Din-Dzietham Rebecca, Liu Yong, Bielo Marie-Vero, Shamsa Falah
Morehouse School of Medicine, Social Epidemiology Research Center, 520 Westview Dr SW, NCPC-315, Atlanta, GA 30310-1495, USA.
Circulation. 2007 Sep 25;116(13):1488-96. doi: 10.1161/CIRCULATIONAHA.106.683243. Epub 2007 Sep 10.
Secular trend data on hypertension in children and adolescents are scarce and inconsistent. In the face of growing obesity, we sought to assess high blood pressure (HBP) secular trends in children and adolescents enrolled in national surveys and to determine whether the HBP trend reversed its course with the rise in obesity.
National survey data obtained from multistage probability sampling of the US noninstitutionalized population from 1963 to 2002 were examined; 8- to 17-year-old non-Hispanic blacks and whites and Mexican Americans were included. HBP ascertainment was based on age-, gender-, and height percentile-specific systolic and diastolic BPs. Weighted analyses were performed to account for the complex design. The BP, pre-HBP, and HBP trends were downward from 1963 to 1988 and upward thereafter. Pre-HBP and HBP increased 2.3% (P=0.0003) and 1% (P=0.17), respectively, between 1988 and 1999. Obesity increase, more so abdominal than general obesity, partially explained the rise in HBP and pre-HBP from 1988 to 1999. BP and HBP reversed their downward trends 10 years after the increase in the prevalence of obesity. Additionally, an ethnic and gender gap appeared in 1988 for pre-HBP and in 1999 for HBP; non-Hispanic blacks and Mexican Americans had a greater prevalence of HBP and pre-HBP than non-Hispanic whites, and males had a greater prevalence than females.
HBP and pre-HBP in children and adolescents are on the rise. These new findings have implications for the cardiovascular disease public health burden, particularly the risk of a new cardiovascular disease transition. They reinforce the urgent call for early prevention of obesity and HBP and illustrate racial/ethnic disparities in this age group.
关于儿童和青少年高血压的长期趋势数据稀缺且不一致。面对日益增加的肥胖问题，我们试图评估参加全国性调查的儿童和青少年的高血压长期趋势，并确定随着肥胖率上升，高血压趋势是否发生逆转。
研究分析了1963年至2002年从美国非机构化人群多阶段概率抽样获得的全国性调查数据；纳入了8至17岁的非西班牙裔黑人和白人以及墨西哥裔美国人。高血压的确定基于年龄、性别和身高百分位数特定的收缩压和舒张压。进行加权分析以考虑复杂的设计。1963年至1988年期间血压、高血压前期和高血压趋势呈下降趋势，此后呈上升趋势。1988年至1999年期间，高血压前期和高血压分别增加了2.3%（P = 0.0003）和1%（P = 0.17）。肥胖增加，尤其是腹型肥胖而非全身肥胖，部分解释了1988年至1999年期间高血压和高血压前期的上升。肥胖患病率上升10年后，血压和高血压趋势逆转了下降趋势。此外，1988年高血压前期出现了种族和性别差距，1999年高血压出现了种族和性别差距；非西班牙裔黑人和墨西哥裔美国人的高血压和高血压前期患病率高于非西班牙裔白人，男性患病率高于女性。
儿童和青少年的高血压和高血压前期呈上升趋势。这些新发现对心血管疾病的公共卫生负担有影响，特别是新的心血管疾病转变风险。它们强化了早期预防肥胖和高血压的迫切呼吁，并说明了该年龄组的种族/民族差异。
