Essential hypertension in children, a growing worldwide problem
Mohammadreza Sabri1, Alaleh Gheissari2, Marjan Mansourian3, Noushin Mohammadifard4, Nizal Sarrafzadegan5
1 Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
4 Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
5 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Submission||26-Aug-2019|
|Date of Decision||30-Aug-2019|
|Date of Acceptance||03-Sep-2019|
|Date of Web Publication||23-Dec-2019|
Prof. Alaleh Gheissari
Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib St, Isfahan
Source of Support: None, Conflict of Interest: None
Hypertension is one of the most common diseases worldwide. For many decades, it was considered as a problem related to adult population; however, its incidence in children has also been increased in recent years. Although secondary causes of hypertension are more common in children, few studies have been published focusing on the growing epidemic rate of essential hypertension in children and adolescents. Considering the importance of essential hypertension and its cardiovascular consequences, we review briefly its epidemiology and risk factors in children.
Keywords: Adolescent, cardiovascular disease, child, essential hypertension, obesity
|How to cite this article:|
Sabri M, Gheissari A, Mansourian M, Mohammadifard N, Sarrafzadegan N. Essential hypertension in children, a growing worldwide problem. J Res Med Sci 2019;24:109
|How to cite this URL:|
Sabri M, Gheissari A, Mansourian M, Mohammadifard N, Sarrafzadegan N. Essential hypertension in children, a growing worldwide problem. J Res Med Sci [serial online] 2019 [cited 2020 Feb 23];24:109. Available from: http://www.jmsjournal.net/text.asp?2019/24/1/109/273825
| Introduction|| |
Hypertension has been known not only as a common disease but also as one of the most prevalent human diseases, leading to high morbidity and mortality. About 10.4 million deaths were attributed to high systolic blood pressure as the leading risk factor of cardiovascular disease. In the past, hypertension and its harmful consequences were attributed to adult patients, and it was unusual in childhood and secondary to some disorders of the renal, endocrine, and cardiac.
One of the first reports on the prevalence of pediatric hypertension was published in 1963. Since then, many papers have been published regarding the prevalence and importance of hypertension in pediatric population.
While primary hypertension is more common in the adult population, secondary causes of hypertension are mostly found in children. Renal and renovascular diseases have their top position among identifiable causes of hypertension in children. Glomerulonephritis, reflux nephropathy, renal artery stenosis, and coarctation of the aorta followed by endocrine disorders are main causes of secondary hypertension in the pediatric population.,, Thus, in this paper, we aim to review the epidemiology of primary hypertension and its determinants including gender, obesity, lifestyles, and genetic factors in children and adolescents.
| Epidemiology|| |
In recent decades, an increase in primary hypertension in adolescents has been reported.,, The prevalence of essential hypertension in adolescents is different among diverse ethnicities from as low as 0.3% up to approximately 21%.,,,,,
Various factors such as obesity, diet, gender, and academic stress have been claimed as responsible causes in increasing the prevalence of primary hypertension in this age group.,,,
Some studies stated that essential hypertension is more common in boys than in girls. Sundar et al. reported a high rate of essential hypertension in boys, with a male/female ratio approximately equals to 3/1. In another survey, Mohan et al. showed that hypertension was more common in boys not only in urban but also in rural area of Ludhiana, India. A study by Buch et al. demonstrated slight increase in the prevalence of hypertension in boys aged older than 13 years compared to girls. However, the gender effect has not been supported by all similar studies.
Obesity and body mass index
Although the rising trend of obesity and mean body mass index (BMI) in high levels has been plateaued in high-income countries, it has enhanced rapidly in the south, east, and southeast of Asia. Growing rate of obesity changes the incidence of overweight-related problems such as hypertension in the world.,,,,
According to the results from the National Health and Nutrition Examination Survey between 1988 and 1994 and between 1999 and 2008, in parallel with increasing BMI, 3.4% and 4.4% rise in the prevalence of hypertension have been reported among boys and girls, respectively.
By various mechanisms including insulin resistance, activation of renin-angiotensin-aldosterone system (RAS), retention of salt, and consequent changes in vascular endothelial function, obesity induces hypertension.
