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High hypertension prevalence and the relationship of body mass index (BMI) to blood pressure in ethnic minority children
14A
ORALS: Can We Predict and Prevent Hypertension?
O-29 HIGH HYPERTENSION PREVALENCE AND THE RELATIONSHIP OF BODY MASS INDEX (BMI) TO BLOOD PRESSURE IN ETHNIC MINORITY CHILDREN Jonathan M. Sorof, Mona A. Eissa, Lillian Bernard, Ronald J. Portman. 1Pediatrics, University of Texas-Houston Medical School, Houston, TX, United States,2Nursing, Prairie View A&M University College of Nursing, Houston, TX, United States Cardiovascular risk factors such as hypertension are reported to be increasing in children. To determine the prevalence of hypertension and the relationship between BMI (kg/m2) and BP in predominantly ethnic minority children, school-based BP and obesity screening was performed in 1659 students in 6 urban public schools. On the 1st screening visit, weight, height, and 3 BP measurements were performed. Students with elevated BP at 1st screening underwent 3 BP measurements at a 2nd screening 1-2 weeks later. Elevated BP was defined as average BP greater than the 90th percentile by the Task Force Report on High Blood Pressure in Children, and Hypertension was defined as average BP greater than the 95th percentile. To control for gender, age and heightrelated differences in BP, a BP index was derived by dividing each student’s average screening BP by his/her Task Force specific 95th percentile BP (i.e., BP index 1.1⫽10% above the 95th percentile). Mean student age was 15 ⫹/-1.3 yrs, gender was 48% male, and ethnicity was 58% Hisp, 32% AA, and 7% white. At 1st screening, 24% of students had elevated BP and 17% had hypertension. Specifically, 16% of students had SBP hypertension (with or without DBP hypertension) and 2% had DBP hypertension (with or without SBP hypertension). Hypertension at 1st screening was more prevalent in males (21%) than females (14%), and in Hisp (18%) and AA (18%) than in whites (7%)(p⬍0.001). At the 2nd screening visit, persistent hypertension was found in 55% of the students with elevated BP at 1st screening. After 2 sets of screening measurements, the overall estimated prevalence of hypertension was 13%. Among all students, BMI correlated significantly with both SBP index (r⫽0.36) and DBP index (r⫽0.13). The correlation between BMI and SBP index, but not DBP index, was significant even when the analysis was restricted to students whose BMI was in the normal range (i.e., less than 25 kg/m2 ). These results confirm a higher prevalence of hypertension in children than has been previously reported, most notably among ethnic minorities. As reported in adults, SBP elevation accounted for the majority of the hypertension. Increased BMI was a significant and independent contributing factor to SBP elevation even in students with normal body habitus. These data demonstrate that pediatric hypertension is becoming more prevalent and suggest that an epidemic of cardiovascular disease may be approaching. Key Words: Child, Hypertension, Epidemiology
O-30 PREDICTORS OF CARDIOVASCULAR EVENTS IN 9,194 HYPERTENSIVE PATIENTS WITH LEFT VENTRICULAR HYPERTROPHY. THE LIFE STUDY Sverre E. Kjeldsen, Bjo¨rn Dahlo˝f, Richard B. Devereux, Stevo Julius, Ulf de Faire, Frej Fyhrquist, Hans Ibsen, Krister Kristianson, Ole Lederballe-Pedersen, Lars H. Lindholm, Markku S. Nieminen, Per Omvik, Suzanne Oparil, Hans Wedel, the LIFE Study Group. 1Ullevaal University Hospital, Oslo, Norway 1. The Losartan Intervention For Endpoints (LIFE) reduction in hypertension study is a randomized, double-blind, prospective trial that compares the effect of losartan with those of atenolol on the reduction of cardiovascular (CV) complications in patients (n⫽9,194) with essential hypertension and electrocardiographically (ECG) documented left ven0895-7061/01/$20.00
AJH–April 2001–VOL. 14, NO. 4, PART 2
tricular hypertrophy (LVH). Baseline blood pressure (BP) was 174.4/ 97.8 (mean), age 66.9 years and 54% of participants were women. BP decreased to 150.5/85.1 mmHg after 12 months and 148.5/83.9 mmHg after 24 months. 2. We assessed clinical and demographic variables at baseline as predictors of the first 694 primary composite endpoints, i.e. approximately 2/3 of the endpoints needed to conclude the study. Primary events were defined as cardiovascular death, myocardial infarction and stroke. 3. Stepwise multivariate analysis identified the following significant predictors: Variable
Chi-square value Hazard ratio p-value
Age (per year) Smoking (category) Diabetes Prior stroke Serum cholesterol (per unit) Prior coronary heart disease Gender (men) Exercise (category) Prior number of antihypertensives History of hypercholesterolemia Serum creatinine (per unit) Serum uric acid (per unit) Body mass index
89.6 50.2 33.8 24.0 21.9 19.6 16.5 9.3 7.6 7.5 6.9 6.3 4.6
1.060 1.220 1.758 1.681 1.186 1.490 1.431 0.866 1.124 0.758 1.005 1.001 0.981
⬍0.0001 ⬍0.0001 ⬍0.0001 ⬍0.0001 ⬍0.0001 ⬍0.0001 ⬍0.0001 ⫽0.002* ⫽0.006 ⫽0.006* ⫽0.008 ⫽0.012 ⫽0.032*
*Inversely related risk.
