Barzin Maryam, Yaghoobpoor Shirin, Mahdavi Maryam, Abiri Behnaz, Valizadeh Majid, Azizi Fereidoun, Dehghan Pooneh, Hosseinpanah Farhad
Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Clin Exp Pediatr. 2024 Dec;67(12):694-703. doi: 10.3345/cep.2024.00248. Epub 2024 Sep 12.
Definitions of childhood and adolescent hypertension (HTN) do not precisely elucidate the relationship between HTN and cardiovascular outcomes. Carotid intima-media thickness (CIMT), as a substitute for cardiovascular outcomes, enables the early identification of cardiovascular events throughout early adulthood.
This study aimed to compare the ability of childhood HTN definitions to predict a high CIMT in early adulthood.
This prospective cohort study included 921 individuals aged 10-17 years from the Tehran Lipid and Glucose Study. The CIMT was measured after 18 years of follow-up. Participants were categorized into normal blood pressure (BP), high-normal BP, HTN stage 1, and HTN stage 2 groups based on the childhood HTN definitions of the 4th report, European Society of Hypertension (ESH), and American Academy of Pediatrics Clinical Practice Guidelines (AAP-CPG). Akaike information criterion (AIC) and relative efficiencies (RE) were calculated to compare the ability of each to predict a high CIMT (≥95th percentile) during early adulthood.
The highest and lowest prevalence of stage 1 HTN was observed with the AAP-CPG (17.7%) and ESH (8.8%), respectively. Similarly, the highest and lowest prevalence of stage 2 HTN was noted with the AAP-CPG (1.5%) and ESH (0.8%), respectively. According to the RE values, the highest to lowest predictive abilities belonged to the 4th report, ESH, and AAP-CPG, respectively. In all models, the 4th report's pediatric HTN definition had the lowest AIC value and offered the best predictive ability.
Among the various definitions of pediatric HTN, the 4th report offered the best ability to predict a high CIMT during early adulthood, followed by the ESH and AAP-CPG. Because the reference population of the 4th report includes overweight, obese, and normal- weight individuals, our findings suggest that excessive adiposity is among the main predictors of early adulthood atherosclerosis risk.
儿童及青少年高血压（HTN）的定义并未精确阐明HTN与心血管结局之间的关系。颈动脉内膜中层厚度（CIMT）作为心血管结局的替代指标，能够在成年早期就对心血管事件进行早期识别。
本研究旨在比较儿童HTN定义预测成年早期高CIMT的能力。
这项前瞻性队列研究纳入了来自德黑兰血脂与血糖研究的921名10 - 17岁个体。在随访18年后测量CIMT。根据欧洲高血压学会（ESH）第4次报告以及美国儿科学会临床实践指南（AAP - CPG）中的儿童HTN定义，将参与者分为正常血压（BP）、高正常BP、1期HTN和2期HTN组。计算赤池信息准则（AIC）和相对效率（RE），以比较各定义预测成年早期高CIMT（≥第95百分位数）的能力。
1期HTN的最高和最低患病率分别在AAP - CPG（17.7%）和ESH（8.8%）中观察到。同样，2期HTN的最高和最低患病率分别在AAP - CPG（1.5%）和ESH（0.8%）中被注意到。根据RE值，预测能力从高到低分别属于第4次报告、ESH和AAP - CPG。在所有模型中，第4次报告的儿童HTN定义具有最低的AIC值，并提供了最佳的预测能力。
在儿童HTN的各种定义中，第4次报告在预测成年早期高CIMT方面具有最佳能力，其次是ESH和AAP - CPG。由于第4次报告的参考人群包括超重、肥胖和体重正常的个体，我们的研究结果表明，过度肥胖是成年早期动脉粥样硬化风险的主要预测因素之一。
