Search

The present article intends to provide an update of the article "Focus on prevention, diagnosis and treatment of hypertension in children and adolescents" published in 2013 (Spagnolo et al., Ital J Pediatr 39:20, 2013) in this journal. This revision is justified by the fact that during the last years there have been several new scientific contributions to the problem of hypertension in pediatric age and during adolescence. Nevertheless, for what regards some aspects of the previous article, the newly acquired information did not require substantial changes to what was already published, both from a cultural and from a clinical point of view. We felt, however, the necessity to rewrite and/or to extend other parts in the light of the most recent scientific publications. More specifically, we updated and extended the chapters on the diagnosis and management of hypertension in newborns and unweaned babies, on the use and interpretation of ambulatory blood pressure monitoring, and on the usefulness of and indications for physical activity. Furthermore, we added an entirely new section on the role that simple carbohydrates (fructose in particular) and uric acid may play in the pathogenesis of hypertension in pediatric age.

Aim: A study was conducted on children from a junior high school in Rome, Monteverde district, to observe data on hypertension and obesity. Data were compared with results from the study carried on two years ago in the same school by the same working group., Methods: The study enrolled 336 students, 52% males and 48% females. Blood pressure was measured with Omron 2 automatic monitor, with child cuffs. Weight and height were measured with Seca scale with stadiometer. We assessed hypertension by means of recent Task Force Tables, overweight and obesity with the tables by Cole et al., Results: A proportion of 5% of screened children presented hypertension, 13.9% overweight, 2.3% obesity., Conclusion: Prevalence of hypertension, overweight and obesity was lower than prevalence observed two years ago in the same school, thanks to a change in eating habits which included breakfast promotion, adoption of correct food choices for lunch and dinner, and most of all an increase in extracurricular sports activity, currently performed by 92% of students.

The European Society of Hypertension has recently published its recommendations on prevention, diagnosis and treatment of high blood pressure in children and adolescents. Taking this contribution as a starting point the Study Group of Hypertension of the Italian Society of Pediatrics together with the Italian Society of Hypertension has conducted a reappraisal of the most recent literature on this subject. The present review does not claim to be an exhaustive description of hypertension in the pediatric population but intends to provide Pediatricians with practical and updated indications in order to guide them in this often unappreciated problem. This document pays particular attention to the primary hypertension which represents a growing problem in children and adolescents. Subjects at elevated risk of hypertension are those overweight, with low birth weight and presenting a family history of hypertension. However, also children who do not present these risk factors may have elevated blood pressure levels. In pediatric age diagnosis of hypertension or high normal blood pressure is made with repeated office blood pressure measurements that show values exceeding the reference values. Blood pressure should be monitored at least once a year with adequate methods and instrumentation and the observed values have to be interpreted according to the most updated nomograms that are adjusted for children's gender, age and height. Currently other available methods such as ambulatory blood pressure monitoring and home blood pressure measurement are not yet adequately validated for use as diagnostic instruments. To diagnose primary hypertension it is necessary to exclude secondary forms. The probability of facing a secondary form of hypertension is inversely proportional to the child's age and directly proportional to blood pressure levels. Medical history, clinical data and blood tests may guide the differential diagnosis of primary versus secondary forms. The prevention of high blood pressure is based on correct lifestyle and nutrition, starting from childhood age. The treatment of primary hypertension in children is almost exclusively dietary/behavioral and includes: a) reduction of overweight whenever present b) reduction of dietary sodium intake c) increase in physical activity. Pharmacological therapy will be needed rarely and only in specific cases.

