Levy Rebecca V, Brathwaite Kaye E, Sarathy Harini, Reidy Kimberly, Kaskel Frederick J, Melamed Michal L
Division of Pediatric Nephrology, Department of Pediatrics, Montefiore Medical Center, Bronx, New York.
Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.
JAMA Netw Open. 2021 Feb 1;4(2):e2037936. doi: 10.1001/jamanetworkopen.2020.37936.
Hypertension is a leading cause of cardiovascular disease in adults; preclinical associations between hypertension and cardiovascular disease are seen in childhood. Nicotine is a known toxin, but its association with pediatric hypertension is unclear.
To test the hypothesis that tobacco exposure is associated with the presence of elevated blood pressure in US children and adolescents and that this association is dose dependent.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the 2007 to 2016 National Health and Nutrition Examination Survey (NHANES), a population-based nationally representative sample of US children and adolescents. Children were eligible if they were aged 8 to 19 years at the time of participation in the main NHANES study. Exclusion criteria included those of the main NHANES study, inability to complete testing, or missing questionnaires. Of the 10 143 participants in NHANES aged 8 to 19 during the study years, 8520 were included in the analysis. Analysis was conducted from October 12, 2019, to July 9, 2020.
Tobacco exposure, defined as serum cotinine levels greater than 0.05 µg/L, or reporting living with a smoker or smoking themselves.
Elevated blood pressure, classified as greater than 90% for a child's age, sex, and height according to the 2017 American Academy of Pediatrics Clinical Practice Guidelines. The a priori hypothesis that there is a positive association between tobacco exposure and elevated blood pressure in the study population was tested. Analysis included logistic regression with adjustment for possible confounders. Subgroup and sensitivity analyses were conducted.
A total of 8520 children were included in the analysis, representing 41 million US children. The mean (SD) age of the participants was 13.1 (0.05) years, 51% (95% CI, 49%-52%) were male, and 58% (95% CI, 54%-62%) were non-Hispanic White individuals. Participants with any tobacco smoke exposure were more likely than those without exposure to be older (mean [SD] age, 13.3 [0.07] years vs 12.8 [0.06] years), male (53% [95% CI, 51%-55%] vs 49% [95% CI, 47%-50%]), and non-Hispanic Black individuals (19% [95% CI, 16%-22%] vs 10% [95% CI, 8%-12%]). The odds of having elevated blood pressure was 1.31 (95% CI, 1.06-1.61) for any tobacco exposure after adjustment; odds were similar across subgroups and remained significant in multiple sensitivity analyses.
This study suggests that tobacco exposure is associated with elevated blood pressure in US children and adolescents. This modifiable risk factor represents a target for further research into reducing hypertension in children and adolescents.
高血压是成人心血管疾病的主要病因；高血压与心血管疾病在儿童期就存在临床前关联。尼古丁是一种已知毒素，但其与儿童高血压的关联尚不清楚。
检验烟草暴露与美国儿童及青少年血压升高相关且这种关联呈剂量依赖性这一假设。
设计、设置和参与者：这项横断面研究使用了2007年至2016年国家健康与营养检查调查（NHANES）的数据，这是一个基于人群的具有全国代表性的美国儿童及青少年样本。参与主要NHANES研究时年龄在8至19岁的儿童符合条件。排除标准包括主要NHANES研究的排除标准、无法完成检测或问卷缺失。在研究期间NHANES年龄在8至19岁的10143名参与者中，8520名被纳入分析。分析于2019年10月12日至2020年7月9日进行。
烟草暴露定义为血清可替宁水平大于0.05μg/L，或报告与吸烟者同住或自己吸烟。
根据2017年美国儿科学会临床实践指南，血压升高定义为高于儿童年龄、性别和身高对应的第90百分位数。检验了研究人群中烟草暴露与血压升高之间存在正相关的先验假设。分析包括对可能的混杂因素进行调整的逻辑回归。进行了亚组分析和敏感性分析。
总共8520名儿童被纳入分析，代表4100万美国儿童。参与者的平均（标准差）年龄为13.1（0.05）岁，51%（95%置信区间，49%-52%）为男性，58%（95%置信区间，54%-62%）为非西班牙裔白人。任何烟草烟雾暴露的参与者比未暴露者更可能年龄较大（平均[标准差]年龄，13.3[0.07]岁对12.8[0.06]岁）、为男性（53%[95%置信区间，51%-55%]对49%[95%置信区间，47%- 50%]）以及为非西班牙裔黑人（19%[95%置信区间，16%-22%]对10%[95%置信区间，8%-12%]）。调整后，任何烟草暴露者血压升高的比值比为1.31（95%置信区间，1.06-1.61）；各亚组的比值比相似，且在多次敏感性分析中仍具有显著性。
本研究表明，烟草暴露与美国儿童及青少年血压升高相关。这种可改变的风险因素是进一步研究降低儿童及青少年高血压的一个目标。
Zotero 插件
