Karla Lorena Mendonça

Office blood pressure measurements with oscillometric devices in adolescents: a comparison with home blood pressure

Abstract Purpose: Compare multiple in office BP measurements in adolescents using an oscillometric device with out-of-office blood pressure measurements (home blood pressure monitoring – HBPM). Materials and methods: Office measurements were performed with validated semi-automatic devices twice (3 minutes interval) in two different moments (1 week apart), with a total of four readings. These BP readings were named R1, R2, R3 and R4 (following the sequence they were performed), FDM (mean of two readings on first day) and SDM (mean of two readings on second day) and SRM (R2–R4 means). The HBPM protocol included two day-time and two evening-time measurements over 6 days. Results: A total of 1024 students between 12 and 17 years were included (mean age 14.68 years; 52.4% females). The mean systolic blood pressure (SBP) values of R2, SDM and SRM were similar to HBPM values. Regarding diastolic blood pressure (DBP) HBPM value was different than R4. High SBP and DBP correlation coefficients with HBPM values were found for R2, SDM and SRM values. Conclusion: The second office BP measurement performed with an oscilometric device in adolescents was comparable to HBPM values, suggesting that two office readings might be suitable to rule out hypertension in this age group.

Correlation of Insulin Resistance with Anthropometric Measures and Blood Pressure in Adolescents

Background Blood pressure is directly related to body mass index, and individuals with increased waist circumference have higher risk of developing hypertension, insulin resistance, and other metabolic changes, since adolescence. Objective to evaluate the correlation of blood pressure with insulin resistance, waist circumference and body mass index in adolescents. Methods Cross-section study on a representative sample of adolescent students. One group of adolescents with altered blood pressure detected by casual blood pressure and/or home blood pressure monitoring (blood pressure > 90th percentile) and one group of normotensive adolescents were studied. Body mass index, waist circumference were measured, and fasting glucose and plasma insulin levels were determined, using the HOMA-IR index to identify insulin resistance. Results A total of 162 adolescents (35 with normal blood pressure and 127 with altered blood pressure) were studied; 61% (n = 99) of them were boys and the mean age was 14.9 ± 1.62 years. Thirty-eight (23.5%) adolescents had altered HOMA-IR. The group with altered blood pressure had higher values of waist circumference, body mass index and HOMA-IR (p<0.05). Waist circumference was higher among boys in both groups (p<0.05) and girls with altered blood pressure had higher HOMA-IR than boys (p<0.05). There was a significant moderate correlation between body mass index and HOMA-IR in the group with altered blood pressure (ρ = 0.394; p < 0.001), and such correlation was stronger than in the normotensive group. There was also a significant moderate correlation between waist circumference and HOMA-IR in both groups (ρ = 0.345; p < 0.05). Logistic regression showed that HOMA-IR was as predictor of altered blood pressure (odds ratio - OR = 2.0; p = 0.001). Conclusion There was a significant association of insulin resistance with blood pressure and the impact of insulin resistance on blood pressure since childhood. The correlation and association between markers of cardiovascular diseases was more pronounced in adolescents with altered blood pressure, suggesting that primary prevention strategies for cardiovascular risk factors should be early implemented in childhood and adolescence.

Multiple cardiovascular risk factors in adolescents from a middle-income country: Prevalence and associated factors

Multiple cardiovascular risk factors are directly related to the severity of atherosclerosis, even in children and adolescents. In this context accurate assessment of risk factors at the individual level play a decisive role in cardiovascular disease (CVD) prevention. The objective of this study was to estimate the prevalence of cardiovascular risk factors, the frequency of their coexistence in individuals, and identify possible determinants associated with this coexistence in Brazilian adolescents. A cross-sectional study with 1170 students (12–17 years) from public and private schools of a large city was conducted. In addition to family history, modifiable cardiovascular risk factors were assessed including: tobacco use, alcohol consumption, sedentary lifestyle, overweight/obesity, increased waist circumference, and high blood pressure (office and home). We built a linear regression model to identify determinants associated with increasing number of modifiable risk factors. Mean study population age was 14.7±1.6 years, 67% were enrolled in public schools and 33% in private ones. The majority of the adolescents had at least two risk factors (68.9%), more than 10% had more than 4 risk factors, and in only 6.7% of the sample no risk factor was identified. Family history of CVD (β-coefficient = 1.20; 95%CI 1.07–1.34; p<0.001), increasing age (β-coefficient = 0.08; 95%CI 0.04–0.11; p<0.001), and being enrolled in private schools (β-coefficient = 0.16; 95%CI 0.02–0.30; p = 0.023) were directly associated with the modifiable CV risk factors. In conclusion, the prevalence of multiple cardiovascular risk factors was high in the population of adolescents studied. School based interventions should be addressed to change this scenario.