4. Thus, in a large sample of patients with ECG-LVH being treated for hypertension in a large randomized outcome trial, it was possible to identify a number of clinical and demographic baseline variables that predict serious CV events. Beyond increasing age, increased CV risk is related to smoking, previous CV disease, diabetes, cholesterol, male gender, serum creatinine, and uric acid, while exercise is inversely related to risk. Grant/Research Support: Merck Key Words: Atenolol, Left ventricular hypertrophy, Losartan
O-31 CARDIAC REMODELING PRECEDES CLINICAL HYPERTENSION IN OFFSPRING OF HYPERTENSIVE PARENTS. THE BERGEN BLOOD PRESSURE STUDY Eva Gerdts, Per Omvik, Rune Mo, Per Lund-Johansen. 1Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Previous studies in offspring of hypertensive families have suggested a predisposition both to hypertension and left ventricular (LV) remodeling. However, it is still not clear whether the cardiac changes are due to genetic predisposition or secondary to hypertension. Methods: To further explore this matter we performed Doppler echocardiography on 24 offspring of hypertensive families and 16 offspring of normotensive families in whom the parental blood pressure had been monitored in the Bergen Blood Pressure Study for 27 years. Hypertension was defined as treated hypertension or a casual blood pressure ⬎ 140/90 mmHg. Offspring of normotensive families were all normotensive (Group 1). Among the offspring of hypertensive families 11 persons were normotensive (Group 2) and 13 persons hypertensive (Group 3). Results: The results are given in the table. Irrespective of hypertension, offspring of hypertensive families had smaller left ventricular enddiastolic diameter (LVIDD), lower E/A ratio, higher atrial filling fraction (AFF) and higher wallstress (all p⬍ 0.01). They also tended to have higher relative wall thickness (RWT)and smaller LV end-systolic diameter (LVIDS)(both p⫽0.08). LV remodeling was only seen in offspring of hypertensive families, while LV hypertrophy (LVH) was present also in 3 persons in group 1 (all athletes). Conclusions: Offspring of hypertensive families have echocardiographic evidence of concentric LV remodeling irrespective of the pres© 2001 by the American Journal of Hypertension, Ltd. Published by Elsevier Science Inc.
ORALS: Can We Predict and Prevent Hypertension?
O-29 HIGH HYPERTENSION PREVALENCE AND THE RELATIONSHIP OF BODY MASS INDEX (BMI) TO BLOOD PRESSURE IN ETHNIC MINORITY CHILDREN Jonathan M. Sorof, Mona A. Eissa, Lillian Bernard, Ronald J. Portman. 1Pediatrics, University of Texas-Houston Medical School, Houston, TX, United States,2Nursing, Prairie View A&M University College of Nursing, Houston, TX, United States Cardiovascular risk factors such as hypertension are reported to be increasing in children. To determine the prevalence of hypertension and the relationship between BMI (kg/m2) and BP in predominantly ethnic minority children, school-based BP and obesity screening was performed in 1659 students in 6 urban public schools. On the 1st screening visit, weight, height, and 3 BP measurements were performed. Students with elevated BP at 1st screening underwent 3 BP measurements at a 2nd screening 1-2 weeks later. Elevated BP was defined as average BP greater than the 90th percentile by the Task Force Report on High Blood Pressure in Children, and Hypertension was defined as average BP greater than the 95th percentile. To control for gender, age and heightrelated differences in BP, a BP index was derived by dividing each student’s average screening BP by his/her Task Force specific 95th percentile BP (i.e., BP index 1.1⫽10% above the 95th percentile). Mean student age was 15 ⫹/-1.3 yrs, gender was 48% male, and ethnicity was 58% Hisp, 32% AA, and 7% white. At 1st screening, 24% of students had elevated BP and 17% had hypertension. Specifically, 16% of students had SBP hypertension (with or without DBP hypertension) and 2% had DBP hypertension (with or without SBP hypertension). Hypertension at 1st screening was more prevalent in males (21%) than females (14%), and in Hisp (18%) and AA (18%) than in whites (7%)(p⬍0.001). At the 2nd screening visit, persistent hypertension was found in 55% of the students with elevated BP at 1st screening. After 2 sets of screening measurements, the overall estimated prevalence of hypertension was 13%. Among all students, BMI correlated significantly with both SBP index (r⫽0.36) and DBP index (r⫽0.13). The correlation between BMI and SBP index, but not DBP index, was significant even when the analysis was restricted to students whose BMI was in the normal range (i.e., less than 25 kg/m2 ). These results confirm a higher prevalence of hypertension in children than has been previously reported, most notably among ethnic minorities. As reported in adults, SBP elevation accounted for the majority of the hypertension. Increased BMI was a significant and independent contributing factor to SBP elevation even in students with normal body habitus. These data demonstrate that pediatric hypertension is becoming more prevalent and suggest that an epidemic of cardiovascular disease may be approaching. Key Words: Child, Hypertension, Epidemiology