A study on about 25,000 schoolchildren revealed a higher prevalence of hypertension in overweight and obese children in comparison to normal weight participants (17%–18% vs. 10%).
The rise of the population with hypertension has been shown not only in adolescents but even in children. Based on the electronic medical data from a cohort of 14,000 children and adolescents aged 3–18 years, a prevalence of 3.4% of hypertensive population was reported and the presence of obesity was accompanied by higher blood pressure.
Dietary patterns, physical activity, and stress have main roles in the incidence and prevention of hypertension in children and adolescents. A diet with high salt intake, saturated and trans-fatty acids, and low consumption of fruits and vegetables, nuts, and olive oil was associated with hypertension in both children and adults. Due to urbanization, children have more consumption of processed food and energy-dense diet, which cause obesity and consequently obesity-related hypertension in childhood. Sedentary lifestyle and poor sleep quality promote hypertension in children. Since the World Health Organization recommended to engage in moderate-to-vigorous physical activity for at least 1 h a day in childhood. Elevated blood pressure in schoolchildren and adolescents can be attributed to high stress, particularly academic stress, because of difficult curriculum in the school and educational competition.
Although excess weight is the main factor responsible for increasing rate of hypertension among adolescent, genetic, and family history, susceptibility should not be ignored.,
Gene polymorphism of RAS has been proposed as a risk factor for essential hypertension and its cardiovascular consequences.
Aldosterone synthase gene (CYP11B2) polymorphism evaluation in Japanese participants with essential hypertension showed a significant difference in the distribution of three genotypes (TT, TC, and CC) between the hypertensive and normotensive population.
A recent study in China demonstrated the higher risk of hypertension in children and adolescents with single-nucleotide polymorphism of ATP2B1 rs17249754.
In addition to RAS, endothelial nitric oxide gene polymorphism has been targeted as a possible genetic factor to contribute to developing essential hypertension. More frequency of one of the most applicable polymorphisms in the NOS3 gene (rs1799983 in exon 7) has been reported in Sudanese patients with essential hypertension than control group.
| Conclusion|| |
Concerning the growing rate of essential hypertension and its link to environmental, genetic, and anthropometric factors, assessing its prevalence and possible cardiovascular complications is necessary for every population and geographical area.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bromfield S, Muntner P. High blood pressure: the leading global burden of disease risk factor and the need for worldwide prevention programs. Curr Hypertens Rep 2013;15:134-6.
GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1923.
Sharma S, Meyers KE, Vidi SR. Secondary forms of hypertension in children: Overview. In: Flynn J, Ingelfinger JR, Redwine K, editors. Pediatric Hypertension. Cham: Springer International Publishing; 2016. p. 1-20.
Chiolero A, Bovet P, Paradis G, Paccaud F. Has blood pressure increased in children in response to the obesity epidemic? Pediatrics 2007;119:544-53.
Baracco R1, Kapur G, Mattoo T, Jain A, Valentini R, Ahmed M, et al
. Prediction of primary vs secondary hypertension in children. J Clin Hypertens (Greenwich). 2012;14:316-21.
Charles L, Triscott J, Dobbs B. Secondary hypertension: discovering the underlying cause. Am Fam Physician 2017;96:453-46.
Stein DR, Ferguson MA. Evaluation and treatment of hypertensive crises in children. Integr Blood Press Control 2016;9:49-58.
Wühl E. Hypertension in childhood obesity. Acta Paediatr 2019;108:37-43.
Sundar JS, Adaikalam JM, Parameswari S, Valarmarthi S, Kalpana S, Shantharam D, et al
. Prevalence and determinants of hypertension among urban school children in the age group of 13- 17 years in, Chennai, Tamilnadu. Epidemiol 2013;3:3-5.
Bell CS, Samuel JP, Samuels JA. Prevalence of hypertension in children. Hypertension 2019;73:148-52.
Gupta R. Trends in hypertension epidemiology in India. J Hum Hypertens 2004;18:3-8.
Sharma A, Grover N, Kaushik S, Bhardwaj R, Sankhyan N. Prevalence of hypertension among school children in Shimla. Indian Pediatr 2010;47:873-6.
Rao G. Diagnosis, epidemiology, and management of hypertension in children. Pediatrics 2016;138. pii: e20153616.