Objectives: A study was carried out on students of a middle school with a medium-high social level in a southern zone of Rome, to assess the current situation regarding obesity and arterial hypertension in subjects with a parental environment favouring correct eating habits., Materials and Methods: We considered 693 students, mean age 11.2 + 0.6. Hypertension was defined according to blood pressure (BP) tables for children and adolescents of the NIH - Fourth Report (systolic and diastolic BP >95th percentile for age and sex). Overweight and obesity were determined according to the International Obesity Task Force. Dietary habits and life-style were investigated by specific questionnaires., Results: The prevalence of overweight and obesity was respectively 23.1% and 3.3% of the subjects studied. Moreover, 5.2% of them showed BP values between 90th and 95th percentile and 7.8% was hypertensive. Food habits of the current students were fairly correct, favouring the Mediterranean diet and with the proper number of daily meals., Discussion: A justification for the high number of hypertensive could be due to the elevated consumption of salt added to food (60% of young people), the elevated frequency of those who often eat fast food (43%) and a family history of hypertension in the parents (24%). Only 24.5% of males and 22.9% of females used to practice physical activity; whereas 40% of males and 41% of females used to spend more than 3 hours a day in front of the TV and/or computer.

Aim: The main objective of the study was to assess the prevalence of obesity, overweight and blood hypertension amongst children and adolescents., Methods: The study enrolled 2045 students between 6 and 17 years of age in three Italian cities, Varese (in the North), Rome (in the Center) and Catanzaro (in the South)., Results: The findings demonstrate that the obesity rate is 3.5% in the North, 6.1% in the Center and 8.8% in the South; these figures represent an increase both in the North and in the South. At the same time, the incidence of arterial hypertension has increased in respect to past years with 5.5% of the total study population diagnosed with hypertension over the 95 degrees percentile and 7.1% with borderline hypertension. Parental obesity has been demonstrated to be a key factor in determining the presence or level of obesity in their children., Conclusion: Obesity and arterial hypertension represent a worrisome departure point for a dangerous metabolic syndrome and hence require the full dedication of pediatricians in order to prevent the disease, with an urgent need for school interventions, support for a healthy diet and insistence on the necessity of adequate daily exercise.

Purpose. To evaluate the relationship between overweight/obesity and dietary/lifestyle factors among Italian adolescents. Methods. On a total of 756 adolescents with mean age 12.4 +/- 0.9, body mass index, food consumption, and time dedicated to after school physical activities and to TV viewing were determined. The data were analysed according to age, nutritional status, and gender. The analysis of variance and multiple logistic regression analysis were performed to investigate the association between dietary/lifestyle factors and overweight/obesity. Results. The percentages of overweight and obesity were, respectively, 28% and 9% among boys, 24% and 7% among girls. The overweight/obesity condition in both genders was associated with parental overweight/obesity (P < .001 for mother), less time devoted to physical activity (P < .001 for boys and P < .02 for girls) and being on a diet (P < .001). Direct associations were also observed between BMI and skipping breakfast and the lower number of meals a day (boys only). Conclusions. This pilot study reveals some important dietary and lifestyle behaviour trends among adolescents that assist with identification of specific preventive health actions.

Aim of the study was to detect the prevalence of hypertension among 11-14 years old schoolchildren (n. 487, mean age 12.7 +/- 0.9). The influence on blood pressure (BP) of body mass index (BMI), dietary habits (frequency of breakfast and food items consumption) and life-style was also investigated. Hypertension was defined according to blood pressure tables for children and adolescents of the NIH-Fourth Report (systolic and diastolic BP >95th percentile for age and sex). Overweight and obesity were determined according to the International Obesity Task Force Dietary habits and life-style were investigated by specific questionnaires. The prevalence of overweight and obesity was respectively 31.8% and 10.3% of the subjects studied. Moreover 10.3% of them showed BP values between 90th and 95th percentile and 10.1% was hypertensive. In general the prevalence of overweight (p < 0.05), obesity (p < 0.001) and sedentary activity (p < 0.05) was higher in hypertensive adolescents. The multivariate logistic regression analysis showed a direct association between obesity (OR = 4.35; IC 95% = 2.24-8.44), sedentary life-style (OR = 2.38; IC 95% = 1.17-4.63) and hypertension. Food habits were not associated with BP levels. The results confirmed that an increase of cardiovascular risk in early age was correlated with the increase of the prevalence of obesity and sedentary life-style. Regular measurement of BP together with healthy dietary and life-style indications are recommended to overweight/obese children and adolescents.

