Childhood Obesity and Blood Pressure Regulation

Chapter
Part of the Clinical Hypertension and Vascular Diseases book series (CHVD)

Abstract

Obesity in children and adolescents continues to occur with increasing frequency and has been associated with the development of clinical consequences of obesity such as hypertension. This chapter will begin with a review of the definitions of hypertension and prehypertension in children and adolescents, followed by discussion of the epidemiology of obesity hypertension. After examining the complex relationship between obesity and hypertension and potential mechanisms contributing to the development of obesity hypertension, clinical approaches to the management of hypertension in the setting of obesity are discussed. The clinical management is multifaceted as one must consider that treating obesity may in fact lead to improved blood pressure. Yet, treating obesity takes time and motivation, and while awaiting the effects of changes in lifestyle on blood pressure, use of antihypertensive medications may be indicated in some children.

Keywords

Obesity BMI Prehypertension Hypertension 

References

  1. 1.
    Rocchini AP. Childhood obesity and blood pressure regulation. In: Portman RJ, Sorof JM, Ingelfinger JR, editors. Pediatric hypertension. 1st ed. Totowa: Humana Press; 2004. p. 307–34.CrossRefGoogle Scholar
  2. 2.
    Rocchini AP. Childhood obesity and blood pressure regulation. In: Flynn JT, Ingelfinger JR, Portman RJ, editors. Pediatric hypertension. 2nd ed. Springer: New York, Dordrecht, Heidelberg, London; 2010. p. 301–27.Google Scholar
  3. 3.
    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Bethesda: National Institutes of Health: 2005. NIH publication 05: 5267.Google Scholar
  4. 4.
    Sinaiko AR. Hypertension in children. New Engl J Med. 1996;335:1968–73.PubMedCrossRefGoogle Scholar
  5. 5.
    Kapur G, Ahmed M, Pan C, Mitsnefes M, Chiang M, Mattoo T. Secondary hypertension in overweight and stage 1 hypertensive children: A Midwest Pediatric Nephrology Consortium report. J Clin Hypertens. 2010;12:34–9.CrossRefGoogle Scholar
  6. 6.
    Babinska K, Kovacs L, Janko V, Dallos T, Feber J. Association between obesity and severity of ambulatory hypertension in children and adolescents. J Am Soc Hypertens. 2012;6:356–63.PubMedCrossRefGoogle Scholar
  7. 7.
    Nguyen T, Lau DCW. The obesity epidemic and its impact on hypertension. Can J Cardiol. 2012;28:326–33.PubMedCrossRefGoogle Scholar
  8. 8.
    Roberts J, Maurer K. Blood pressure of youths 12–17 years: United States. Vital Health Stat. 1977; iii, 1–62.Google Scholar
  9. 9.
    Rowland M, Roberts J. Blood pressure levels and hypertension in persons ages 6–74 years: United States, 1976–90. Adv Data. 1982;84:1–11.PubMedGoogle Scholar
  10. 10.
    Drizd T, Dannenberg AL, Engel A. Blood pressure levels in persons 18–74 years of age in 1976–80, and trends in blood pressure from 1960 to 1980 in the United States. Vital Health Stat. 1986;11:1–68.Google Scholar
  11. 11.
    Burt VL, et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991. Hypertension. 1993;26:60–9.CrossRefGoogle Scholar
  12. 12.
    Luepker RV, et al. Cardiovascular risk factor change – 1974–74 to 1980–82: the Minnesota Heart Survey. J Clin Epidemiol. 1988;41:825–33.PubMedCrossRefGoogle Scholar
  13. 13.
    Department of Health. Health survey for England: trend data for adults. 1993–2000. Department of Health, 2002. Available from http://www.doh.gov.uk/stats/trends1.htm
  14. 14.
    Shaw A, McMunn A, Field J. The Scottish health survey 1998. Edinburgh: Joint Health Surveys Unit of Social and Community Planning Research and University College London. 2000. Available from http://www.show.scot.nhs.uk/scottishhealthsurvey/sh8-00.html
  15. 15.
    Sjol A, Thomsen KK, Schroll M. Secular trends in blood pressure levels in Denmark 1964–1991. Int J Epidemiol. 1998;27:614–22.PubMedCrossRefGoogle Scholar
  16. 16.
    Heinemann L, Barth W, Hoffmeister H. Trend of cardiovascular risk factors in the East German population 1968–1992. J Clin Epidemiol. 1995;48:787–95.PubMedCrossRefGoogle Scholar
  17. 17.
