title: Frequency of diarrhoea as a predictor of elevated blood pressure in children.
abstract: BACKGROUND
  Diarrhoeal illness is a major public health problem for children worldwide, particularly among developing countries, and is a proxy condition for severe dehydration. It has been hypothesized that severe dehydration in the first 6 months of life could be associated with increased blood pressure later in life. This study aimed to explore whether frequency of diarrhoea is associated with elevated blood pressure in children in a setting with a high incidence of diarrhoeal disease.
  
  
  METHODS
  The present study is a cross-sectional study of blood pressure among children from a longitudinal child diarrhoeal disease cohort in Lima, Peru. From 2001 to 2006, daily diarrhoeal surveillance was made. Children were revisited in 2006 and blood pressure was measured. Diarrhoeal exposures were evaluated in terms of total number of diarrhoea days, number of episodes of diarrhoea, persistent diarrhoeal episodes and by the quartiles of daily incidence and episode incidence of diarrhoea.
  
  
  RESULTS
  The overall incidence of diarrhoeal episodes at age under 1 year was 4.35 (95% confidence interval: 3.79-4.98) and under 5 years was 2.80 (95% confidence interval: 2.69-2.92). No association was observed between the total number of diarrhoeal days, diarrhoeal episodes or diarrhoeal incidence rates with childhood blood pressure. There was weak evidence that hospital admission due to severe dehydration in the first year of life showed a gradient towards an increase in both, systolic and diastolic blood pressure.
  
  
  CONCLUSIONS
  In the first study to date to examine the association in a setting with a high incidence of diarrhoeal disease, diarrhoeal frequency did not show an association with increased blood pressure. Our observations of elevated levels of blood pressure among those admitted into hospitals in the first year of life are in line with the original hypothesis of dehydration in early infancy and high blood pressure. However, the effect of episodes of severe dehydration on later blood pressure remains uncertain.
authors.affiliation: Noncommunicable Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. jaime.miranda@lshtm.ac.uk
authors.forename: Juan Jaime
authors.initials: JJ
authors.lastname: Miranda
authors.forename: Alisha R
authors.initials: AR
authors.lastname: Davies
authors.forename: George Davey
authors.initials: GD
authors.lastname: Smith
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
authors.forename: Lilia
authors.initials: L
authors.lastname: Cabrera
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: Héctor H
authors.initials: HH
authors.lastname: García
authors.forename: Ynes R
authors.initials: YR
authors.lastname: Ortega
authors.forename: Vitaliano A
authors.initials: VA
authors.lastname: Cama
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003681:Dehydration / Q000150:complications; D003968:Diarrhea, Infantile / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007223:Infant; D010568:Peru / Q000453:epidemiology