Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion School Study

• Published in: Journal of human hypertension Vol. 23; no. 8; pp. 512 - 520
• Main Authors: KARATZI, K, PROTOGEROU, A, RARRA, V, STERGIOU, G. S
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.08.2009
• Subjects: Adolescent; Adolescents; Age Factors; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure; Blood Pressure Determination - methods; Body height; Body Mass Index; Body Weight; Cardiology. Vascular system; Child; Children; Comorbidity; Complications and side effects; Diastole; Electronic equipment; Female; Greece - epidemiology; Humans; Hypertension; Hypertension - diagnosis; Hypertension - epidemiology; Hypertension - physiopathology; Male; Medical sciences; Metabolic diseases; Obesity; Obesity - epidemiology; Obesity - physiopathology; Obesity in adolescence; Obesity in children; Office Visits; Physiological aspects; Prospective Studies; Risk factors; Students - statistics & numerical data; Systole; Teenagers; Greece; Human; Hypertension; Obesity; Nutrition disorder; Cardiovascular disease; Body mass index; School; office blood pressure; Adolescent; Arterial pressure; Blood pressure; obesity in children and adolescents; home blood pressure; Child; Nutritional status
• ISSN: 0950-9240; 1476-5527
• DOI: 10.1038/jhh.2008.158

Obesity is related to office blood pressure (OBP). Important discrepancies exist between OBP and home blood pressure (HBP), providing complementary information for the management of hypertension. The association between obesity and HBP has not been investigated in children. The evidence on the role of obesity in the predominance of systolic blood pressure (SBP) over diastolic (DBP) in paediatric hypertension is limited. A total of 778 healthy subjects aged 6-18 years were recruited in this study. OBP and HBP were measured using electronic devices validated in children. Anthropometric measurements were measured and expressed as z-scores for height or age. Among all indices of obesity (z-scores), body mass index (BMI) showed the best association with BP. The effect of obesity (BMI) was more pronounced on: (i) SBP than DBP and (ii) H-SBP than O-SBP (O-SBP: r2=0.09, O-DBP: r2=0.05, H-SBP: r2=0.12, H-DBP: r2=0.06). The prevalence of systolic hypertension was higher than that of diastolic hypertension. This difference was significant only in office readings and independent from obesity (normal weight: 6.3% systolic hypertension versus 1.2% diastolic; obese: 37.9% versus 6.9%, P<0.05 for both). These data imply that in children and adolescents the z-score of BMI is the most appropriate index of the association between BP and obesity. It also suggests that obesity is probably more closely associated with home than office BP. Finally, although obesity appears to affect SBP more than DBP, these results suggest that the predominance of systolic hypertension in children and adolescents might not be only related to obesity but also to the measurement setting (office).