Skip to main content
SpringerLink
Log in

Circadian and ultradian cardiovascular rhythmicity in obese children

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Altered circadian and ultradian blood pressure (BP) and heart rate (HR) rhythmicity have been described in diseases with increased cardiovascular risk. We analyzed cardiovascular rhythmicity in obese children. BP and HR rhythmicity was assessed with Fourier analysis from 24-h ambulatory BP measurements in 75 obese children and compared with an age- and gender-matched, lean healthy reference group of 150 subjects. Multivariate regression analysis was applied to identify significant independent factors explaining variability of rhythmicity. Prevalence of 24- and 6-h BP rhythmicity in the obese group was lower (p = 0.03 and p = 0.02), whereas the prevalence of HR rhythmicity was comparable in both groups. Excluding hypertensive participants, the results remained similar. Twenty-four-hour BP and HR acrophase were delayed in obese children (p = 0.004, p < 0.0001), 24-h BP amplitude did not differ (p = 0.07), and 24-h HR amplitude was blunted (p = < 0.0001). BP Mesor in the obese group was higher (p = 0.02); HR Mesor did not differ (p = 0.1). Multivariate regression analysis failed to identify a single anthropometric or blood pressure parameter explaining the variability of BP and HR rhythmicity.

Conclusion: Prevalence and parameters of circadian and ultradian BP and HR rhythmicity in obese children are altered compared to a healthy reference group, independent of preexisting hypertension.

What is Known:

• Altered cardiovascular rhythmicity has been described in children with different diseases such as primary hypertension or chronic renal failure.

What is New:

• This study reveals altered cardiovascular rhythmicity in obese children compared to an age and gender-matched healthy reference group independent from preexisting hypertension.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

ABPM:

Ambulatory blood pressure measurement

BMI:

Body mass index

BP:

Blood pressure

BPM:

Beats per minute

CRF:

Chronic renal failure

DBP:

Diastolic blood pressure

GLM:

Generalized linear model

HR:

Heart rate

IQR:

Interquartile range

MAP:

Mean arterial blood pressure

OR:

Odds ratio

PH:

Primary hypertension

SBP:

Systolic blood pressure

SGA:

Small for gestational age

SDS:

Standard deviation score

WCH:

White coat hypertension

References

  1. Aggoun Y, Farpour-Lambert NJ, Marchand LM, Golay E, Maggio AB, Beghetti M (2008) Impaired endothelial and smooth muscle functions and arterial stiffness appear before puberty in obese children and are associated with elevated ambulatory blood pressure. Eur Heart J 29:792–799

    Article  PubMed  Google Scholar 

  2. Braegger C, Jenni O, Konrad D, Molinari L (2011) Neue Wachstumskurven fuer die Schweiz. Paediatrica 22:10–11

    Google Scholar 

  3. Diedrich A, Jordan J, Tank J, Shannon JR, Robertson R, Luft FC, Robertson D, Biaggioni I (2003) The sympathetic nervous system in hypertension: assessment by blood pressure variability and ganglionic blockade. J Hypertens 21:1677–1686

    Article  CAS  PubMed  Google Scholar 

  4. Dong B, Wang Z, Wang HJ, Ma J (2015) The association between resting heart rate and blood pressure among children and adolescents with different waist circumferences. Eur J Pediatr 174:191–197

    Article  PubMed  Google Scholar 

  5. Elkiran O, Yilmaz E, Koc M, Kamanli A, Ustundag B, Ilhan N (2013) The association between intima media thickness, central obesity and diastolic blood pressure in obese and overweight children: a cross-sectional school-based study. Int J Cardiol 165:528–532

    Article  PubMed  Google Scholar 

  6. Farah BQ, Christofaro DGD, Balagopal PB, Cavalcante BR, de Barros MVG, Ritti-Dias RM (2015) Association between resting heart rate and cardiovascular risk factors in adolescents. Eur J Pediatr 174:1621–1628

    Article  PubMed  Google Scholar 

  7. Flynn JT, Daniels SR, Hayman LL, Maahs DM, McCrindle BW, Mitsnefes M, Zachariah JP, Urbina EM, American Heart Association Atherosclerosis H, Obesity in Youth Committee of the Council on Cardiovascular Disease in the Y (2014) Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension 63:1116–1135

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Hadtstein C, Wuhl E, Soergel M, Witte K, Schaefer F, German Study Group for Pediatric H (2004) Normative values for circadian and ultradian cardiovascular rhythms in childhood. Hypertension 43:547–554

    Article  CAS  PubMed  Google Scholar 

  9. Holt-Lunstad J, Steffen PR (2007) Diurnal cortisol variation is associated with nocturnal blood pressure dipping. Psychosom Med 69:339–343

    Article  PubMed  Google Scholar 

  10. I’Allemand D, Wiegand S, Reinehr T, Muller J, Wabitsch M, Widhalm K, Holl R, Group AP-S (2008) Cardiovascular risk in 26,008 European overweight children as established by a multicenter database. Obesity (Silver Spring) 16:1672–1679

