© Borgis - Postępy Nauk Medycznych 11/2015, s. 756-759
Tadeusz Dereziński1, Zbigniew Kułaga2, *Mieczysław Litwin3
Występowanie nadciśnienia tętniczego i ocena antropometrycznych predyktorów podwyższonego ciśnienia tętniczego u nastolatków w wieku 14 lat
Prevalence of arterial hypertension and anthropometrical predictors of elevated blood pressure in 14 years old adolescents
1Esculap Medical Center, Gniewkowo
2Department of Public Health, The Children’s Memorial Health Institute, Warszawa
3Department of Nephrology and Arterial Hypertension, The Children’s Memorial Health Institute, Warszawa
Streszczenie
Wstęp. Niewiele badań oceniających częstość nadciśnienia tętniczego (NT) opiera się na pomiarach wykonanych w trakcie trzech różnych wizyt. Nadal dyskutowane jest znaczenie wskaźnika masy ciała (BMI) i obwodu talii (OT) jako markerów nadciśnienia, jego ciężkości i ewentualnych powikłań narządowych.
Cel pracy. Oszacowanie występowania NT i czułości oraz swoistości BMI i obwodu talii jako predyktorów ryzyka NT i jego stadiów.
Materiał i metody. W badaniu udział wzięło 416 adolescentów (210 chłopców) w wieku 14,5 ± 0,9 roku, którzy stanowili 90% populacji w tym wieku miejscowości Gniewkowo. Ciśnienie tętnicze mierzono osłuchowo w trakcie trzech różnych wizyt. BMI i OT analizowano jako wartości odchylenia standardowego od mediany normy oraz jako wartości centylowe.
Wyniki. Ciśnienie wysokie prawidłowe/stan przednadciśnieniowy rozpoznano u 9% chłopców i 7,7% dziewczynek, a NT w 12,3% (11,4% chłopców i 13,1% dziewcząt). Stadium 1 NT stwierdzono u 8,6% chłopców i 9,7% dziewcząt, a stadium 2 NT u 2,9% chłopców i 3,4% dziewcząt. OT ≥ 95. centyla miał większą czułość i swoistość niż BMI ≥ 95. centyla (odpowiednio 0,57 i 0,95 vs 0,25 i 0,96) jako predyktor stanu przednadciśnieniowego i NT. 85. centyl OT i BMI miał czułość i swoistość (0,67 i 0,78 vs 0,62 i 0,80) dla rozpoznania stadium 2 NT zarówno dla całej grupy, jak i tylko dzieci nieotyłych.
Wnioski. Częstość NT u nastolatków w wieku 14 lat wyniosła 12,3%, a stanu przednadciśnieniowego 8,4%. BMI i OT są dobrymi predyktorami rozpoznania NT, ale OT ma większą swoistość i czułość w rozpoznawaniu stadium 2 NT zarówno w populacji ogólnej, jak i u dzieci nieotyłych.
Summary
Introduction. Prevalence of arterial hypertension (AH) based on blood pressure (BP) measurements done on three occasions and assessment of BMI and waist circumference (WC) as predictors of AH was assessed in few studies.
Aim. To assess prevalence of AH and to estimate specificity and sensitivity of BMI and WC in predicting BP status in 416 adolescents (210 males) in mean age 14.5 ± 0.9 yrs.
Material and methods. Recruited subjects represented 90% of local population in this age. BP was measured with auscultatory sphygmomanometer on three different occasions.
Results. Prehypertension was diagnosed in 9% of boys and 7.7% of girls, and AH in 12.3% (11.4% in boys, 13.1% in girls). Stage 1 AH was found in 8.6% of boys and 9.7% of girls and stage 2 AH in 2.9% and 3.4% of boys and girls, respectively. 95th percentile of WC had better sensitivity and specificity over 95th percentile of BMI (0.57 and 0.95 vs 0.25 and 0.96, respectively) in predicting prehypertension and AH. For diagnosis of stage 2 AH 85th percentiles of WC and BMI had sensitivity and specificity of 0.67 and 0.78 vs 0.62 and 0.80, respectively. The same was found when only non-obese children were included to analysis.
