| Part 1Study on the Distribution and Determinants of Brachial Blood Pressures among Children and Adolescents in Xinzhuang Community of ShanghaiObjectives:To investigate the distribution and determinants of brachial blood pressure among children and adolescents in Xinzhuang Community,Shanghai,so as to provide reference information for the prevention and treatment of hypertension in children and adolescents.Methods:In the frame of the routine physical examination of primary and secondary school students in Xinzhuang Town of Shanghai,we invited students aged 7-17 years to participate in our study.Brachial blood pressure was measured three times consecutively by the Omron HBP 1100 electronic sphygmomanometer at the sitting position.The average values were analyzed.The general demographic data,medical history,birth history,medication status,maternal pregnancy-labor history,parents' smoking habits and history of hypertension and diabetes and family history were inquired by the questionnaire.EpiData 3.0 software was used for dual-track data input.SAS 9.4 software was used for data management and statistical analysis.High blood pressure,overweight and obesity,and high waist circumference were defined according to the criteria issued by the Chinese Ministry of Health in the year of 2018.Student t-test or analysis of variance were used to compare the means,and chi-square test to compare the rates,and multiple linear or logistic regression models to analyze the relationship of blood pressure with age,sex,BMI and other factors in children and adolescents.Results:1)A total of 14715 subjects were included in the analysis,of whom 7703 were boys(52.4%)and 7012 were girls(47.6%).2)The blood pressure was approximately normally distributed,with an average of 117.0±12.3/74.4±7.8 mmHg.Boys had a higher mean systolic blood pressure(118.6±12.4 mmHg)than girls(115.2±11.8 mmHg,P<0.05).The difference in diastolic blood pressure between boys(74.3±7.8 mmHg)and girls(74.4±7.7)was not statistical significant.3)The prevalence of overweight,obesity and high waist circumference was 17.3%,13.9%and 18.0%,respectively.Both systolic and diastolic blood pressures were higher in the group of obesity(122.8±13.5/76.2±8.0 mmHg)than that in the group of overweight(120.3±12.3/74.7±7.7 mmHg)and the group with normal BMI(115.1±11.4/73.9±7.7 mmHg).Similar results were observed in the comparisons among students with high waist circumference(122.6±13.2/75.8±7.9 mmHg),high-normal waist circumference(118.9±11.9/74.7±7.8 mmHg),and normal waist circumference(115.1±11.5/73.9±7.7 mmHg).Differences between the above groups were all significant(P<0.01).4)Systolic blood pressure was positively correlated with age(r=0.208,P<0.001)and body height(r=0.302,P<0.001);diastolic blood pressure was also positively correlated with age(r=0.033,P<0.001)and height(r=0.071,P<0.001).5)The multiple linear regression analysis showed that both systolic and diastolic blood pressures were correlated with age,BMI,father hypertension and mother pregnancy-induced hypertension,while systolic blood pressure was additionally positively associated with male sex and waist circumference,and diastolic blood pressure with mother hypertension.6)The prevalence of high brachial blood pressure was 44.8%.Age,BMI,father or mother hypertension were independent determinants of high brachial blood pressure.Conclusions:Based on electronic blood pressure measurement at a single visit of physical examination,the prevalence of high blood pressure was high in children and aldolescents in the Xinzhuang Community,Shanghai.In addition to the inreversible factors,such as age and parents hypertension,blood pressure of children and adolescents was associated with BMI and waist circumference,indicating that the rapid prevalence of overweight and obesity likely cause the outbreak of hypertension in children and adolescents.Obesity control is a key point of hypertension control in children and adolescents.Part2Distribution and Determinants of Central Blood Pressures among Children and Adolescents in Xinzhuang Community,ShanghaiObjectives:In order to provide some reference information for the blood pressure control in children and adolescents,we analyzed the distribution of central blood pressure and its correlation with peripheral brachial blood pressure among children and adolescents in the Xinzhuang Community,Shanghai,and explored the determinants of the central blood pressure and the status of central systolic blood pressure in children and adolescents with isolated brachial systolic high blood pressure.Methods:The inclusion and exclusion criteria,the questionnaire survey,anthropological measurements,brachial blood pressure measurements,and the definitions of overweight,obesity,and etc.were the same as that in the first part of this study.Central arterial pressure was measured with the Australia-made SphygmoCor-xcel pulse wave analyzer.Pulse waves and blood pressure were recorded and measured at the brachial artery with a cuff in an appropriate size.Central systolic pressure and other central hemodynamic parameters were estimated and automatically output with the use of transfer function by running the built-in software.The distribution of central blood pressure was analyzed in subjects with normal brachial blood pressure according to the same criteria of age and body height.High central systolic blood pressure was defined as a central blood pressure above the 95th percentile in each group according to sex,age and body height.Student t-test or analysis of variance were used to compare the means,and chi-square test to compare the rates,and multiple stepwise linear regression models to analyze the determinants of central systolic blood pressure.Results:1)The mean of the central systolic blood pressure was 111.1±10.7 mmHg in the 5056 participating students.Boys(111.0±10.7 mmHg)and girls(111.3±10.7 mmHg)had similar central systolic blood pressure.2)Peripheral brachial systolic blood pressure(123.3±12.5 mmHg)was significantly higher than that of central artery.Central systolic blood pressure was positively correlated with peripheral systolic blood pressure(r=0.94,P<0.001).3)The central systolic blood pressure increased with waist circumference and BMI.Central systolic blood pressure was higher in the group of obesity(116.6±11.7 mmHg)than the group of overweight(112.4±9.8 mmHg),and the group of normal BMI(108.6±9.4 mmHg)?The central systolic blood pressure was also higher in the group of high waist circumference(116.1±11.5 mmHg)than the group of high-normal waist circumference(112.1±9.6 mmHg)and the group with normal waist circumference(108.3±9.3 mmHg).The differences among the groups were all statistical significant(P<0.01).4)Among subjects with isolated high brachial systolic blood pressure,79.9%had normal central pressure,and only 20.1%had elevated central systolic blood pressure.5)Irrespective of in the 2911 boys or in the 2145 girls,central systolic blood pressure was positively correlated with BMI,waist circumference,and heart rate.In addition,central systolic blood pressure in boys was associated with mother hypertension and that in girls with father hypertension.In the multiple stepwise regression analysis in boys and girls combined,the partial r-square of BMI was largest among all the covariates.Conclusions:Preperal brachial systolic blood pressure was higher than central systolic pressure in children and adolescents.Only 20%of the children and adolescents with isolated high brachial systolic blood pressure had an increased central systolic blood pressure.Central systolic blood pressuer was associated with age,sex,waist circumference,BMI,heart rate,and parents hypertension,indicating that body weight control was important in keeping normal central blood pressure.Healthy life style should be actively implemented in children and adolescents. |
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