Isolated systolic hypertension, obesity, and hyperkinetic hemodynamic states in children.
OBJECTIVE
To determine the factors that contribute to the pathogenesis of isolated systolic hypertension in children.


METHODS
School-based measurement was performed of blood pressure (BP), heart rate, weight, and height in 2460 students (49% Hispanic, 31% black, 13% white) 12 to 16 years of age in 8 urban public schools. An independent group of 71 untreated children underwent 24-hour ambulatory BP monitoring (ABPM) to confirm clinic hypertension and assess circadian BP patterns.


RESULTS
Hypertension and obesity were found in 17% and 23% of students, respectively. Among hypertensive students, 88% (363/413) had isolated systolic hypertension. Hypertension was more prevalent in obese than nonobese students (33% vs 11%, P <.0001). Obese hypertensive students had higher resting heart rate than nonobese normotensive patients (85.9 vs 79.6 beats/min, P <.001). Among patients who underwent ABPM, isolated systolic hypertension was found in 51% (36/71) by clinic BP and in 62% (18/29) with confirmed hypertension by ABPM. Blood pressure variability during daytime and sleep periods was higher in obese than nonobese patients for systolic BP (P <.01) and diastolic BP (P <.05).


CONCLUSIONS
The findings of increased heart rate and BP variability in obese children with isolated systolic hypertension suggest that sympathetic nervous system hyperactivity may contribute to its pathogenesis.
Sorof
Jonathan M
JM
Department of Pediatrics, University of Texas-Houston Medical School, Houston, Texas 77030, USA.
Poffenbarger
Tim
T
Franco
Kathy
K
Bernard
Lillian
L
Portman
Ronald J
RJ
D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D003971:Diastole; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D009765:Obesity / Q000503:physiopathology*; D012189:Retrospective Studies; D013564:Sympathetic Nervous System / Q000503:physiopathology; D013599:Systole