White-coat, masked and sustained hypertension detected by home blood pressure monitoring in adolescents: prevalence and associated factors

Abstract Purpose: Population-based studies estimating prevalence’s of white-coat, masked and sustained hypertension in non-European adolescents are needed, particularly in developing countries. Aiming to determine these estimates and, additionally identify factors associated to these conditions this study was conducted. Materials and methods: Cross-sectional study with a representative sample of secondary school students from a Brazilian state capital. Office measurements were performed with validated semi-automatic devices. Home BP (blood pressure) monitoring protocol included two day-time and two evening-time measurements over 6 days. Adolescents’ were classified as: normotensives (office and home BP <95th percentile); sustained hypertensives (office and home BP ≥95th percentile); white-coat hypertensives (office BP ≥95th percentile and home BP <95th percentile) and masked hypertensives (office BP <95th percentile and home BP ≥95th percentile). Logistic regression models were built to identify if sex, age, BMI and family history of HTN were independently associated with white-coat, masked and sustained hypertension. Results: In a sample of 1024 adolescents, prevalence of white-coat, masked and sustained hypertension was 7.5%, 2.2% and 1.7%, respectively. Male sex was positively associated with white-coat hypertension (OR 2.68; 95%CI 1.58–4.54; p < 0.001). BMI was positively associated with both white-coat (OR 1.23; 95%CI 1.16–1.30; p < 0.001) and sustained hypertension (OR 1.19; 95%CI 1.11–1.29; p < 0.001). None of the independent variables were associated with masked hypertension in this population. Conclusion: The estimated prevalence of white-coat hypertension, masked and sustained hypertension in a population of non-European adolescents assessed by home BP monitoring was 7.5%, 2.2% and 1.7% respectively. Male sex was positively associated with white-coat hypertension in these adolescents while BMI was positively associated with both white-coat and sustained hypertension.

Excesso de peso e fatores associados em adolescentes de uma capital brasileira

Objective: To evaluate the prevalence of overweight in adolescents and its associated factors. Methods: A cross-sectional study in public and private schools in Goiania, Brazil. Socioeconomic status, family history of obesity, lifestyle, blood pressure and Body Mass Index were studied in a sample of 1,169 Brazilian youth aged 12 - 18 years, who attended public and private schools. Data were obtained from a questionnaire and anthropometric measurements previously tested in a pilot study. Poisson regression was used to estimate the prevalence of overweight, prevalence ratios and associations with the other factors. Results: The prevalence of overweight was 21.2%, with a significant difference between boys and girls (26.3 and 16.8% respectively). Regression analysis showed that maternal obesity was associated with a higher prevalence of overweight in boys (PR = 1.86; p = 0.004), and boys aged 15 - 18 years had a lower prevalence of overweight than boys aged 12 - 14 years (PR = 0.70; p = 0.021). Among the girls, the presence of obese parents was associated with higher prevalence of overweight (PR = 2.42; p < 0.001), and the girls from a C class socioeconomic position were negatively associated with overweight (PR = 0.67; p = 0.035). Conclusions: Overweight in adolescence is associated with gender, obesity family history, and socioeconomic position. These data should be considered when planning intervention programs.

[LB.01.24] HOME BLOOD PRESSURE NORMALCY IN NON-EUROPEAN ADOLESCENTS

Objective: Evidence on normal range of home blood pressure (BP) in adolescents relies on only one European study. This study aims to investigate the normal range of home BP in a healthy non-European population of adolescents. Design and method: Cross-sectional study with a representative sample of secondary school students (12–17 years) from a Brazilian capital. Adolescents’ heights were classified in percentiles according to age and gender. Height percentiles were divided in <=50th or >50th percentile. The home BP protocol included two day-time and two evening-time measurements over 6 days. Exams were considered valid with at least 12 measurements. Results: A total of 1024 adolescents were included, mean age 14.68 ± 1.61 years, predominantly female (52.4%), from public schools (68.4%) and non-white (51.3%). The 50th (midpoint of distribution) and the 95th percentile (upper normal limit) for systolic and diastolic home BP in adolescents are provided by gender, age and height percentiles. There was a marked increase in the estimated 95th percentile for systolic home BP with increasing age in males for both height percentiles examined (16 mmHg for <=50th percentile and 14.5mmHg for >50th percentile) and less so for diastolic home BP (1 mmHg and 5 mmHg, respectively). In females the 95th percentile increase with age was less significant for systolic and similar for diastolic BP when compared to males in the two height percentiles evaluated (6/2 mmHg for <=50th percentile and 4/4 mmHg for >50th percentile). Conclusions: Reference values for home BP by height percentiles for age and sex in a non-European population of adolescents are provided.