    Falkner B, Gidding SS, Portman R, Rosner B. Blood pressure variability and classification prehypertension and hypertension in adolescence. Pediatrics. 2008;122:238–42.PubMedCrossRefGoogle Scholar
  18. 18.
    Redwine K, Acosta A, Poffenbarger T, Portman R, Samuels J. Development of hypertension in adolescents with prehypertension. J Pediatr. 2012; 160:98–103.PubMedCrossRefGoogle Scholar
  19. 19.
    Chen X, Weng Y. Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation. 2008;117:3171–80.PubMedCrossRefGoogle Scholar
  20. 20.
    May AL, Kuklina EV, Yoon PW. Prevalence of cardiovascular disease risk factors among US adolescents, 1999–2008. Pediatrics. 2012;129:1035–41.PubMedCrossRefGoogle Scholar
  21. 21.
    Elcarte LR, Villa EI, Sada GJ, Gasco EM, Oyarzabal IM, Sola MA, Martino GA, Elcarte LT, Ayensa MI, Castiella LF. The Navarra study. Prevalence of arterial hypertension, hyperlipidemia and obesity in the infant-child population of Navarra. Association of risk factors. An Esp Pediatr. 1995;38:428–36.Google Scholar
  22. 22.
    Verma M, Chhatwal J, George SM. Obesity and hypertension in children. Indian J Pediatr. 1994; 31:1065–9.Google Scholar
  23. 23.
    Macedo ME, Trigueiros D, de Freitas F. Prevalence of high blood pressure in children and adolescents. Influence of obesity. Rev Port Cardiol. 1997; 16:27–8.PubMedGoogle Scholar
  24. 24.
    Guillaume M, Lapidus L, Beckers F, Lambert A, Bjorntorp P. Cardiovascular risk factors in children from the Belgian province of Luxembourg. The Belgian Luxembourg Child study. Am J Epidemiol. 1996;144:867–80.PubMedCrossRefGoogle Scholar
  25. 25.
    Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents. The Bogalusa Heart study. Pediatrics. 1999;103:1175–82.PubMedCrossRefGoogle Scholar
  26. 26.
    Sorof JM, Poffenberger T, Franco K, Bernard L, Portman RJ. Isolated systolic hypertension, obesity, and hyperkinetic hemodynamic states in children. J Pediatr. 2002;140:660–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Rosner B, Prineas R, Daniels SR, Loggie J. Blood pressure differences between blacks and whites in relation to body size among US children and adolescents. Am J Epidemiol. 2000;151:1007–19.PubMedCrossRefGoogle Scholar
  28. 28.
    Juhola J, Oikonen M, Magnussen CG, et al. Childhood physical, environmental, and genetic predictors of adult hypertension. The Cardiovascular Risk in Young Finns study. Circulation. 2012;126:402–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Bao W, Threefoot SA, Srinivasan SR, Berenson GS. Essential hypertension predicted by tracking of elevated blood pressure from childhood to adulthood: the Bogalusa Heart study. Am J Hypertens. 1995; 8: 657–65.PubMedCrossRefGoogle Scholar
  30. 30.
    Chandramohan G, Kalantar-Zadeh K, Kermah D, Go SC, Vaziri ND, Norris KC. Relationship between obesity and pulse pressure in children: results of the National Health and Nutrition Survey (NHANES) 1988–1994. J Am Soc Hypertens. 2012;6:277–83.PubMedCrossRefGoogle Scholar
  31. 31.
    Rosner B, Cook N, Portman R, Daniels S, Falkner B. Determination of blood pressure percentiles in normal-weight children: some methodological issues. Am J Epidemiol. 2008;167:653–66.PubMedCrossRefGoogle Scholar
  32. 32.
    Whincup PH, Cook DG, Shaper AG. Blood pressure measurement in children: the importance of cuff bladder size. J Hypertens. 1989;7:845–50.PubMedCrossRefGoogle Scholar
  33. 33.
    Gomez-Marin O, Prineas RJ, Rastam L. Cuff bladder width and blood pressure measurement in children and adolescents. J Hypertens. 1992;10:1235–41.PubMedCrossRefGoogle Scholar
  34. 34.
    Prineas RJ. Measurements of blood pressure in the obese. Ann Epidemiol. 1991;1:321–36.PubMedCrossRefGoogle Scholar
  35. 35.
    Prineas RJ, Ostchega Y, Carroll M, Dillon C, McDowell M. US demographic trends in mid-arm circumference and recommended blood pressure cuffs for children and adolescents: data from the National Health and Nutrition Examination Survey 1988-2004. Blood Press Monit. 2007;12:75–80.PubMedCrossRefGoogle Scholar
  36. 36.
