Study On The Influencing Factors And Prediction Model Of Exercise Ability In Children With Essential Hypertensio

PART Ⅰ Exercise capacity assessment in children with primary hypertensionBackground:Hypertension,as one of the most common diseases threatening human health,is a major risk factor for cardiovascular events and kidney diseases.In recent years,with the development of social economy and the change of people’s lifestyle,the incidence of hypertension in children has increased annually.Pediatric primary hypertension(PHT)has gradually become the main cause of hypertension in adolescents.Exercise intervention is a primary part of early treatment of PHT patients.However,exercise capacity assessment in PHT children is still undergoing consistent exploration,improvement and renewal.Exercise prescription based on exercise ability in PHT will have more guiding value.Methods:We reviewed the records of PHT children hospitalized in our hospital from September 2017 to September 2020.24-hour blood pressure monitoring was constructed before exercise tests.The hypertension in children was diagnosed and graded according to the 2017 Chinese Hypertension Guidelines.The treadmill exercise test(TET)stages and metabolic equivalents(METs)were obtained from the TET tests using the Bruce protocol to evaluate exercise capacities.Patients were divided into low TET group and high TET group according to the TET stages.Differences between the two groups were analyzed by the Mann-Whitney rank sum test.The correlations between age,sex,blood pressure and METs in children with PHT were analyzed respectively by using the bivariate correlation method.Results:(1)189 children with PHT were included in this study,including 146 males(77.2%)and 43 females(22.8%),with a median age of 13 years(12,14).90 patients(47.6%)were diagnosed with stage 1 hypertension and 98 patients(52.4%)were diagnosed with stage 2 hypertension.The median resting systolic blood pressure(SBP)was 123(118,128)mmHg.The median resting diastolic blood pressure(DBP)was 65(59,71)mmHg.The median 24h average systolic blood pressure(24h ASBP)was 124(118,133)mmHg.The median 24h mean diastolic blood pressure(24h ADBP)was 70(66,74)mmHg.The median resting mean arterial pressure(RMAP)was 84(79,90)mmHg.The median 24-hour mean arterial pressure(24h MAP)was 88(84,92)mmHg.(2)All children enrolled in this part of study successfully completed TET tests and reached submaximal heart rate.Compared with the high TET group,lower proportion of males,increased RDBP and RMAP were noted in the low TET group(p<0.05).(3)The median METs value at the end of TET tests was 9.5(8.3,11.5)ml/(min.kg).METs values differed in males and females with a statistically significance[10.3(8.3,12.3 vs.8.6(8.2,10.2),p<0.05].RDBP,RMBP,24h ADBP were negatively correlated with METs values while ages were positively correlated with METs values(p<0.05).Conclusions:In this study,RDBP and RMAP of children with PHT were significantly increased in low TET group.The METs of males were significantly higher than that of females.Age was positively correlated with METs,while RDBP,RMAP and 24h ADBP were negatively correlated with METs.This study suggests that PHT may provide a basis for developing individualized PHT exercise program for children.PART Ⅱ Influencing factors and prediction model of TET stage in pediatric primary hypertensionBackground:Pediatric primary hypertension(PHT)has become the major cause of hypertension in adolescents.Exercise intervention is a primary part of the early control of hypertension in PHT children.However,there is limited guidance on the choice of exercise programs in the domestic and overseas.Exercise risk in children with PHT differed because of age,blood pressure level and exercise ability.Treadmill exercise test(TET)is an effective tool for exercise capacity assessment.However,the prediction of exercise capacity by using conventional clinical and laboratory indicators in PHT patients who cannot conducted TET is still challenging.Based on the different tolerated exercise levels in early PHT children,this study identified the influenced factors of TET stages.Then a prediction model for TET stages was constructed to predict exercise capacity and provide scientific exercise prescriptions for PHT patients.Methods:We collected the clinical records of children with PHT in our hospital between September 2017 and September 2020.Demographic features,laboratory parameters and multiple organs involvement were analyzed by the logistic regression analysis to identify the influencing factors for the TET stages.We used general clinical data including age,gender,and body mass index(BMI)to construct the basic model.Then combined with selected risk factors,a full model was constructed.The predictive performance and calibration of the model was evaluated by calibration curve and the C-index.Results:(1)A total of 189 children with PHT were enrolled in this study.There were 92 cases with high TET stage including 84 males(91.3%)and 8 females(8.7%),and 97 cases with low TET stage including 62 males(63.9%)and 35 females(36.1%).(2)Lower proportion of males,higher serum insulin(INS),left ventricular hypertrophy(LVH)and RMAP levels were noted in the low TET group compared with high TET group(p<0.05).(3)INS and RMAP were risk factors for low TET stages(p<0.05).(4)The full model which was a combination of general clinical data and risk factors revealed better calibration,compared with the basic prediction model.(5)We constructed a nomogram which incorporated general clinical data and risk factors.Patients with higher scores in the nomograph had a higher probability of low TET stage.Conclusions:The study demonstrated that INS and RMAP were risk factors for low TET stages.The full model revealed better performances.The study may have a reference value in selecting an appropriate exercise prescription for children with PHT.PART Ⅲ Influencing factors and prediction model of metabolic equivalents in pediatric primary hypertensionBackground:Exercise intervention is a primary part of early-stage blood pressure control in children with primary hypertension(PHT).However,there is limited guidance on the choice of exercise programs in the domestic and overseas.Metabolic equivalents(METs)are the most used indexes to evaluate exercise intensity in the Treadmill exercise test(TET).As previously mentioned METs differed in PHT children.This study aimed to explore the influencing factors of METs.Then a prediction model for METs in PHT children was constructed to estimate exercise ability and provide scientific exercise prescription.Methods:The study population was consistent with the second part.The METs were assessed by TET using the improved Bruce protocol.Potential factors related to METs value were identified by the generalized linear model.Then a prediction model of METs value integrating indicators selected by all-subsets regression was constructed.Finally,the regression equation was proposed for practical use.The predictive performance of the model was evaluated by strong point analysis,variance inflation factor(VIF)analysis,residual normality analysis,and multicollinearity,residual normality,and homogeneity of variance test variables.Results:(1)189 PHT children enrolled in this study successfully completed TET.The median METs value at the TET termination was 9.5(8.3,11.5)ml/(min.kg).There were statistically significant differences in the METs values between males and females[10.3(8.2,12.3)vs 8.6(8.2,10.2),p<0.05].(2)The METs of males were significantly higher than that of females.Age was positively correlated with METs values(p<0.05).BMI,INS and RMAP were significantly correlated with METs(p<0.05).The METs value was lower in children with hypertensive kidney lesion(p<0.05).(3)Age,gender,BMI,total cholesterol(TC),triglycerides(TG),insulin(INS),resting mean arterial pressure(RMAP),and hypertensive kidney lesion were selected as optimal predictive factors to construct the prediction model by using the full subset regression method.Conclusions:Age,gender,BMI,RMAP,and hypertensive kidney lesion were independent influencing factors for METs values.A prediction model integrating age,sex,BMI,TC,TG,INS,RMAP,and kidney impairment had reliable diagnostic performance.The study may be useful for the prediction of PHT exercise intensity in children.