MEDICC Rev. 2019 Apr-Jul;21(2-3):10-15. doi: 10.37757/MR2019.V21.N2-3.4.
INTRODUCTION Hypertension is one of the most studied risk factors for cardiovascular disease in adults; in children and adolescents, its global prevalence changes with age, from 1%-3% in children to 3.2% in adolescents. In adults, in addition to hypertension, several biochemical markers of cardiovascular risk have been identified. Confirming an association between these and hypertension in childhood and adolescence would allow for more timely diagnosis and monitoring of cardiovascular disease, since the presence of both the markers and hypertension would imply increased risk. OBJECTIVE Confirm an association between biochemical risk markers of cardiovascular disease and hypertension in children aged 8 to 11 years. METHODS A cross-sectional study of 373 children aged 8-11 years was conducted in 3 primary schools in the city of Santa Clara in central Cuba. The variables examined were age, sex, height, blood pressure, cholesterol, triglycerides, lipoproteins and apolipoproteins. The children were classified as normotensive, prehypertensive or hypertensive, based on blood pressure readings and percentiles for age, sex and height. Descriptive statistics were calculated for quantitative variables. A bivariate analysis, tests of independence for qualitative variables and a means comparison for quantitative variables (ANOVA and its nonparametric alternative, the Kruskal Wallis test) were performed. Fisher's F-test and its associated probability value were employed. RESULTS Some 32.2% of the children were prehypertensive and 5.1% hypertensive. Cholesterol and triglyceride values were significantly higher in hypertensive than in normotensive children (p = 0.028 and p = 0.047, respectively). HDL numbers were higher in normotensive children (p =0.001), and LDL numbers and the LDL/HDL ratio were higher in the hypertensive children, with differences between groups (p = 0.001 for both variables). There were differences between the three blood pressure categories for lipoprotein(a) and ApoA (p <0.001 and p = 0.001), for ApoB and for the ApoB/ApoA ratio (p <0.001 for both variables), with lower ApoA values and higher ApoB and ApoB/ApoA values in the hypertensive children. CONCLUSIONS The biochemical risk markers most strongly associated with hypertension in children are ApoB values, LDL, lipoprotein(a), and LDL/HDL and ApoB/ApoA ratios. KEYWORDS Adolescent, child, hypertension, apolipoproteins, cardiovascular diseases, risk factors, Cuba.
简介 高血压是成年人中研究最多的心血管疾病风险因素之一；在儿童和青少年中，其全球患病率随年龄变化，从儿童的 1%-3%到青少年的 3.2%。在成年人中，除了高血压，还确定了一些心血管风险的生化标志物。如果能证实这些标志物与儿童和青少年期的高血压之间存在关联，就可以更及时地诊断和监测心血管疾病，因为这些标志物和高血压的存在都意味着风险增加。 目的 证实 8 至 11 岁儿童的心血管疾病生化风险标志物与高血压之间存在关联。 方法 在古巴中部圣克拉拉市的 3 所小学中进行了一项 373 名 8-11 岁儿童的横断面研究。所检查的变量包括年龄、性别、身高、血压、胆固醇、甘油三酯、脂蛋白和载脂蛋白。根据血压读数和年龄、性别和身高的百分位值，将儿童分为血压正常、前期高血压或高血压。对定量变量进行描述性统计。进行了双变量分析、定性变量的独立性检验和定量变量的均值比较（方差分析及其非参数替代，克鲁斯卡尔-沃利斯检验）。采用 Fisher F 检验及其相关概率值。 结果 约 32.2%的儿童处于前期高血压状态，5.1%的儿童患有高血压。高血压儿童的胆固醇和甘油三酯值明显高于血压正常的儿童（p=0.028 和 p=0.047）。血压正常的儿童的 HDL 数量较高（p=0.001），而高血压儿童的 LDL 数量和 LDL/HDL 比值较高，两组之间存在差异（p=0.001，均为这两个变量）。在三个血压类别中，脂蛋白(a)和 ApoA 的差异具有统计学意义（p<0.001 和 p=0.001），ApoB 和 ApoB/ApoA 比值也具有统计学意义（p<0.001，均为这两个变量），高血压儿童的 ApoA 值较低，ApoB 和 ApoB/ApoA 值较高。 结论 在儿童中与高血压关联最密切的生化风险标志物是 ApoB 值、LDL、脂蛋白(a)、LDL/HDL 和 ApoB/ApoA 比值。 关键词 青少年、儿童、高血压、载脂蛋白、心血管疾病、危险因素、古巴。