Aim: The aim of this study was to investigate the prevalence of overweight/obese and hypertensive roman adolescents belonging to a medium-low social environment. The purpose of this research was also to find out the correlations between high blood pressure and obesity, dietary habits and physical activity., Methods: Nutritional status of 474 subjects (age 12.7+/-0.9 years) of a low-medium social class public school was assessed by measuring height, weight and waist circumference according to international indications. Over-weight and obesity were defined by body mass index (BMI) according to International Obesity Task Force (IOTF). Blood pressure (BP) was measured in duplicate and hypertension was defined by international percentiles. Food habits and lifestyle were investigated by a questionnaire. Multivariate logistic regression was used to relate variables., Results: The prevalence of overweight and obese adolescents was respectively 31.7% and 10.3% with a slight higher presence of males in both cases. The whole sample showed a prevalence of hypertension of 10.1%. Systolic and diastolic BP showed a direct association with BMI and waist circumference (P<0.01). BMI and systolic and diastolic BP were lower in active students (>7 h a week of physical activity). Food habits were not associated with hypertension., Conclusions: The high prevalence of hypertensive adolescents could be explained with the consistent number of overweight/obese subjects, their social medium-low context and their being sedentary. As reported in literature, all these factors may contribute to the ''metabolic syndrome'' aetiology.

Aim: The aim of this research was to evaluate the incidence of hypertension in adolescents by assessing their anthropometric measurements and diet, since recent literature data suggest that 30% of obese adolescents are hypertensive., Methods: The 293 schoolchildren engaged in the study were aged 11-14 years and 54% were male. They attended a Secondary School in Rome with a middle-high class background. Blood pressure, heart rate, weight, height, tricipital and subscapular skinfolds and body mass index (BMI) were measured and dietary patterns assessed through 24-h recall. The findings were then statistically evaluated., Results: The incidence of hypertension was 6.5%, without distinction between sexes. On the basis of the statistical evaluation of the correlations between hypertension and obesity, familial hypertension, weaning with the addition of salt and bottle-feeding from birth, only obesity was found to be statistically significant (p<0.001). Even though the hypertensive adolescents had a high intake of snacks, salt, meat, sausages and cheese in their daily diet, only the excess of proteins was statistically significant (p<0.05). The incidence of obesity (calculated as being 20% over the ideal weight for a given height) was 17.3%. This finding was confirmed by the mean value of the both skinfolds, whereas BMI, for which obesity and overweight were considered together, showed a slight overestimation of this percentage., Conclusion: A high number of hypertensive adolescents was found, about 1/3 of the obese adolescents examined. This confirms the findings of an extensive study previously carried out by the Group of Hypertension of the Italian Society of Pediatrics. From a nutritional point of view, the excessive intake of proteins of the 19 hypertensive adolescents was found to be statistically significant. However, a more extensive study could probably provide further data on other nutrients which, in this case, were not quite statistically significant.

The present study investigates how blood pressure (BP) circadian rhythm (CR) changes in its rhythmic properties as a function of chronological age in normotensive healthy subjects (NHS). The age-related trend for BP CR was investigated via the Clinospectror method, a periodic-linear analysis of regression for rhythmic parameters. The study was performed on 437 NHS (219 males and 218 females, ranging in age from 1 year to 102 years), who were monitored in their 24-h BP via a noninvasive automated recorder. An age-related trend was detected for the three properties of BP CR, i.e., mesor (M), amplitude (A) and acrophase (cent). Such a trend was positive for M and A, and negative for cent. According to the clinospectrometric formula, the BP CR can be classified as a "dianaclinous rhythm", i.e., a rhythm which increases in its oscillatory level and extent with advancing years. The documented age-related trend for the rhythmic properties suggests that the biological clock which regulates the BP CR in human beings undergoes a resetting of its mechanisms of tonic, amplitude and phasic modulation as a function of chronological age. The readjustment of the pressure clock may be regarded as one of the physiological features which characterize the aging process in human beings.