    Voors AW, Webber LS, Berenson GS. Resting heart rate and pressure-rate product of children in a total biracial community. The Bogalusa Heart study. Am J Epidemiol. 1982;116:276–86.PubMedGoogle Scholar
  37. 37.
    Jung X, Srinivasan SR, Urbina E, Berenson GS. Hyperdynamic circulation and cardiovascular risk in children and adolescents. The Bogalusa Heart study. Circulation. 1995;91:1101–6.CrossRefGoogle Scholar
  38. 38.
    Rocchini AP, katch V, Schork A, Kelch RP. Insulin and blood pressure during weight loss in obese adolescents. Hypertension. 1987;10:267–73.PubMedCrossRefGoogle Scholar
  39. 39.
    Riva P, Martini G, Rabbia F, Milan A, Paglieri C, Chiandussi L, Veglio F. Obesity and autonomic function in adolescence. Clin Exp Hypertens. 2001; 23:57–67.PubMedCrossRefGoogle Scholar
  40. 40.
    Martini G, Riva P, Rabbia F, Molini V, Ferrero GB, Cerutti F, Carra R, Veglio F. Heart rate variability in childhood obesity. Clin Auton Res. 2001;11:87–91.PubMedCrossRefGoogle Scholar
  41. 41.
    Gutin B, Owens S, Slavens G, Riggs S, Treiber F. Effect of physical training on heart-period variability in obese children. J Pediatr. 1997;130:938–43.PubMedCrossRefGoogle Scholar
  42. 42.
    Voors AW, Radhakrishnamurthy B, Srinivasan SR, Webber LS, Berenson GS. Plasma glucose level related to blood pressure in 272 children, ages 7–15 years, sampled from a total biracial population. Am J Epidemiol. 1981;113:347–56.PubMedGoogle Scholar
  43. 43.
    Kanai H, Matsuzawa Y, Tokunaga K, Keno Y, Kobatake T, Fujioka S, Nakajima T, Tarui S. Hypertension in obese children: fasting serum insulin levels are closely correlated with blood pressure. Int J Obes. 1990;14:1046–56.Google Scholar
  44. 44.
    Saito I, Nishino M, Kawabe H, Wainai H, Hasegawa C, Saruta T, Nagano S, Sekihara T. Leisure time physical activity and insulin resistance in young obese children. Am J Hypertens. 1992;5:915–8.PubMedGoogle Scholar
  45. 45.
    Pozzan R, Brandao AA, de Silva SL, Brandao AP. Hyperglycemia, hyperinsulinemia, overweight, and high blood pressure in young adults. The Rio de Janeiro study. Hypertension. 1997;30:650–3.PubMedCrossRefGoogle Scholar
  46. 46.
    Chen W, Srinivasan SR, Elkasabany A, Berenson GS. Cardiovascular risk factors clustering features of insulin resistance syndrome (syndrome X) in a biracial (black-white) population of children, adolescents, and young adults. The Bogalusa Heart study. Am J Epidemiol. 1999;150:667–74.PubMedCrossRefGoogle Scholar
  47. 47.
    Young-Hyman D, Schlundt DG, Herman L, De Luca F, Counts D. Evaluation of the insulin resistance syndrome in 5- to 10-year-old overweight/obese African-American children. Diabetes Care. 2001;24: 1359–64.PubMedCrossRefGoogle Scholar
  48. 48.
    Lughetti L, Bedogni G, Ferrari M, Pagliato E, Manzieri AM, De Simone M, Battistini N, Bernasconi S. Is fasting insulin associated with blood pressure in obese children? Ann Hum Biol. 2000;27:499–506.CrossRefGoogle Scholar
  49. 49.
    Wabitsch M, Hauner H, Heinze E, Muche R, Bockmann A, Parthon W, Mayer H, Teller W. Body-fat distribution and changes in the atherogenic risk-factor profile in obese adolescent girls during weight reduction. Am J Clin Nutr. 1994;60:54–60.PubMedGoogle Scholar
  50. 50.
    Csabi G, Molnar D, Hartmann G. Urinary sodium excretion: association with hyperinsulinaemia, hypertension and sympathetic nervous system activity in obese and control children. Eur J Pediatr. 1996;155:895–7.PubMedCrossRefGoogle Scholar
  51. 51.