Ewald DR, Haldeman LA. Risk factors in adolescent hypertension. Glob Pediatr Health 2016;3:2333794X15625159.
Raj M. Essential hypertension in adolescents and children: Recent advances in causative mechanisms. Indian J Endocrinol Metab 2011 Suppl 4:S367-73.
Mohan B, Kumar N, Aslam N, Rangbulla A, Kumbkarni S, Sood NK, et al.
Prevalence of sustained hypertension and obesity in urban and rural school going children in Ludhiana. Indian Heart J 2004;56:310-4.
Buch N, Goyal JP, Kumar N, Parmar I, Shah VB, Charan J. Prevalence of hypertension in school going children of Surat city, Western India. J Cardiovasc Dis Res 2011;2:228-32.
] [Full text]
Papandreou DA, Stamou MA, Malindretos PB, Rousso IA, Mavromichalis I. Prevalence of hypertension and association of dietary mineral intake with blood pressure in healthy schoolchildren from Northern Greece aged 7–15 years. Ann Nutr Metab 2007;51:471-6.
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 2017;390:2627-42.
Din-Dzietham R, Liu Y, Bielo MV, Shamsa F. High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation 2007;116:1488-96.
Harris K, Benoit G, Dionne J, Feber J, Cloutier L, Zarnke K et al.
Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, and Assessment of Risk of Pediatric Hypertension. Can J Cardiol 2016;32:589e597.
Kelly RK, Magnussen CG, Sabin MA, Cheung M, Juonala M. Development of hypertension in overweight adolescents: a review. Adolesc Health Med Ther 2015;6:171-8.
Rosner B, Cook NR, Daniels S, Falkner B. Childhood blood pressure trends and risk factors for high blood pressure: the NHANES experience 1988-2008. Hypertension 2013;62:247-54.
Kotchen TA. Obesity-related hypertension: Epidemiology, pathophysiology, and clinical management. Am J Hypertens 2010;23:1170-8.
Raj M, Sundaram KR, Paul M, Deepa AS, Kumar RK. Obesity in Indian children: Time trends and relationship with hypertension. Natl Med J India 2007;20:288-93.
Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA 2007;298:874-9.
Giontella A, Bonafini S, Tagetti A, Bresadola I, Minuz P, Gaudino R, et al.
Relation between dietary habits, physical activity, and anthropometric and vascular parameters in children attending the primary school in the Verona south district. Nutrients 2019;11:14.
Casas R, Castro-Barquero S, Estruch R, Sacanella E. Nutrition and Cardiovascular Health. Int J Mol Sci 2018;19:3988.
World Health Organization. Commission on ending childhood obesity. Report of the Commission on Ending Childhood Obesity. Geneva, Switzerland: World Health Organization; 2016.
Ambrosini GL. Childhood dietary patterns and later obesity: A review of the evidence. Proc Nutr Soc 2014;73:137-46.
World Health Organization. Information Sheet: Global Recommendations on Physical Activity for Health 5-17 Years Old. Geneva, Switzerland: World Health Organization; 2015.
Arun DJ, Kavinilavu R. A study of risk factors associated with hypertension among the school going children in Puducherry. Int J Community Med Public Health 2018;5:764-8.
Solanki JD, Mehta HB, Shah CJ. Pulse wave analyzed cardiovascular parameters in young first degree relatives of hypertensives. J Res Med Sci 2018;23:72.
] [Full text]
Ji X, Qi H, Li DB, Liu RK, Zheng Y, Chen HL, et al
. Associations between human aldosterone synthase CYP11B2 (-344T/C) gene polymorphism and antihypertensive response to valsartan in Chinese patients with essential hypertension. Int J Clin Exp Med 2015;8:1173-7.
Xi B, Shen Y, Zhao X, Chandak GR, Cheng H, Hou D, et al.
Association of common variants in/near six genes (ATP2B1, CSK, MTHFR, CYP17A1, STK39 and FGF5) with blood pressure/hypertension risk in Chinese children. J Hum Hypertens 2014;28:32-6.
Gamil S, Erdmann J, Abdalrahman IB, Mohamed AO. Association of NOS3 gene polymorphisms with essential hypertension in Sudanese patients: a case control study. BMC Med Gen 2017;18:128.