Blood Pressure Differences by Ethnic Group Among United States Children and Adolescents

Rosner, Bernard; Cook, Nancy R.; Portman, Ron; Daniels, Steven R.; Falkner, Bonita

doi:10.1161/hypertensionaha.109.134049

Cited by 80 publications

(62 citation statements)

References 22 publications

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“…This suggests that at some point, the obesity effect on BP may overshadow the race effect on BP. Consistent with our data, the Pediatric Task Force also shows BMI-adjusted differences in rates of BP elevation in Hispanic versus white boys (15).…”

Section: Discussionsupporting

confidence: 91%

“…The same study also found white children with the highest BMIs had more hypertension than black children with equivalent BMIs (28). The Pediatric Task Force shows black-white race differences in BMI-adjusted rates of BP elevation in normal weight populations only (15). This suggests that at some point, the obesity effect on BP may overshadow the race effect on BP.…”

Section: Discussionmentioning

confidence: 87%

“…Blood pressure data from Hispanic pediatric populations are more limited and are conflicting. Some studies have found BP to be higher in Hispanic children than white children, while others report no race differences (15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

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The effect of body mass index on blood pressure varies by race among obese children

Hannon

Gupta

et al. 2015

Journal of Pediatric Endocrinology and Metabolism

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Objective: Previous studies have shown that the effect of adiposity on blood pressure (BP) intensifies as children become increasingly obese. Black children tend to have greater body mass index (BMI) and higher BP than age-matched white children. It is unclear whether the BP effects of BMI are race-specific among black and white children, and data on obese Hispanic children are sparse. We compared the BP effect of BMI in obese white, black, and Hispanic children. Methods: We examined the medical records of children enrolled in a pediatric obesity clinic. Height, weight, BP, and fasting insulin were assessed as part of routine clinical care. The concurrent effects of age and BMI on BP percentile values were examined using semiparametric regression, which allows the accommodation of nonlinear effects. Results: The study included 873 children (338 male; 354 black, 447 white, 72 Hispanic; 11.7 ± 3.5 years, BMI 36.2 ± 8.5 kg/m 2 ). While BMI Z-scores were similar among the groups, systolic BP (SBP) was higher in black children and Hispanic children (white: 107 mm Hg; black: 112 mm Hg; Hispanic: 112 mm Hg; p = 0.0001). Age, sex, and height-adjusted SBP percentiles were significantly different among the three groups (white: 50; black: 59; Hispanic: 59; p = 0.0006). In children of the same age, BP was higher at any given BMI in black children and Hispanic children. Conclusions: Among children referred for treatment of obesity, black children and Hispanic children are at a greater risk for having elevated BP when compared to white children of similar age and BMI.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 87%

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The effect of body mass index on blood pressure varies by race among obese children

Hannon

Gupta

et al. 2015

Journal of Pediatric Endocrinology and Metabolism

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“…A recent study, however, showed a higher prevalence of elevated BP among Black compared with White American boys aged Ͻ18 years even after controlling for BMI. 26 A US-United Kingdom comparison of children of African origin is complicated by the differences in migration history, with Africans in the United Kingdom being much more likely to be migrants or born to migrant parents than Black Americans in the United States. The history of Black Caribbeans reflects longer generational distance from West Africa than that of Africans in the United Kingdom but less than that of Black Americans.…”