    Peppa-Patrikiou M, Scordili M, Antoniou A, Giannaki M, Dracopoulou M, Dacou-Voutetakis C. Carotid atherosclerosis in adolescents and young adults with IDDM. Relation to urinary endothelin, albumin, free cortisol, and other factors. Diabetes Care. 1998;21:1004–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Jarvisalo MJ, Putto-Laurila A, Jartti L, Lehtimaki T, Solakivi T, Ronnemaa T, Raitakari OT. Carotid artery intima-media thickness in children with type 1 diabetes. Diabetes. 2002;51:493–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Tonstad S, Joakimsen O, Stensland-Bugge E, Leren TP, Ose L, Russell D, Bonaa KH. Risk factors related to carotid intima-media thickness and plaque in children with familial hypercholesterolemia and control subjects. Arterioscler Thromb Vasc Biol. 1996;16:984–91.PubMedCrossRefGoogle Scholar
  54. 54.
    Jarvisalo MJ, Jartti L, Nanto-Salonen K, Irjala K, Ronnemaa T, Hartiala JJ, Celermajer DS, Raitakari OT. Increased aortic intima-media thickness: a marker of preclinical atherosclerosis in high-risk children. Circulation. 2001;104:2943–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Virkola K, Pesonen E, Akerblom HK, Siimes MA. Cholesterol and carotid artery wall in children and adolescents with familial hypercholesterolaemia: a controlled study by ultrasound. Acta Paediatr. 1997;86:1203–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Parikh A, Sochett EB, McCrindle BW, Dipchand A, Daneman A, Daneman D. Carotid artery distensibility and cardiac function in adolescents with type 1 diabetes. J Pediatr. 2000;137:465–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Aggoun Y, Bonnet D, Sidi D, Girardet JP, Brucker E, Polak M, Safar ME, Levy BI. Arterial mechanical changes in children with familial hypercholesterolemia. Arterioscler Thromb Vasc Biol. 2000;20:2070–5.PubMedCrossRefGoogle Scholar
  58. 58.
    Tounian P, Aggoun Y, Dubern B, Varille V, Guy-Grand B, Sidi D, Girardet JP, Bonnet D. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet. 2001;358:1400–4.PubMedCrossRefGoogle Scholar
  59. 59.
    Rocchini AP, Moorehead C, Katch V, Key J, Finta KM. Forearm resistance vessel abnormalities and insulin resistance in obese adolescents. Hypertension. 1992;19:615–20.PubMedCrossRefGoogle Scholar
  60. 60.
    Rocchini AP, Katch V, Anderson J, Hinderliter J, Becque D, Martin M, Marks C. Blood pressure in obese adolescents: effect of weight loss. Pediatrics. 1988;82:16–23.PubMedGoogle Scholar
  61. 61.
    Grøntved A, Steene-Johannessen J, Kynde I, Franks PW, Helge JW, Froberg K, Anderssen SA, Andersen LB. Association between plasma leptin and blood pressure in two population-based samples of children and adolescents. J Hypertens. 2011;29:1093–100.PubMedCrossRefGoogle Scholar
  62. 62.
    Shatat IF, Freeman KD, Vuguin PM, Dimartino-Nardi JR, Flynn JT. Relationship between adiponectin and ambulatory blood pressure in obese adolescents. Ped Res. 2009;65:691–5.CrossRefGoogle Scholar
  63. 63.
    Mohamed-Ali V, Bulmer K, Clarke D, Goodrick S, Coppack SW, Pinkney JH. beta-Adrenergic regulation of proinflammatory cytokines in humans. Int J Obes Relat Metab Disord. 2000; 24 Suppl 2:S154–5.CrossRefGoogle Scholar
  64. 64.
    Jung RT, Shetty PS, Barrand M, Callingham BA, James WP.Role of catecholamines in hypotensive response to dieting. Br Med J. 1979;1:12–3.PubMedCrossRefGoogle Scholar
  65. 65.
    Chrousos GP. The hypothalamic-pituitary-adrenal axis and immune-mediated inflammation. N Engl J Med. 1995;332:1351–62.PubMedCrossRefGoogle Scholar
  66. 66.
    Brownell KD, Kelman JH, Stunkard AJ. Treatment of obese children with and without their mothers: changes in weight and blood pressure. Pediatrics. 1983;71:515–23.PubMedGoogle Scholar
  67. 67.
    Clarke WR, Woolson RF, Lauer RM. Changes in ponderosity and blood pressure in childhood. The Muscatine study. Am J Epidemiol. 1986;124:195–206.PubMedGoogle Scholar
  68. 68.
    Figueroa-Colon R, von Almen TK, Franklin FA, Schuftan C, Suskind RM. Comparison of two hypocaloric diets in obese children. Am J Dis Child. 1993; 147:160–6.PubMedGoogle Scholar
  69. 69.
