Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan.
Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California.
J Adolesc Health. 2021 Jul;69(1):127-133. doi: 10.1016/j.jadohealth.2020.10.025. Epub 2020 Dec 4.
Hypertension (HTN) is associated with increased cardiovascular risk and unhealthy lifestyles in adults. However, data on both physiological and lifestyle factors associated with abnormal blood pressure (BP) in adolescents, as well as the effectiveness of interventions in improving these factors among adolescents with abnormal BP, is scarce.
Students enrolled in a middle-school-based wellness program, Project Healthy Schools (PHS), between 2005-2016 were eligible. Three systolic (SBP) and diastolic (DBP) BP measurements were taken pre-PHS and post-PHS; averages of the final two were analyzed. Students were grouped by baseline BP: abnormal BP (≥90th percentile for SBP and/or DBP, or ≥120/80 mmHg) or normal BP (<90th percentile for SBP and/or DBP, or <120/80 mmHg). Demographics, physiologic measures, and health behaviors were compared between groups pre- and post-PHS.
Of 2,865 students, 812 (28.3%) had abnormal BP. Median SBP was 119 mmHg in abnormal BP students and 103 mmHg in normal BP students (p < .001). Females were less likely to have abnormal BP than males (48.4% vs. 51.6%, p < .01). Pre-PHS, abnormal BP students were more likely to be overweight (62.3% vs. 28.2%, p < .001) or obese (38.9% vs. 11.3%, p < .001) than normal BP students. Their total cholesterol, triglycerides, random glucose, resting, and recovery heart rates were also higher, and they had worse dietary and sedentary habits. Post-PHS, abnormal BP students demonstrated greater reduction in SBP (-4.0 vs. 2.8 mmHg, p < .001) and DBP (-3.3 vs. .8 mmHg, p < .001) than normal BP students.
Abnormal BP was prevalent and associated with worse cardiometabolic health parameters and behaviors at baseline. Abnormal BP students demonstrated significant improvements in BP post-PHS, suggesting school-based programs may be effective as nonpharmacological lifestyle interventions in this population.
高血压（HTN）与成年人的心血管风险增加和不健康的生活方式有关。然而，关于青少年中与异常血压相关的生理和生活方式因素，以及改善异常血压青少年这些因素的干预措施的有效性的数据还很缺乏。
符合条件的是在 2005-2016 年期间参加基于中学的健康计划“健康学校项目”（PHS）的学生。在 PHS 之前和之后进行了三次收缩压（SBP）和舒张压（DBP）血压测量；分析最后两次的平均值。根据基线血压将学生分为两组：异常血压（SBP 和/或 DBP 的第 90 百分位以上，或≥120/80mmHg）或正常血压（SBP 和/或 DBP 的第 90 百分位以下，或<120/80mmHg）。在 PHS 前后比较两组之间的人口统计学、生理指标和健康行为。
在 2865 名学生中，812 名（28.3%）有异常血压。异常血压学生的 SBP 中位数为 119mmHg，正常血压学生的 SBP 中位数为 103mmHg（p<0.001）。女性异常血压的可能性低于男性（48.4%比 51.6%，p<0.01）。PHS 之前，异常血压学生超重（62.3%比 28.2%，p<0.001）或肥胖（38.9%比 11.3%，p<0.001）的可能性高于正常血压学生。他们的总胆固醇、甘油三酯、随机血糖、静息和恢复心率也较高，且饮食习惯和久坐习惯较差。PHS 后，异常血压学生的 SBP 降低更明显（-4.0 比-2.8mmHg，p<0.001）和 DBP 降低更明显（-3.3 比.8mmHg，p<0.001）。
异常血压很常见，且与基线时较差的心血管代谢健康参数和行为有关。异常血压学生在 PHS 后血压显著改善，表明基于学校的计划可能是该人群非药物生活方式干预的有效方法。
