polish blood pressure standards. Within the group of students with normal body mass, overweight and obesity, the frequency of higher systolic and diastolic blood pressure and significant family history were calculated, and the relationship between the variables was calculated by means of chi2 test, assuming p0.05. In order to calculate the odds ratio and the probability of incidence of higher systolic and diastolic blood pressure, the variables significant in the logistic regression model were taken into consideration.Overweight and obesity was observed in 845 subjects, which made up 17.2% of the population included in the study. Overweight and obesity were significantly more often observed in boys (485 - 22,2%) than in girls (362 - 17.0%) (p0.05). In boys, the significant family history increases the odds ratio of prevalence of higher systolic blood pressure 1.90 times, obesity - 8.86 times and significant family history combined with obesity - 16.85 times, in comparison with the boys who have normal body mass and no significant family history. Obesity in girls increases the odds ratio of prevalence of higher systolic blood pressure by 9.24 times. Obesity in boys increases the odds ratio of prevalence of higher diastolic blood pressure by 5.88 and in obese girls the odds ratio of elevated diastolic blood pressure are 4.17 times higher.1. Obesity and positive family history in pupils of both genders considerably increased the probability of elevated systolic and diastolic blood pressure occurrence. This obliges to: - perform further medical diagnostics, towards identification of other risk-factors of cardiovascular diseases; - to qualify such adolescents to "groups of increased risk" (this information should be entered in the school medical records).

The objective of this study was to develop age- and gender-specific reference ranges for blood pressure in a large national database on blood pressure levels throughout childhood and adolescence in young Poles. A prospective cross-sectional study was performed in 2002−2005 in the representative sampling sites, selected randomly from the entire Poland. Altogether, 6,447 school pupils, aged 7−18 years, were involved in the study of which 3,176 were boys and 3,271 were girls. Statistical analysis was performed using STATISTICA for Windows 7.1. The normal range of blood pressure, determined by age and the category of body height percentiles, revealed percentiles values which might serve as reference values to identify cases of high normal blood pressure (the mean blood pressure between 90th and 95th percentiles for age and gender) and hypertension (the mean blood pressure equals or exceeds the 95th percentiles on at least three occasions).

In Poland, there is no data on parental socioeconomic status (SES) as a potent risk factor in adolescent elevated blood pressure, although social differences in somatic growth and maturation of children and adolescents have been recorded since the 1980s. This study aimed to evaluate the association between parental SES and blood pressure levels of their adolescent offspring. A cross-sectional survey was carried out between 2009 and 2010 on a sample of 4941 students (2451 boys and 2490 girls) aged 10–18, participants in the ADOPOLNOR study. The depended outcome variable was the level of blood pressure (optimal, pre- and hypertension) and explanatory variables included place of residence and indicators of parental SES: family size, parental educational attainments and occupation status, income adequacy and family wealth. The final selected model of the multiple multinomial logistic regression analysis (MLRA) with backward elimination procedure revealed the multifactorial dependency of blood pressure levels on maternal educational attainment, paternal occupation and income adequacy interrelated to urbanization category of the place of residence after controlling for family history of hypertension, an adolescent’s sex, age and weight status. Consistent rural-to-urban and socioeconomic gradients were found in prevalence of elevated blood pressure, which increased with continuous lines from large cities through small- to medium-sized cities to villages and from high-SES to low-SES familial environments. The adjusted likelihood of developing systolic and diastolic hypertension decreased with each step increase in maternal educational attainment and increased urbanization category. The likelihood of developing prehypertension decreased with increased urbanization category, maternal education, paternal employment status and income adequacy. Weight status appeared to be the strongest confounder of adolescent blood pressure level and, at the same time, a mediator between their blood pressure and parental SES. Conclusion: The findings of the present study confirmed socioeconomic disparities in blood pressure levels among adolescents. This calls for regularly performed blood pressure assessment and monitoring in the adolescent population. It is recommended to focus on obesity prevention and socioeconomic health inequalities by further trying to improve living and working conditions in adverse rural environments. What is known: • Socioeconomic gradient exists in adolescent blood pressure levels. • Adolescents from lower SES families are at greater risk of hypertension. What is new: • Urbanization levels of residence area affect adolescent blood pressure by parental socioeconomic status. • Socioeconomic inequalities in adolescent hypertension may be modulated through effects of body weight.