    Gallistl S, Sudi KM, Aigner R, Borkenstein M. Changes in serum interleukin-6 concentrations in obese children and adolescents during a weight reduction program. Int J Obes Relat Metab Disord. 2001;25:1640–3.PubMedCrossRefGoogle Scholar
  70. 70.
    Torrance B, McGuire KA, Lewanczuk R, McGavock J. Vasc Health Risk Manag. 2007;3(1):139–49.PubMedGoogle Scholar
  71. 71.
    Alpert BS. Exercise as a therapy to control hypertension in children. Int J Sports Med. 2000;21 suppl 2:S94–6.PubMedCrossRefGoogle Scholar
  72. 72.
    Ribeiro MM, Silva AG, Santos NS, Guazzelli I, Matos LN, Trombetta IC, Halpern A, Negrão CE, Villares SM. Diet and exercise training restore blood pressure and vasodilatory responses during physiological maneuvers in obese children. Circulation. 2005;111:1915–23.PubMedCrossRefGoogle Scholar
  73. 73.
    Mu JJ, Liu ZQ, Liu WM, Liang YM, Yang DY, Zhu DJ, Wang ZX. Reduction of blood pressure with calcium and potassium supplementation in children with salt sensitivity: a 2-year double-blinded placebo-controlled trial. J Hum Hypertens. 2005;19:479–83.PubMedCrossRefGoogle Scholar
  74. 74.
    Moore LL, Singer MR, Bradlee ML, Djousse L, Proctor MH, Cupples LA, Ellison RC. Epidemiology. 2005;16(1):4–11.PubMedCrossRefGoogle Scholar
  75. 75.
    Gunther ALB, Liese AD, Bell RA, Dabelea D, Lawrence JM, Rodriguez BL, Standiford DA, Mayer-Davis EJ. Association between the dietary approaches to hypertension diet and hypertension in youth with diabetes mellitus. Hypertension. 2009;53:6–12.PubMedCrossRefGoogle Scholar
  76. 76.
    Couch SC, Saelens BE, Levin L, Dart K, Falcigua G, Daniels SR. The efficacy of a clinic-based behavioral nutrition intervention emphasizing a DASH-type diet for adolescents with elevated blood pressure. J Pediatr. 2008;152:494–501.PubMedCrossRefGoogle Scholar
  77. 77.
    Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA. 1990;264:2519–23.PubMedCrossRefGoogle Scholar
  78. 78.
    Tershakovec AM, Watson MH, Wenner WJJ, Marx AL. Insurance reimbursement for the treatment of obesity in children. J Pediatr. 1999;134:573–8.PubMedCrossRefGoogle Scholar
  79. 79.
    Very low-calorie diets. National Task Force on the Prevention and Treatment of Obesity, National Institutes of Health. JAMA. 1993; 270:967–74.Google Scholar
  80. 80.
    Bistrian BR. Clinical use of a protein-sparing modified fast. JAMA. 1978;240:2299–302.PubMedCrossRefGoogle Scholar
  81. 81.
    Singhal V, Schwenk WF, Kumar S. Evaluation and management of childhood and adolescent obesity. Mayo Clin Proc. 2007;82:1258–64.PubMedCrossRefGoogle Scholar
  82. 82.
    Godoy-Matos AF, Guedes EP, Souza LL, Martins MF. Management of obesity in adolescents: state of art. Arq Bras Endocrinol Metabol. 2009;53:252–61.PubMedCrossRefGoogle Scholar
  83. 83.
    Colman E, Golden J, Roberts M, Egan A, Weaver J, Rosebraugh C. The FDA’s assessment of two drugs for chronic weight management. N Engl J Med. 2012;367:1577–9.PubMedCrossRefGoogle Scholar
  84. 84.
    Sharma AM, Pischon T, Engeli S, Scholze J. Choice of drug treatment for obesity-related hypertension: where is the evidence? J Hypertens. 2001;19:667–74.PubMedCrossRefGoogle Scholar
  85. 85.
    Welch WP, Yang W, Taylor-Zapata P, Flynn JT. Antihypertensive drug use by children: are the drugs labeled and indicated? J Clin Hypertens. 2012; 14:388–95.CrossRefGoogle Scholar
  86. 86.
    Batisky DL. What is the optimal first-line agent in children requiring antihypertensive medication? Curr Hypertens Rep. 2012;14(6):603–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Division of Pediatric NephrologyEmory-Children’s CenterAtlantaUSA

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