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Increased adiposity raised hypertension risk in children
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Children who are overweight or obese have nearly a threefold higher prevalence of hypertension compared with normal-weight children, according to new research.
Researchers used a BMI cut-off of ≥85th percentile to define overweight and obesity in 1,111 healthy Indiana children. Among children whose BMI was ≥85th percentile, the adiposity effect on BP was more than four times that of children who had a normal BMI. "The effect of relative adiposity on BP was minimal until the BMI percentile reached 85," according to the researchers.
When the researchers studied the effect of adiposity on hypertension risk by age, they found "similarly intensified" adiposity effects on BP in children aged younger than 10 years, 11 to 14 years, and older than 15 years. Additionally, BMI percentile (52% vs. 89%; P<.0001) and systolic BP (107 mm Hg vs. 118 mm Hg; P<,.0001) were lower in children who did not exceed the 85th percentile threshold before age 15 years.
Serum levels of leptin and heart rate had a similar pattern as BP, the researchers said.
This study reinforces the importance of separately considering overweight and obese children from those of normal weight; otherwise, the adiposity effect may be overestimated in normal-weight children and underestimated in overweight children, according to the researchers.
"The adiposity effects on BP in children are not as simple as we thought," Wanzhu Tu, PhD, professor of biostatistics at Indiana University School of Medicine, said in a press release issued by the American Heart Association.
In an accompanying editorial, Bonita Falkner, MD, of the division of medicine, and Samuel Gidding, MD, of the department of pediatrics, both at Thomas Jefferson University in Philadelphia, said: "Although there is now public awareness about childhood obesity, there are substantial needs in delivery of childhood health care, public health programs, and health policies to support and reinforce prevention and early intervention on childhood obesity, high BP, and other comorbidities associated with excess adiposity."
For more information:
- Falkner B. Hypertension. 2011;doi:10.1161/HYPERTENSIONAHA.111.180430.
- Tu W. Hypertension. 2011;doi:10.1161/HYPERTENSIONAHA.111.175695.
Disclosures: Drs. Tu, Falkner and Gidding report no relevant financial disclosures.
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The epidemic of obesity is an overwhelming problem for those of us practicing general pediatrics. We understand the grave public health issues involved and we witness the private agony of those burdened by the condition while truly having little to offer. I have recently made the comment that from a public health perspective it makes more sense to advocate for more hours of exercise in the school day and less salt in our food than to have pediatricians check blood pressures in our offices. I am impressed with the significance of the current study in potentially changing the approach I need to take in my office on a daily basis. It has been easy to assume that the multiple risks of obesity on the current and future health of our patients increases gradually as the degree of adiposity increases. Clearly, the current study shifts the paradigm. It also begs those researchers interested in the field to sharpen their attention on strategies to effect change in this population.
– William T. Gerson, MD
Clinical Professor of
Pediatrics, University of Vermont College of Medicine
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