Conclusions. The prevalence of AH among 14 years old adolescents was 12.3% and of prehypertension was 8.4%. Both BMI and WC predicted prehypertension and AH but WC had better specificity and sensitivity in predicting stage 2 AH both in general population and among non-obese children.
Introduction
It is estimated that prevalence of arterial hypertension (AH) in children and adolescents is 3-5% and rises with age from 0 to 18 years (1). However, there are only few data based on triple measurements of BP done on three occasions. Although historically the most prevalent form of AH in childhood was secondary hypertension, it changed in last 2 decades. Now, primary hypertension (PH) starts to dominate as the cause of AH in children older than 6 years and its prevalence is at least the same as of secondary hypertension (2). The recent rise in prevalence of PH in childhood and adolescence is strictly associated with the obesity epidemic and the dominant intermediate phenotype of hypertensive adolescent is overweight and metabolic abnormalities typical of metabolic syndrome. Although the role of visceral fat is of utmost importance in pathogenesis of PH and associated abnormalities it is still debated which anthropometrical parameter has the better predictive value in assessment of cardiovascular risk and blood pressure status (3). Both body mass index (BMI) and waist circumference (WC) are crude markers of adiposity. BMI reflects general relations between mass and height. It is the main marker of overweight and obesity. However, in some cases of excessive muscle mass BMI may falsely indicate adiposity. On the contrary, persons with normal BMI may have increased amount of visceral fat and decreased muscle mass with all metabolic and hemodynamic consequences. WC is the crude marker of visceral fat. However, WC measures also subcutaneous fat. Nevertheless, there is strict relation between WC and metabolic abnormalities both in children and adults (4). In contrast to adults, in childhood and adolescence anthropometrical parameters change with age. Thus, pediatric definitions of overweight and obesity are based on percentile values and not on absolute values.
Aim
The aim of the study was to assess prevalence of AH among 14 years old adolescents and to determine the sensitivity and specificity of BMI and WC as indicators of blood pressure status from prehypertension to stage 2 arterial hypertension.
Material and methods
418 adolescents (210 males) in mean age 14.5 ± 0.9 yrs were included to the study. Subjects were recruited voluntarily from schools of town Gniewkowo and represented 90% of local population of schoolchildren in this age. The exclusion criteria were body deformities interfering with blood pressure and anthropometrical measurements, chronic disease associated with blood pressure elevation, chronic kidney disease, diabetes and use of antihypertensive medications. All subjects were examined when in good state of health.
Blood pressure (BP) was measured with auscultatory mercury sphygmomanometer. Three measurements were done on right arm on three different occasions. The mean of three BP measurements was analyzed. The cut-off values for diagnosis of high-normal blood pressure/prehypertension, stage 1 and stage 2 of AH were based on referential values for auscultatory measurements from 4th Task Report (5).
During first visit in all subjects height, weight and WC was measured. WC was measured midway between the lowest rib and the superior border of the iliac crest at the end of a normal expiration with a flexible non-elastic anthropometric tape, to the nearest 0.1 cm. Anthropometrical values including BMI and WC were analyzed as absolute and as standard deviation score (SDS) values according to referential normative data for Polish children and adolescents (6). Overweight and obesity were defined according to the International Obesity Task Force cut-off points.
Statistical analysis
Descriptive analyses were used to calculate means and standard deviations. A Mann-Whitney U test and T-test were used to determine differences between the sexes in the case of non-normally distributed data and normally distributed data, respectively. Prevalence of overweight, obesity and blood pressure status was analyzed using chi-square test. The sensitivity and specificity of BMI and WC as predictors of AH and stage 1 and stage 2 of AH was done after calculation of receiver operating curves (ROC). Statistical analysis was performed using SAS 9.3 software. The significance level of all tests was 0.05.
