Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, 181 Longwood Ave, Boston, MA 02115, USA.
Hypertension. 2013 Aug;62(2):247-54. doi: 10.1161/HYPERTENSIONAHA.111.00831. Epub 2013 Jul 15.
The obesity epidemic in children makes it plausible that prevalence rates of elevated blood pressure (BP) are increasing over time. Yet, previous literature is inconsistent because of small sample sizes. Also, it is unclear whether adjusting for risk factors can explain longitudinal trends in prevalence of elevated BP. Thus, we analyzed a population-based sample of 3248 children in National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and 8388 children in continuous NHANES (1999-2008), aged 8 to 17 years. Our main outcome measure was elevated BP (systolic BP or diastolic BP ≥ 90th percentile or systolic BP/diastolic BP ≥ 120/80 mm Hg). We found that the prevalence of elevated BP increased from NHANES III to NHANES 1999-2008 (Boys: 15.8% to 19.2%, P=0.057; Girls: 8.2% to 12.6%, P=0.007). Body mass index (Q4 versus Q1; odds ratio=2.00; P<0.001), waist circumference (Q4 versus Q1; odds ratio=2.14; P<0.001), and sodium (Na) intake (≥ 3450 mg versus <2300 mg/2000 calories; odds ratio=1.36; P=0.024) were independently associated with prevalence of elevated BP. Also, mean systolic BP, but not diastolic BP, was associated with increased Na intake in children (quintile 5 [Q5] versus quintile 1 [Q1] of Na intake; β=1.25 ± 0.58; P=0.034). In conclusion, we demonstrate an association between high Na intake and elevated BP in children. After adjustment for age, sex, race/ethnicity, body mass index, waist circumference, and sodium intake, odds ratio for elevated BP in NHANES 1999-2008 versus NHANES III=1.27, P=0.069.
儿童肥胖症的流行使得血压升高的患病率随着时间的推移而增加的可能性变得合理。然而，由于样本量小，之前的文献并不一致。此外，调整风险因素是否可以解释血压升高的患病率的纵向趋势尚不清楚。因此，我们分析了美国国家健康和营养调查（NHANES）III（1988-1994 年）中的 3248 名儿童和连续 NHANES（1999-2008 年）中的 8388 名儿童的基于人群的样本，年龄在 8 至 17 岁之间。我们的主要观察指标是血压升高（收缩压或舒张压≥第 90 百分位数或收缩压/舒张压≥120/80mmHg）。我们发现，从 NHANES III 到 NHANES 1999-2008 年，血压升高的患病率有所增加（男孩：15.8%至 19.2%，P=0.057；女孩：8.2%至 12.6%，P=0.007）。体重指数（Q4 与 Q1；比值比=2.00；P<0.001）、腰围（Q4 与 Q1；比值比=2.14；P<0.001）和钠（Na）摄入量（≥3450mg 与<2300mg/2000 卡路里；比值比=1.36；P=0.024）与血压升高的患病率独立相关。此外，在儿童中，平均收缩压而不是舒张压与 Na 摄入量的增加相关（Na 摄入量的第 5 个五分位数[Q5]与第 1 个五分位数[Q1]；β=1.25±0.58；P=0.034）。总之，我们证明了高 Na 摄入量与儿童血压升高之间存在关联。在调整年龄、性别、种族/民族、体重指数、腰围和钠摄入量后，NHANES 1999-2008 与 NHANES III 相比，血压升高的比值比为 1.27，P=0.069。