Section: Discussionmentioning

confidence: 99%

Emergence of Ethnic Differences in Blood Pressure in Adolescence

et al. 2010

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Abstract-The cause of ethnic differences in cardiovascular disease remains a scientific challenge. Blood pressure tracks from late childhood to adulthood. We examined ethnic differences in changes in blood pressure between early and late adolescence in the United Kingdom. Longitudinal measures of blood pressure, height, weight, leg length, smoking, and socioeconomic circumstances were obtained from London, United Kingdom, schoolchildren of White British (nϭ692), Black Caribbean (nϭ670), Black African (nϭ772), Indian (nϭ384), and Pakistani and Bangladeshi (nϭ402) ethnicity at 11 to 13 years and 14 to 16 years. Predicted age-and ethnic-specific means of blood pressure, adjusted for anthropometry and social exposures, were derived using mixed models. Among boys, systolic blood pressure did not differ by ethnicity at 12 years, but the greater increase among Black Africans than Whites led to higher systolic blood pressure at 16 years (ϩ2.9 mm Hg). Among girls, ethnic differences in mean systolic blood pressure were not significant at any age, but while systolic blood pressure hardly changed with age among White girls, it increased among Black Caribbeans and Black Africans. Ethnic differences in diastolic blood pressure were more marked than those for systolic blood pressure. Body mass index, height, and leg length were independent predictors of blood pressure, with few ethnic-specific effects. Socioeconomic disadvantage had a disproportionate effect on blood pressure for girls in minority groups. The findings suggest that ethnic divergences in blood pressure begin in adolescence and are particularly striking for boys. They signal the need for early prevention of adverse cardiovascular disease risks in later life. Key Words: ethnicity Ⅲ blood pressure Ⅲ adolescence Ⅲ growth Ⅲ social circumstances T he cause of ethnic variations in cardiovascular risk remains a scientific challenge. Elevated blood pressure (BP) in populations of African origin and excess coronary events in populations of South Asian origin are widely documented. 1 BP is an established risk factor for cardiovascular disease, and the evidence for BP tracking from late childhood to adulthood is strong. 2 Remarkably little is known about the change in BP over time in these ethnic groups and, in particular, in childhood and adolescence. In the United States, Black-White differences in BP in girls become apparent from Ϸ13 years of age. [3][4][5][6][7] What factors drive the emergence of this BP difference, when many earlier-life determinants are already operating, are not clear. Cruickshank et al 8 showed recently that lower birth weights of Blacks accounted for Black-White differences in BP in adolescence, with the strength of the association between birthweight and BP being the same for both groups. In the Coronary Artery Risk Development in Young Adults Study, obesity and lifestyle factors accounted for the differences in mean BP and in hypertension in African American subjects. 9 There are few longitudinal studies and none to our knowledge comparing seve...

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“…Significant prevalence rates of prehypertension and hypertension have been reported in adolescents. 7 Rosner et al 8 completed a pooled analysis of children and adolescents Յ17 years of age and found hypertension in 6% and prehypertension in another 15% of the study population. The racial disparities in prevalence rates found in adult blood pressures were also evident in this younger group.…”

mentioning

confidence: 99%

Hypertension Risk Prediction

Lackland¹

2010

Hypertension

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H ypertension has been recognized for decades as a major predictor of adverse outcomes, including stroke, heart failure, end-stage renal disease, heart disease, and peripheral vascular disease. These disease risk estimates are the key components for the development and implementation of prevention, treatment, and control guidelines with a general theme of lower blood pressure levels associated with less adverse events. 1 The public health burden from high blood pressure and the process to design interventions are further complicated by the high proportion of the population affected (Ϸ1 in 3 adults), a linear increase with age, and disproportionally higher rates for segments of the population, such as blacks and Hispanics. 2 Changes in awareness, treatment, and control of hypertension can be assessed and monitored in the population with a series of cross-sectional observational studies. Although these prevalence rates can be determined from single measurements in time, hypertension management and prevention strategies are dependent on incidence rates and the disease progression. These evidence-based guidelines are dependent on incidence and progression rates of high blood pressure derived from longitudinal cohort studies. For example, the residual lifetime risk for developing hypertension for 55-to 65-year-old subjects determined from the Framingham Heart Study cohort is 90%. 3 Thus, interventions should be designed to delay the onset of elevated blood pressure, and the methods of determining the risk of hypertension are important in the development of intervention strategies.In this issue of Hypertension, Muntner et al 4 present the comparison of 2 models for determining risk prediction of hypertension. The investigators used the cohort from the well-designed Multi-Ethnic Study of Atherosclerosis, concluding that the Framingham Heart Study prediction model for estimating hypertension risks for an individual was not significantly better than using systolic blood pressure alone. These results provide valuable information in support of aggressive individual and population-based approaches to lower systolic blood pressure. In addition, the authors have applied the models to different race and ethnic groups.However, the study has a significant limitation: nearly half of the Multi-Ethnic Study of Atherosclerosis cohort (nϭ6814) was excluded from the current analyses as having hypertension at the baseline measurements. The exclusion because of existing high blood pressure was disproportional by race, with 49% of the white Multi-Ethnic Study of Atherosclerosis participants and 49% of Asians included in the analyses compared with only 31% of the blacks in the cohort. 5 The disparities in the exclusion rates are indicative of the earlier onset of hypertension and higher rates for blacks. These findings might also be attributable in part to a faster progression to higher blood pressures. Likewise, these individuals may have developed hypertension at a younger age and, thus, would have functioned with elevated blood pressur...

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Blood Pressure Differences by Ethnic Group Among United States Children and Adolescents

Cited by 80 publications

References 22 publications

The effect of body mass index on blood pressure varies by race among obese children

The effect of body mass index on blood pressure varies by race among obese children

Emergence of Ethnic Differences in Blood Pressure in Adolescence

Hypertension Risk Prediction

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