Objectives: To develop a national standard level of blood pressure (BP) for Italian children on the basis of a large sample of the population., Design: We analyzed data available from 21 Italian studies conducted according to the recommendations of the American Task Force between 1988 and 1994. Percentile curves of systolic and diastolic BP were constructed by fitting a third-order polynomial model of BP on age and height using multiple regression analysis., Participants: BP was measured in 11 519 healthy individuals (6258 boys and 5261 girls) aged 5-17 years in various locations throughout Italy. All measurements were performed at school., Results: Percentile curves (5th, 10th, 25th, 50th, 75th, 90th and 95th) of systolic and diastolic BP are reported by age and by height for males and females., Conclusions: With respect to the American standards, the levels in Italy for the 90th and 95th percentiles were 3-8 mmHg higher for systolic and diastolic BP in both sexes between 5 and 12 years of age, and 2-3 mmHg higher in older males. With respect to Northern Europe, in the lower ages, levels in Italy were quite similar, although slightly higher, whereas in late adolescence, the Northern European levels were much higher, especially in males, with differences of 4-5 mmHg for the mean values and 8-12 mmHg for the 95th percentile.

Using a 24 hour monitoring of the systo-diastolic blood pressure, 127 new born babies were studied in the first five days of life. 45 of these new born babies were premature (35 +/- 1 week) and 82 full-term. The results showed an overlap in the systo-diastolic blood pressure in the 2 groups of subjects with a rise and fall in pressure in the 24 hour period and no fall in pressure during the night typical to a healthy adult.

During the first five days of life, 102 babies, 41 premature births (35 +/- 1 weeks) and 61 in time have been studied, through a 24 hours monitoring of the systo-diastolic arterial pressure. The results show that the systo-diastolic arterial pressure is overlap in both groups of subjects, with an "intermittent" trend during the 24 hours, without falling of night-pressure typical in the healthy grown-up. In the research also mono and biovular twins have been included who showed a pressure trend, during the 24 hours, very much alike in the two subjects.

The systolic and diastolic blood pressure was monitored on healthy subjects of different ages, spanning from newborns (24-48 hs old, to elderly age (70-80 years old). Each subject was monitored for 15 minutes, and the pressure values collected every minute. This protocol allowed a statistical evaluation of both inter- and intraindividual variabilities among and within different class ages. As expected, increasing age is paralleled by a marked increase in the average values of systolic blood pressure; the trend of variabilities around the average, however, as traced by standard deviations, is just the opposite: a marked decrease going from newborns to adults is accompanied--in most cases--by a statistically significant difference in the same direction also between adults and old men. This can be rationalized, in the light of recent findings on the role of deterministic chaos in the functional behaviour of complex biological systems, in terms of decreased functional flexibility characteristic of the aging process.

The research in particular the incidence of obesity, hypertension and hyperlipemia was evaluated involved 201 primary school children. The results show an obesity percentage equal to 28%; 23% of the young were hypercholesterolic and 21% had hypertriglyceridemia. Nobody was hypertensioned. The high percentage of obese and hjperlipemic subjects suggest the immediate needs of Courses of alimentary education in schools, as well as to resort to sound daily sporting activity.

We controlled, after nine months, 29 obese children, who attended the primary school, and to whom it was advised a good balanced base diet of 1200 kcal. One child wasn't obese anymore, and in 13 cases there was a sensible reduction of overweight percentage. We consider these results positively, because our aim was to obtain a gradual resolution of the overweight, trying to avoid some very dangerous relapses for the young's future. Finally, we underline the necessity to begin some conferences about the young's and family's alimentary education, as soon as possible. These conferences have to be addressed to all the teachers, parents and pupils, from the primary school.

