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© 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
The mean BMI and BMI-SDS was 20.7 and 20.29 in boys and girls, respectively (ns) (tab. 1). The mean WC were 74.4 and 68.1 cm in boys and girls respectively (p = 0.0001). Similarly, WC-SDS values were 0.4 ± 0.97 and 0.04 ± 1.12 in boys and girls, respectively (p = 0.001). The overall prevalence of overweight (16.1%) and obesity (3.4%) was 19.5%. The prevalence of overweight was higher among boys compared to girls, whereas the prevalence of obesity did not differ between sexes.
Table 1. Description of basic anthropometrical and blood pressures data (mean (SD)) and body weight and blood pressure status (%).
VariableBoysGirlsp
Age (years)14.4 (1.0)14.5 (1.0)ns
BMI (kg/m2)20.7 (4.2)20.3 (3.4)ns
BMI-SDS0.15 (1.06)0.00 (1.09)ns
Waist (cm)74.4 (9.3)68.1 (7.2)0.0001
Waist-SDS0.42 (0.97)0.04 (1.12)0.001
SBP (mmHg)120.7 (11.01)117.1 (10.69)0.0009
DBP (mmHg)68.7 (6.57)67.2 (7.26)0.027
Overweight (overall prevalence 16.1%)20.0%12.1%0.03
Obesity (overall prevalence 3.4%)3.8%2.9%ns
High-normal blood pressure (overall prevalence 8.4%)9%7.7%ns
Arterial hypertension (overall prevalence 12.3%)11.4%13.1%ns
Stage 1 (overall prevalence 9.2%)8.6%9.7%ns
Stage 2 (overall prevalence 3.1%)2.9%3.4%ns
BMI – body mass index; BMI-SDS – body mass index-standard deviation score; SBP – systolic blood pressure; DBP – diastolic blood pressure
High-normal blood pressure was diagnosed in 9% of boys and 7.7% of girls, and arterial hypertension in 12.3% of cases (11.4% in boys and 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. Systolic AH dominated in nearly 80% of all cases of AH.

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Piśmiennictwo
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otrzymano: 2015-09-08
zaakceptowano do druku: 2015-09-30

Adres do korespondencji:
*Mieczysław Litwin
Department of Nephrology and Arterial Hypertension The Children’s Memorial Health Institute
Aleja Dzieci Polskich 20, 04-730 Warszawa
tel. +48 (22) 815-15-40
fax +48 (22) 815-15-39
m.litwin@ipczd.pl

Postępy Nauk Medycznych 11/2015
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