    Article  Google Scholar 

  11. Jones A, Charakida M, Falaschetti E, Hingorani AD, Finer N, Masi S, Donald AE, Lawlor DA, Smith GD, Deanfield JE (2012) Adipose and height growth through childhood and blood pressure status in a large prospective cohort study. Hypertension 59:919–925

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Juhola J, Magnussen CG, Viikari JS, Kahonen M, Hutri-Kahonen N, Jula A, Lehtimaki T, Akerblom HK, Pietikainen M, Laitinen T, Jokinen E, Taittonen L, Raitakari OT, Juonala M (2011) Tracking of serum lipid levels, blood pressure, and body mass index from childhood to adulthood: the Cardiovascular Risk in Young Finns Study. J Pediatr 159:584–590

    Article  CAS  PubMed  Google Scholar 

  13. Kimm SY, Obarzanek E (2002) Childhood obesity: a new pandemic of the new millennium. Pediatrics 110:1003–1007

    Article  PubMed  Google Scholar 

  14. Kohara K, Nishida W, Maguchi M, Hiwada K (1995) Autonomic nervous function in non-dipper essential hypertensive subjects. Evaluation by power spectral analysis of heart rate variability. Hypertension 26:808–814

    Article  CAS  PubMed  Google Scholar 

  15. Kumari M, Chandola T, Brunner E, Kivimaki M (2010) A nonlinear relationship of generalized and central obesity with diurnal cortisol secretion in the Whitehall II study. J Clin Endocrinol Metab 95:4415–4423

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Litwin M, Niemirska A, Sladowska J, Antoniewicz J, Daszkowska J, Wierzbicka A, Wawer ZT, Grenda R (2006) Left ventricular hypertrophy and arterial wall thickening in children with essential hypertension. Pediatr Nephrol 21:811–819

    Article  PubMed  Google Scholar 

  17. Litwin M, Simonetti GD, Niemirska A, Ruzicka M, Wuhl E, Schaefer F, Feber J (2010) Altered cardiovascular rhythmicity in children with white coat and ambulatory hypertension. Pediatr Res 67:419–423

    Article  PubMed  Google Scholar 

  18. Lobstein T, Frelut ML (2003) Prevalence of overweight among children in Europe. Obes Rev 4:195–200

    Article  CAS  PubMed  Google Scholar 

  19. Loredo JS, Nelesen R, Ancoli-Israel S, Dimsdale JE (2004) Sleep quality and blood pressure dipping in normal adults. Sleep 27:1097–1103

    PubMed  Google Scholar 

  20. Luma GB, Spiotta RT (2006) Hypertension in children and adolescents. Am Fam Physician 73:1558–1568

    PubMed  Google Scholar 

  21. Lurbe E, Torro I, Aguilar F, Alvarez J, Alcon J, Pascual JM, Redon J (2008) Added impact of obesity and insulin resistance in nocturnal blood pressure elevation in children and adolescents. Hypertension 51:635–641

    Article  CAS  PubMed  Google Scholar 

  22. National High Blood Pressure Education Program Working Group on High Blood Pressure in C, Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

    Article  Google Scholar 

  23. Niemirska A, Litwin M, Feber J, Jurkiewicz E (2013) Blood pressure rhythmicity and visceral fat in children with hypertension. Hypertension 62:782–788

    Article  CAS  PubMed  Google Scholar 

  24. Ohkubo T, Hozawa A, Yamaguchi J, Kikuya M, Ohmori K, Michimata M, Matsubara M, Hashimoto J, Hoshi H, Araki T, Tsuji I, Satoh H, Hisamichi S, Imai Y (2002) Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study. J Hypertens 20:2183–2189

    Article  CAS  PubMed  Google Scholar 

  25. Pall D, Juhasz M, Lengyel S, Molnar C, Paragh G, Fulesdi B, Katona E (2010) Assessment of target-organ damage in adolescent white-coat and sustained hypertensives. J Hypertens 28:2139–2144

    Article  CAS  PubMed  Google Scholar 

  26. Pires A, Martins P, Pereira AM, Marques M, Castela E, Sena C, Seica R (2016) Childhood adiposity: being male is a potential cardiovascular risk factor. Eur J Pediatr 175:63–69

    Article  PubMed  Google Scholar 

  27. Ralph MR, Foster RG, Davis FC, Menaker M (1990) Transplanted suprachiasmatic nucleus determines circadian period. Science 247:975–978

    Article  CAS  PubMed  Google Scholar 

  28. Redwine KM, Acosta AA, Poffenbarger T, Portman RJ, Samuels J (2012) Development of hypertension in adolescents with pre-hypertension. J Pediatr 160:98–103

    Article  PubMed  Google Scholar 

  29. Richards J, Gumz ML (2013) Mechanism of the circadian clock in physiology. Am J Physiol Regul Integr Comp Physiol 304:R1053–R1064

