These results confirm an evolving epidemic of cardiovascular risk in youth, as evidenced by an increase in the prevalence of overweight and hypertension, notably among ethnic minority children.

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Abstract-To determine whether ambulatory blood pressure is more predictive of left ventricular hypertrophy than is casual blood pressure in hypertensive children, echocardiography and ambulatory blood pressure data from 37 untreated hypertensive children were analyzed. Left ventricular mass was calculated using the Devereux equation, left ventricular mass index was calculated as left ventricular mass (in grams)/height 2.7 (in meters), and left ventricular hypertrophy was defined as left ventricular mass index Ͼ51 g/m 2.7 . Average blood pressure, blood pressure load, and blood pressure index (average blood pressure divided by pediatric ambulatory blood pressure 95th percentile) were calculated. Left ventricular mass index was strongly correlated with 24-hour systolic blood pressure index (rϭ0.43, Pϭ0.008) and was also correlated with 24-hour systolic blood pressure (rϭ0.34, Pϭ0.037), 24-hour systolic blood pressure load (rϭ0.38, Pϭ0.020), wake systolic blood pressure load (rϭ0.37, Pϭ0.025), sleep systolic blood pressure (rϭ0.33, Pϭ0.048), and sleep systolic blood pressure load (rϭ0.38, Pϭ0.021). Left ventricular mass index did not correlate with age, weight, clinic blood pressure, or ambulatory diastolic blood pressure. The overall prevalence of left ventricular hypertrophy was 27%. The prevalence of left ventricular hypertrophy was 47% (8 of 17) in patients with both systolic blood pressure load Ͼ50% and 24-hour systolic blood pressure index Ͼ1.0, compared with 10% (2 of 20) in patients without both criteria (Pϭ0.015). These data suggest ambulatory blood pressure monitoring may be useful for the clinical assessment of hypertensive children by identifying those at high risk for the presence of end organ injury. T he most recent update from the Task Force on High Blood Pressure in Children and Adolescents 1 provided population-based 95th percentile blood pressure values in children adjusted for age, gender, and height. These pediatric normative data have guided the interpretation of blood pressure values and provided criteria for the diagnosis of hypertension in children. However, the paucity of data in children linking this statistically based definition of hypertension with evidence of hypertensive end-organ injury has created uncertainty regarding the indications for initiating antihypertensive medication in children whose blood pressure exceeds these threshold values. Because overt morbid cardiovascular events are rare in the majority of hypertensive children, attention has focused on other markers of hypertensive injury, such as increased left ventricular mass index (LVMI) and the presence of left ventricular hypertrophy (LVH). Studies of normal and hypertensive children have found that systolic blood pressure (SBP) and LVMI are positively associated across a wide range of blood pressure values, with no clear blood pressure threshold to predict pathologically increased LVMI. 2-8 Studies of hypertensive children have reported prevalences of LVH that vary widely. 6 -14 Although these data suggest that childre...

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These findings raise the possibility that carotid duplex ultrasound, by indicating the presence of early arterial wall changes, may be useful for predicting other cardiovascular sequelae in hypertensive children.

LVH occurs commonly in children with hypertension and is associated with an increased BMI. LVH may be more prevalent in Hispanic children than in other ethnic groups. Prevention and treatment of obesity is important in reducing the cardiovascular risk for children with hypertension. Further evaluation of the frequency of LVH in multiethnic populations is needed.

Abstract-Obesity has become an increasingly important medical problem in children and adolescents. In national surveys from the 1960s to the 1990s, the prevalence of overweight in children grew from 5% to 11%. Outcomes related to childhood obesity include hypertension, type 2 diabetes mellitus, dyslipidemia, left ventricular hypertrophy, nonalcoholic steatohepatitis, obstructive sleep apnea, orthopedic problems, and psychosocial problems. Once considered rare, primary hypertension in children has become increasingly common in association with obesity and other risk factors, including a family history of hypertension and an ethnic predisposition to hypertensive disease. Obese children are at approximately a 3-fold higher risk for hypertension than nonobese children. In addition, the risk of hypertension in children increases across the entire range of body mass index (BMI) values and is not defined by a simple threshold effect. As in adults, a combination of factors including overactivity of the sympathetic nervous system (SNS), insulin resistance, and abnormalities in vascular structure and function may contribute to obesity-related hypertension in children. The benefits of weight loss for blood pressure reduction in children have been demonstrated in both observational and interventional studies. Obesity in childhood should be considered a chronic medical condition that is likely to require long-term management. Ultimately, prevention of obesity and its complications, including hypertension, is the goal. Key Words: hypertension, obesity Ⅲ children Ⅲ epidemiology Ⅲ cardiovascular diseases Ⅲ risk factors O besity has become an increasingly important medical problem in children and adolescents. Many of the outcomes associated with obesity that were previously thought of as diseases of adults are now affecting children as well. Outcomes related to childhood obesity include hypertension, type 2 diabetes mellitus, dyslipidemia, left ventricular hypertrophy, nonalcoholic steatohepatitis, obstructive sleep apnea, and orthopedic problems (such as slipped capital-femoral epiphysis), as well as social and psychological problems. 1 Obesity is also the most common nutritional problem among children in developed countries. This epidemic of pediatric obesity has resulted in great concern regarding the management of obesity and its complications. Although prevention would be an optimum strategy, it may be difficult to identify children at risk of obesity before they become overweight. Even with appropriate preventive approaches, it is likely that many children will become overweight and require treatment to prevent the long-term sequelae of obesity, such as cardiovascular morbidity and mortality. 2 In concert with the increasing prevalence of obesity in children, pediatric hypertension has undergone an epidemiological shift. The conventional wisdom has been that hypertension in children is a relatively rare condition most commonly associated with renal disease. In actuality, secondary hypertension in children resulting from re...

Epidemiology, socioeconomic burden and natural history of diabetic retinopathy and diabetic macular edema Diabetes epidemic Diabetes mellitus is a global health problem associated with serious long-term micro-and macrovascular complications and premature death [Centers for Disease Control and Prevention,