This study investigates 263 full-term clinically healthy newborn babies: subdivided into two groups depending on a positive (113 individuals) or negative (150 subjects) family history for hypertension. The babies were comparable for body weight and statural height and equipartitioned into males and females. The infants underwent a non-invasive, automated monitoring of blood pressure during the first three days of their life, according to protocol in which the systolic and diastolic measurements were performed at 1 min intervals over 15 minutes. The babies of the two groups showed superimposable mean values for systolic and diastolic blood pressure. However, the neonates with a positive familiarity for hypertension showed a higher number of systolic readings above the reference limit of 90 mmHg. The higher incidence of the abnormally-elevated systolic values (> 13%) in babies with a positive familiarity for hypertension was seen to be significant, suggesting that their blood pressure pattern is characterized by a larger variability at least in the systolic component. Such a wider variability may be regarded as a phenotypic expression of the genetic predisposition to hypertension, whose risk can be detected by a short-term monitoring of BP soon after the birth.

A long-term follow-up which is still being carried out was started in the school-year 1985-86 in a Primary School of Rome and we suggested a written diet of 1300 calories and correct physical exercises. During this long follow-up we studied the changes in percentage of obesity of these subjects, considering their familiarity with obesity. It resulted that after a starting benefit due to the diet and the sport activity, which lasted till 1989, the youngsters with familiarity have subsequently regained the initial situation in 62.5% of cases, unlike those without familiarity who have kept themselves slim in 75% of cases. Even many other facts have been considered, as for example the psychologic approach, blood-tests for cholesterol, triglycerides etc, arterial pressure and above all a very careful feeding recall that has shown as the now obese subjects intake more calories than not obese one, with and excess of calories from fats to the detriment of carbon hydrates.

The complexity of the cardiovascular function is related to a wide interindividual variability (VA) that changes with age. The aim of our study was to investigate the spontaneous blood pressure (BP) VA in 3 groups of 20 healthy subjects (S) each, 10 M and 10 F: Group I newborns 24 hours old; Group II 30-40 yrs; Group III 70-80 yrs. Each S underwent BP monitoring in a comfortable condition for 15'. Our data show an increase, with age, of both the average systolic and diastolic BP, paralleled by a simultaneous decrease of their standard deviations. Furthermore, the three distributions show a reasonably gaussian behaviour (maximum absolute value of the skewness was 0.21). These results emphasize the age-dependent reduction in functional flexibility of the cardiovascular system. A major pool of subjects is required to confirm our preliminary data.

Ochratoxin A (OA) is a mycotoxin detected in a variety of food and feeds mostly from countries with temperate or continental climate, because the fungi that produce it, mainly Aspergillus ochraceus, Penicillium verrucosum, and Penicillium viridicatum, can grow under a great variety of climate conditions. The aim of this article was, firstly, to confirm the occurrence of OA in human milk in Italy. Then, a preliminary calculation of OA intake via human milk was made, from ingested food. For this investigation, food and milk samples were collected, continuously for a week, from 4 lactating mothers. The obtained results revealed a significant exposure of sucklings and mothers to OA levels higher than the tolerable daily intake as estimated from animal models. On the basis of these data, a major effort in planning surveillance and research programs to control OA contamination in food, feed, and biological fluids should be pursued.

Two hundred new mothers who breastfed their babies were followed over a 2-month period. The nursing mothers' diet was monitored with both qualitative and quantitative suggestions according to modern dietary recommendations. A detailed questionnaire allowed the knowledge of new mothers to be analysed in relation the advantages of breast-feeding, desire to breast-feed, possible breast-feeding of the nursing mother herself, early attachment of the baby to the breast, etc. After 2 months, each mother completed a dietary recall showing how her diet had been corrected both quantitatively and qualitatively. The large number of nursing mothers who had given birth spontaneously and were still breastfeeding (72%) compared to 28% of those undergoing cesarean sections revealed, in view of the equal diet followed, a penalising problem relating to a structural deficiency at a hospital level. In the case of cesarean sections in Italian hospitals, the mother does see her newborn baby and therefore put it to the breast before it is 3-4 days old.