Blood pressure in children has consistently been related to adult blood pressure, with implications for long-term prevention of cardiovascular disease. The epidemic of obesity in children has resulted in corresponding increases in childhood blood pressure. In this paper, the authors develop norms for childhood blood pressure among normal-weight children (body mass index <85th percentile based on Centers for Disease Control and Prevention guidelines) as a function of age, sex, and height, using data from 49,967 children included in the database of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (the Pediatric Task Force). The authors considered three types of models for pediatric blood pressure data, including polynomial regression, restricted cubic splines, and quantile regression, with the latter providing the best fit. The sex-specific norms presented here are a nonlinear function of both age and height and are generally slightly lower than previously developed norms based on Pediatric Task Force data including both normal-weight and overweight children.

Obstructive sleep apnea (OSA) has been shown to be an independent risk factor for cardiovascular disease in adults. However, there are severe limitations in the extent to which the cardiovascular consequences of OSA are being studied in children. To investigate the echocardiographic changes in children with OSA, right and left ventricular (RV, LV) dimensions and LV mass index and geometry were measured in 28 children with OSA and 19 children with primary snoring (PS). The study showed that LV mass index and relative wall thickness were greater in the OSA group compared with those with PS (p = 0.012 and p < 0.0001, respectively). An apnea-hypopnea index of more than 10 per hour was significantly associated with RV dimension above the 95th percentile (odds ratios, 6.7; 95% confidence interval, 1.4-32) and LV mass index above the 95th percentile (odds ratios, 11.2; confidence interval, 1.9-64). Abnormality of LV geometry was present in 15% of children with PS compared with 39% of children with OSA. We conclude that OSA in children is associated with increased LV mass.

No abstract

Hypertension is associated with left ventricular hypertrophy (LVH), a risk factor for cardiovascular events. Since cardiovascular events in youth are rare, hypertension has historically been defined by the 95th percentile of the normal blood pressure (BP) distribution in healthy children. The optimal BP percentile associated with LVH in youth is unknown. We aimed to determine the association of systolic BP (SBP) percentile, independent of obesity, on left ventricular mass index (LVMI), and to estimate which SBP percentile best predicts LVH in youth. We evaluated SBP, anthropometrics, and echocardiogram in 303 adolescents (mean age 15.6 years, 63% white, 55% male) classified by SBP as low-risk (L=141, <80th percentile), mid-risk (M=71, 80–<90th percentile), or high-risk (H=91, ≥90th percentile) using the mean of 6 measurements at 2 visits according to the 2017 guidelines. Logistic regression was used to determine the sensitivity and specificity of various SBP percentiles associated with LVH. Results: BP groups did not differ by age or demographics but differed slightly by body mass index. Mean BP, LVMI, and prevalence of LVH increased across groups (BP: L=111/75, M=125/82, and H=133/92 mm Hg; LVMI: L=31.2, M=34.2, and H=34.9 g/m 2.7 ; LVH: L=13%, M=21%, H=27%, all P <0.03). SBP percentile remained a significant determinant of LVMI after adjusting for covariates. The 90th percentile for SBP resulted in the best balance between sensitivity and specificity for predicting LVH (LVMI≥38.6 g/m 2.7 ). Abnormalities in cardiac structure in youth can be found at BP levels below those used to define hypertension.

Large differences in blood pressure by ethnic group are apparent among adults. There is uncertainty as to whether similar differences by ethnic group exist among children and if so, the age of onset. Blood pressure (BP) measurements were obtained from 58,698 children at 78,556 visits using data from the Pediatric Task Force data, a collection of 11 studies with BP data from children and adolescents age 1–17. Generalized estimating equation methods were used to identify sex-specific differences in body mass index (BMI)-adjusted rates of BP elevation and pre-hypertension by ethnic group. Significant BMI-adjusted differences in rates of BP elevation were found between Hispanic boys vs. Caucasian boys (OR = 1.21, 95% CI = 1.07–1.37, p=0.002). No overall significant differences were found between African-American (AA) boys vs. Caucasian (Cauc) boys (OR = 1.03, 95% CI = 0.95–1.12, p=0.49); however, there was significant effect modification (p = 0.01) with significant differences found for normal weight boys (BMI < 85th percentile) (ORAA vs. Cauc = 1.14, 95% CI = 1.03 –1.27, p=0.01), but not for overweight boys (BMI ≥ 85th percentile) (ORAA vs. Cauc = 0.90, 95% CI = 0.78–1.05, p=0.20). No overall ethnic group differences in BMI-adjusted rates of hypertension were found for girls. Ethnic differences in prevalence rates of pediatric BP elevation that are not explained by obesity are present, primarily in boys. Whether these differences are due to genetic or environmental factors is unknown.