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Shatat IF, Freeman KD, Vuguin PM, Dimartino-Nardi JR, Flynn JT (2009) Relationship between adiponectin and ambulatory blood pressure in obese adolescents. Pediatr Res 65:691–695

    Article  CAS  PubMed  Google Scholar 

  31. Sherwood A, Steffen PR, Blumenthal JA, Kuhn C, Hinderliter AL (2002) Nighttime blood pressure dipping: the role of the sympathetic nervous system. Am J Hypertens 15:111–118

    Article  PubMed  Google Scholar 

  32. Somers VK, Dyken ME, Mark AL, Abboud FM (1993) Sympathetic-nerve activity during sleep in normal subjects. N Engl J Med 328:303–307

    Article  CAS  PubMed  Google Scholar 

  33. Sorof JM, Cardwell G, Franco K, Portman RJ (2002) Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension 39:903–908

    Article  CAS  PubMed  Google Scholar 

  34. Stabouli S, Kotsis V, Papamichael C, Constantopoulos A, Zakopoulos N (2005) Adolescent obesity is associated with high ambulatory blood pressure and increased carotid intimal-medial thickness. J Pediatr 147:651–656

    Article  PubMed  Google Scholar 

  35. Steinberger J, Daniels SR, American Heart Association Atherosclerosis H, Obesity in the Young C, American Heart Association Diabetes C (2003) Obesity, insulin resistance, diabetes, and cardiovascular risk in children: an American Heart Association scientific statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). Circulation 107:1448–1453

    Article  PubMed  Google Scholar 

  36. Suglia SF, Clark CJ, Gary-Webb TL (2013) Adolescent obesity, change in weight status, and hypertension: racial/ethnic variations. Hypertension 61:290–295

    Article  CAS  PubMed  Google Scholar 

  37. Tu W, Eckert GJ, DiMeglio LA, Yu Z, Jung J, Pratt JH (2011) Intensified effect of adiposity on blood pressure in overweight and obese children. Hypertension 58:818–824

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Verdecchia P, Carini G, Circo A, Dovellini E, Giovannini E, Lombardo M, Solinas P, Gorini M, Maggioni AP, Group MS (2001) Left ventricular mass and cardiovascular morbidity in essential hypertension: the MAVI study. J Am Coll Cardiol 38:1829–1835

    Article  CAS  PubMed  Google Scholar 

  39. Wang Y, Lobstein T (2006) Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 1:11–25

    Article  PubMed  Google Scholar 

  40. Wolfenstetter A, Simonetti GD, Poschl J, Schaefer F, Wuhl E (2012) Altered cardiovascular rhythmicity in children born small for gestational age. Hypertension 60:865–870

    Article  CAS  PubMed  Google Scholar 

  41. Wuhl E, Hadtstein C, Mehls O, Schaefer F, Group ET (2005) Ultradian but not circadian blood pressure rhythms correlate with renal dysfunction in children with chronic renal failure. J Am Soc Nephrol 16:746–754

    Article  PubMed  Google Scholar 

  42. Wuhl E, Witte K, Soergel M, Mehls O, Schaefer F, German Working Group on Pediatric H (2002) Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 20:1995–2007

    Article  PubMed  Google Scholar 

  43. Zuther SGaBL (2009) Chronos-Fit 1.06, http://www.ma.uni-heidelberg.de/inst/phar/lehre/chrono.html.

Download references

Acknowledgments

We thank Chantal Cripe-Mamie MD for her careful linguistic revision of this manuscript.

Author’s contribution

All the above listed authors contributed substantially to the conception of the study, the acquisition of the raw data and its analysis and interpretation. The initial manuscript has been consecutively edited for its scientific content and accuracy by all the listed authors and the revised version has been approved to be published.

Author information

Authors and Affiliations

  1. University Children’s Hospital UKBB, Spitalstrasse 33, CH-4056, Basel, Switzerland

    Christoph Saner

  2. Division of Pediatric Nephrology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland

    Giacomo D. Simonetti

  3. Pediatric Department of Southern Switzerland, Via Ospedale, CH-6500, Bellinzona, Switzerland

    Giacomo D. Simonetti

  4. Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany

    Elke Wühl

  5. Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH- 3010, Bern, Switzerland

    Primus E. Mullis & Marco Janner

Authors
  1. Christoph Saner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giacomo D. Simonetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elke Wühl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Primus E. Mullis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marco Janner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giacomo D. Simonetti.

Ethics declarations

Ethical approval

The study was approved by the local ethical review board and performed in accordance with the ethical standards as laid in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

All subjects and parents gave informed consent prior to inclusion in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Communicated by Mario Bianchetti

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Table 1

(DOCX 13 kb)

Supplementary Table 2

(DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saner, C., Simonetti, G.D., Wühl, E. et al. Circadian and ultradian cardiovascular rhythmicity in obese children. Eur J Pediatr 175, 1031–1038 (2016). https://doi.org/10.1007/s00431-016-2736-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-016-2736-4

Keywords

Search

Navigation