Hypertension up to Six Times More Likely in Obese vs Slim Youth

Selected by Pietro Cazzola

HypertensionBARCELONA, SPAIN — Compared with children of normal weight, obese girls were 5.9 times more likely to have hypertension and obese boys were 4.3 times more likely to have hypertension, in a new study[1]. Even being overweight upped the risk of prehypertension and hypertension in this community-based study of more than 22 000 young people.
Prof Peter Schwandt (Atherosclerosis Prevention Institute, Munich, Germany) presented these findings from the Prevention Education Program (PEP) Family Heart Study in a press briefing and then at a moderated poster session at the European Society of Cardiology (ESC) 2014 Congress
Overall, the prevalence of hypertension increased stepwise—from 5.4% in normal-weight participants to 9.8% in overweight participants to 21.5% in obese participants. The children had a mean age of seven, and the adolescents had a mean age of 14.
These findings clearly show that the more overweight young people are, the greater their risk of prehypertension or hypertension, Schwandt told the press, "so any weight loss they can achieve by making lifestyle changes will help to reduce this risk" for hypertension and thus their risk for CVD.
"Each adipocyte is paving the way for hypertension, even in children," ESC spokesperson Dr Pedro Marques-Vidal (Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland) commented. "I don't know how many of you have children who are age seven. Imagine, some of them are already hypertensive now. How will they be when they are 80?" This study reinforces the need to teach children good lifestyle habits in school, by implementing policies where children have regular physical activity and learn about and have access to healthy food, he added.

PEP Study Probes CVD Risk in Children 
The PEP Family Heart Study is a prospective, observational study of CVD risk in three- to 18-year-old children and adolescents in Nuremburg, Germany, who were enrolled from 1994 to 2008.
In the current analysis, the researchers determined the body-mass index (BMI), waist circumference, waist-to-height ratio, percentage of body fat, and skinfold thickness in 14 213 children and 7838 adolescents to see whether hypertension was associated with body fat.
These measures are simple and inexpensive, Schwandt said. However, they must be performed correctly, using age- and gender-specific cutoffs for growing children and adolescents.
Similarly, "you have to measure blood pressure very carefully in children and adolescents—three times on separate occasions," he stressed. Prehypertension is a blood pressure in the 90th to 95th percentile for children of the same age, sex, and height, or a reading of 120/80 mm Hg or greater, and hypertension is a blood pressure in the 95th percentile or greater, he said.
Compared with having a normal weight, the odds for prehypertension increased from 1.6 to 1.8 among boys who were overweight or obese, respectively, and from 1.8 to 2.1 among girls who were overweight or obese, respectively.
Similarly, compared with their thin peers, being heavy greatly upped the risk of having hypertension; the odds increased from 2.7 to 4.3 among boys who were overweight or obese, respectively, and from 2.1 to 5.9 among girls who were overweight or obese, respectively.
Having a large waist circumference and a large waist-to-height ratio were even better predictors of early hypertension than having an elevated BMI.
These findings highlight the need to measure blood pressure in overweight children and take action to help them lose weight, Schwandt summarized.

Start Early to Thwart Childhood Obesity
In a comment, ESC spokesperson Prof Heinz Drexel (VIVIT-Institut, Feldkirch, Austria) agreed. "[The] main message was that you should look at overweight in young people, because that is associated with hypertension at a very early age. The second message is . . . the waist circumference measured at the right point . . . is a very good predictor of future events."
Press-briefing cochair Prof Joep Perk (Linnaeus University, Health and Caring Sciences, Kalmar, Sweden) said that "in the World Health Organization, we say that 80% of all cardiovascular disease could easily be prevented." This study shows that "if you want to do it, do it early. . . . I think this is an excellent study that shows that we should simply not accept obesity in children. We should counsel the parents. We should help the kids. We should create an environment where play is allowed and pleasant," he said.
Moreover, "we should focus on the onset of disease, which is the four-, five-, six-, seven-, and eight-year-old . . . and not wait until the children are 16, 17, or 18."

References

  1. Schwandt P, ScholzeJE, BertschT, et al. Body fat distribution and elevated blood pressure in 22051 youths: The PEP Family Heart Study. European Society of Cardiology (ESC) 2014 Congress; September 1, 2014; Barcelona, Spain. Abstract P2992

​​Marlene Busko