Objective To test the hypothesis that a change in A1c over a follow-up interval of approximately 2 years would be associated with concomitant changes in fasting lipids in individuals with type 1 diabetes (T1D). Study design All subjects with T1D diagnosed 2002–2005 in the SEARCH for Diabetes in Youth study with at least two study visits approximately 12 and 24-months after an initial visit were included (age at initial visit=10.6±4.1 years, 48% female, diabetes duration=10±7 months, 76% non-Hispanic White, A1c=7.7±1.4%). Longitudinal mixed models were fit to examine the relationship between change in A1c and change in lipid levels (total cholesterol [TC], high-density lipoprotein-cholesterol [HDL-c], low-density lipoprotein-cholesterol [LDL-c], log triglycerides [TG], and non-high-density lipoprotein-cholesterol [non-HDL-c]) with adjustment for possible confounders. Results Change in A1c over time was significantly associated with changes in TC, HDL-c, LDL-c, TG, and non-HDL-c over the range of A1c values. For example, for a person with an A1c of 10% and then a 2% decrease in A1c 2-years later (to 8%), the model predicted concomitant changes in TC (−0.29 mmol/l, −11.4 mg/dl), HDL-c (0.03 mmol/l, 1.3 mg/dl), LDL-c (−0.23 mmol/l, −9.0 mg/dl), and non-HDL-c (−0.32 mmol/l, −12.4 mg/dl), and an 8.5% decrease in TG (mmol/l). Conclusions Improved glucose control over a 2-year follow-up was associated with a more favorable lipid profile, but may be insufficient to normalize lipids in dyslipidemic T1D youth needing to decrease lipids to goal.

Previous studies estimated critical periods of childhood body mass index (BMI) growth and linked these events to adult adiposity and cardiovascular health. We expand upon both results to link childhood BMI growth patterns with adult blood pressure. Data from male and female participants in the Fels Longitudinal Study were used to estimate childhood BMI growth curves, from which we isolate ages of childhood BMI divergence based upon adult BMI and blood pressure measurements. Repeated measure analysis of variances models were used to estimate BMI growth curves from ages 2 to 17.5 based on both adult BMI (< 25 kg/m2 or ≥ 25 kg/m2) and adult blood pressure (< 120 mmHg or ≥ 120 mmHg for systolic blood pressure; < 80 mmHg or ≥ 80 mm Hg for diastolic blood pressure). Participants with lower bodyweight throughout childhood had lower systolic and diastolic blood pressures in early adulthood. Any relationships between childhood adiposity and adult bodyweight and blood pressure disappeared by age 60. These results were independent of adult BMI and were observed in both men and women. Increased adult blood pressure has its genesis in part from increased childhood BMI.

Purpose This study examined longitudinal changes in waist-to-height ratio and components of BMI among black and white females. Methods Girls were recruited at age 9 through the NHLBI Growth and Health Study (NGHS), and followed annually over ten years. Girls were grouped into low (<20th %tile), middle, and high (>80th %tile) BMI on the basis of race-specific BMI percentile rankings at age 9, and low, middle, and high waist-to-height ratio, on the basis of waist-to-height ratio at age 11. BMI was partitioned into fat mass and fat-free mass index (FMI and FFMI). Results Girls accrued fat mass at a greater rate than fat-free mass, and the ratio of fat mass to fat-free mass increased from ages 9 through 18. There was a significant increase in this ratio after age at peak height velocity. Participants with elevated BMI and waist-to-height ratios at age 18 tended to have been elevated at ages 9 and 11, respectively. There were strong correlations between BMI at age 9 with several outcomes at age 18: BMI (0.76) and FMI (0.72), weaker but significant with FFMI (0.37), and ratio of fat mass to fat-free mass (0.53). Additionally, there was significant tracking of elevated BMI from ages 9 through 18. Conclusions In girls, higher BMI levels during childhood lead to greater waist-to-height ratios and greater than expected changes in BMI at age 18, with disproportionate increases in fat mass. These changes are especially evident in blacks and after the pubertal growth spurt.