Results
Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Mam kod dostępu
- Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu albo wszystkich artykułów (w zależności od wybranej opcji), należy wprowadzić kod.
- Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.
- Aby kupić kod proszę skorzystać z jednej z poniższych opcji.
Opcja #1
24 zł
Wybieram
- dostęp do tego artykułu
- dostęp na 7 dni
uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony
Opcja #2
59 zł
Wybieram
- dostęp do tego i pozostałych ponad 7000 artykułów
- dostęp na 30 dni
- najpopularniejsza opcja
Opcja #3
119 zł
Wybieram
- dostęp do tego i pozostałych ponad 7000 artykułów
- dostęp na 90 dni
- oszczędzasz 28 zł
Piśmiennictwo
1. McNiece KL, Poffenbarger TS, Turner JL et al.: Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 2007; 150: 640-644.
2. Gupta-Malhotra M, Banker A, Shete S et al.: Essential hypertension vs. secondary hypertension among children. Am J Hypertens 2015; 28: 73-80.
3. Gröber-Grätz D, Widhalm K, de Zwaan M et al.: Body mass index or waist circumference: which is the better predictor for hypertension and dyslipidemia in overweight/obese children and adolescents? Association of cardiovascular risk related to body mass index orwaist circumference. Horm Res Paediatr 2013, 80: 170-178.
4. Kaczmarzyk PT, Srinivasan SR, Chen W et al.: Body mass index, waist circumference and clustering of cardiovascular risk factors in a biracial sample of children and adolescents. Pediatrics 2004; 144: 198-205.
5. National High Blood Pressure Education Program Working Group on High Blood pressure in children and adolescents: The fourth report on diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555-576.
6. Kułaga Z, Litwin M, Grajda A et al.: Normy rozwojowe wysokości i masy ciała, wskaźnika masy ciała, obwodu talii i ciśnienia tętniczego dzieci i młodzieży w wieku 0-18 lat. Standardy Med. Pediatria 2015; 12 (supl. 1): 3-44.
7. Litwin M, Śladowska J, Antoniewicz J et al.: Metabolic abnormalities, insulin resistance, and metabolic syndrome in children with primary hypertension. Am J Hypertens 2007; 20: 875-882.
8. Lurbe E, Cifkova R, Cruikshank JK et al.: Management of high blood pressure in children and adolescents: Recommendations of the European Society of Hypertension. J Hypertens 2009; 27: 1719-1742.
9. Litwin M: Nadciśnienie tętnicze u dzieci i młodzieży – problemy diagnostyczne i kontrowersje terapeutyczne. Terapia 2015; XXIII: 66-73.
10. Daniels SR, Morrison JA, Sprecher DL et al.: Association of body fat distribution and cardiovascular risk factors in children and adolescents. Circulation 1999; 99: 541-545.
11. Litwin M, Niemirska A, Sladowska-Kozlowska J et al.: Regression of target organ damage and metabolic abnormalities in children and adolescents with primary hypertension – prospective study. Pediatr Nephrol 2010; 25: 2489-2499.
12. Bloetzer C, Bovet P, Chiolero A: Performance of targeted screening for the identification of hypertension in children. J Hypertens 2015; 33 (suppl. 1): e34.
13. Sorof JM, Poffenbarger T, Franco K et al.: Isolated systolic hypertension, obesity, and hyperkinetic hemodynamic states in children. J Pediatr 2002; 140: 660-666.
14. O’Rourke MF, Adji A: Guidelines on guidelines: focus on isolated systolic hypertension in youth. J Hypertens 2013; 31: 649-654.
15. Protogerou AD, Blacher J, Safar ME: Isolated systolic hypertension: ‘to treat or not to treat’ and the role of central haemodynamics. J Hypertens 2013; 31: 655-658.