Birth weight and its association with blood pressure and nutritional status in adolescents

Objective The management of children with low birth weight is not the same in countries with different resources. The authors assessed the association of birth weight with blood pressure and nutritional status in a representative sample of adolescents from a Brazilian state, aiming to identify possible consequences of these differences.OBJECTIVE The management of children with low birth weight is not the same in countries with different resources. The authors assessed the association of birth weight with blood pressure and nutritional status in a representative sample of adolescents from a Brazilian state, aiming to identify possible consequences of these differences. METHODS A cross-sectional school-based study was conducted with adolescents (12-18 years) enrolled in public and private schools. Birth weight, office blood pressure, home blood pressure measurements, and nutritional status (body mass index, height z-score for the age, and waist circumference) were assessed. The association of birth weight with the outcomes (blood pressure, height, body mass index, and waist circumference) was studied through univariate and multivariable linear regression models. RESULTS A total of 829 adolescents with a mean age of 14.6±1.62 years were included; 43.3% were male, and 37.0% from private schools. The prevalence of low birth weight was 8.7%. Mild low height prevalence was higher among those adolescents with low/insufficient birth weight when compared to those with normal/high birth weight (11.7 vs. 4.2%; p<0.001). In the multiple linear regression analysis, for each increase of 100g in birth weight, height increased by 0.28cm (95% CI: 0.18-0.37; p<0.01). Birth weight did not influence office blood pressure and home blood pressure, body mass index, or waist circumference of adolescents. CONCLUSIONS Birth weight was directly associated to height, but not associated to blood pressure, body mass index, and waist circumference in adolescents from an urban area of a developing country.

Original articleBirth weight and its association with blood pressure and nutritional status in adolescentsPeso ao nascer e sua associação com pressão arterial e estado nutricional em adolescentes

Objective The management of children with low birth weight is not the same in countries with different resources. The authors assessed the association of birth weight with blood pressure and nutritional status in a representative sample of adolescents from a Brazilian state, aiming to identify possible consequences of these differences.OBJECTIVE The management of children with low birth weight is not the same in countries with different resources. The authors assessed the association of birth weight with blood pressure and nutritional status in a representative sample of adolescents from a Brazilian state, aiming to identify possible consequences of these differences. METHODS A cross-sectional school-based study was conducted with adolescents (12-18 years) enrolled in public and private schools. Birth weight, office blood pressure, home blood pressure measurements, and nutritional status (body mass index, height z-score for the age, and waist circumference) were assessed. The association of birth weight with the outcomes (blood pressure, height, body mass index, and waist circumference) was studied through univariate and multivariable linear regression models. RESULTS A total of 829 adolescents with a mean age of 14.6±1.62 years were included; 43.3% were male, and 37.0% from private schools. The prevalence of low birth weight was 8.7%. Mild low height prevalence was higher among those adolescents with low/insufficient birth weight when compared to those with normal/high birth weight (11.7 vs. 4.2%; p<0.001). In the multiple linear regression analysis, for each increase of 100g in birth weight, height increased by 0.28cm (95% CI: 0.18-0.37; p<0.01). Birth weight did not influence office blood pressure and home blood pressure, body mass index, or waist circumference of adolescents. CONCLUSIONS Birth weight was directly associated to height, but not associated to blood pressure, body mass index, and waist circumference in adolescents from an urban area of a developing country.

Home Blood Pressure Monitoring as an Alternative to Confirm Diagnoses of Hypertension in Adolescents with Elevated Office Blood Pressure from a Brazilian State Capital

Background Regional differences of using home blood pressure monitoring (HBPM) as an alternative to ambulatory blood pressure monitoring (ABPM) in hypertensive adolescents are unknown. Objectives Define if HBPM is an option to confirm diagnoses of hypertension in adolescents from a Brazilian capital with elevated office blood pressure (BP). Methods Adolescents (12-18years) from public and private schools with BP > 90th percentile were studied to compare and evaluate the agreement among office BP measurements, HBPM and ambulatory BP monitoring. Office BP measurements, HBPM and ABPM were performed according to guidelines recommendations. Semi-automatic devices were used for BP measurements. Values of p < 0.05 were considered significant. Results We included 133 predominantly males (63.2%) adolescents with a mean age of 15±1.6 years. HBPM systolic blood pressure and diastolic blood pressure mean values were similar to the daytime ABPM values (120.3 ± 12.6 mmHg x 121.5 ± 9.8 mmHg - p = 0.111 and 69.4 ± 7.7 mmHg x 70.2 ± 6.6 mmHg - p = 0.139) and lower than the office measurement values (127.3 ± 13.8 mmHg over 74.4 ± 9.5 mmHg - p < 0,001). The Bland-Altman plots showed good agreement between HBPM and ABPM. Conclusions HBPM is an option to confirm diagnoses of hypertension in adolescents from a Brazilian state capital with elevated office BP and can be used as an alternative to ABPM.