O-30 PREDICTORS OF CARDIOVASCULAR EVENTS IN 9,194 HYPERTENSIVE PATIENTS WITH LEFT VENTRICULAR HYPERTROPHY. THE LIFE STUDY Sverre E. Kjeldsen, Bjo¨rn Dahlo˝f, Richard B. Devereux, Stevo Julius, Ulf de Faire, Frej Fyhrquist, Hans Ibsen, Krister Kristianson, Ole Lederballe-Pedersen, Lars H. Lindholm, Markku S. Nieminen, Per Omvik, Suzanne Oparil, Hans Wedel, the LIFE Study Group. 1Ullevaal University Hospital, Oslo, Norway 1. The Losartan Intervention For Endpoints (LIFE) reduction in hypertension study is a randomized, double-blind, prospective trial that compares the effect of losartan with those of atenolol on the reduction of cardiovascular (CV) complications in patients (n⫽9,194) with essential hypertension and electrocardiographically (ECG) documented left ven0895-7061/01/$20.00
AJH–April 2001–VOL. 14, NO. 4, PART 2
tricular hypertrophy (LVH). Baseline blood pressure (BP) was 174.4/ 97.8 (mean), age 66.9 years and 54% of participants were women. BP decreased to 150.5/85.1 mmHg after 12 months and 148.5/83.9 mmHg after 24 months. 2. We assessed clinical and demographic variables at baseline as predictors of the first 694 primary composite endpoints, i.e. approximately 2/3 of the endpoints needed to conclude the study. Primary events were defined as cardiovascular death, myocardial infarction and stroke. 3. Stepwise multivariate analysis identified the following significant predictors: Variable
Chi-square value Hazard ratio p-value
Age (per year) Smoking (category) Diabetes Prior stroke Serum cholesterol (per unit) Prior coronary heart disease Gender (men) Exercise (category) Prior number of antihypertensives History of hypercholesterolemia Serum creatinine (per unit) Serum uric acid (per unit) Body mass index
89.6 50.2 33.8 24.0 21.9 19.6 16.5 9.3 7.6 7.5 6.9 6.3 4.6
1.060 1.220 1.758 1.681 1.186 1.490 1.431 0.866 1.124 0.758 1.005 1.001 0.981
⬍0.0001 ⬍0.0001 ⬍0.0001 ⬍0.0001 ⬍0.0001 ⬍0.0001 ⬍0.0001 ⫽0.002* ⫽0.006 ⫽0.006* ⫽0.008 ⫽0.012 ⫽0.032*
*Inversely related risk.
4. Thus, in a large sample of patients with ECG-LVH being treated for hypertension in a large randomized outcome trial, it was possible to identify a number of clinical and demographic baseline variables that predict serious CV events. Beyond increasing age, increased CV risk is related to smoking, previous CV disease, diabetes, cholesterol, male gender, serum creatinine, and uric acid, while exercise is inversely related to risk. Grant/Research Support: Merck Key Words: Atenolol, Left ventricular hypertrophy, Losartan
O-31 CARDIAC REMODELING PRECEDES CLINICAL HYPERTENSION IN OFFSPRING OF HYPERTENSIVE PARENTS. THE BERGEN BLOOD PRESSURE STUDY Eva Gerdts, Per Omvik, Rune Mo, Per Lund-Johansen. 1Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Previous studies in offspring of hypertensive families have suggested a predisposition both to hypertension and left ventricular (LV) remodeling. However, it is still not clear whether the cardiac changes are due to genetic predisposition or secondary to hypertension. Methods: To further explore this matter we performed Doppler echocardiography on 24 offspring of hypertensive families and 16 offspring of normotensive families in whom the parental blood pressure had been monitored in the Bergen Blood Pressure Study for 27 years. Hypertension was defined as treated hypertension or a casual blood pressure ⬎ 140/90 mmHg. Offspring of normotensive families were all normotensive (Group 1). Among the offspring of hypertensive families 11 persons were normotensive (Group 2) and 13 persons hypertensive (Group 3). Results: The results are given in the table. Irrespective of hypertension, offspring of hypertensive families had smaller left ventricular enddiastolic diameter (LVIDD), lower E/A ratio, higher atrial filling fraction (AFF) and higher wallstress (all p⬍ 0.01). They also tended to have higher relative wall thickness (RWT)and smaller LV end-systolic diameter (LVIDS)(both p⫽0.08). LV remodeling was only seen in offspring of hypertensive families, while LV hypertrophy (LVH) was present also in 3 persons in group 1 (all athletes). Conclusions: Offspring of hypertensive families have echocardiographic evidence of concentric LV remodeling irrespective of the pres© 2001 by the American Journal of Hypertension, Ltd. Published by Elsevier Science Inc.