Dietary Approaches to Stop Hypertension Dietary Intervention Improves Blood Pressure and Vascular Health in Youth With Elevated Blood Pressure

This randomized control trial assessed the post-intervention and 18-month follow-up effects of a 6-month dietary approaches to stop hypertension (DASH)-focused behavioral nutrition intervention, initiated in clinic with subsequent telephone and mail contact, on blood pressure (BP) and endothelial function in adolescents with elevated BP. Adolescents (n=159) 11 to 18 years of age with newly diagnosed elevated BP or stage 1 hypertension treated at a hospital-based clinic were randomized. DASH participants received a take-home manual plus 2 face-to-face counseling sessions at baseline and 3 months with a dietitian regarding the DASH diet, 6 monthly mailings, and 8 weekly and then 7 biweekly telephone calls focused on behavioral strategies to promote DASH adherence. Routine care participants received nutrition counseling with a dietitian consistent with pediatric guidelines established by the National High Blood Pressure Education Program. Outcomes, measured pre- and post-intervention and at 18-months follow-up, included change in BP, change in brachial artery flow-mediated dilation, and change in DASH score based on 3-day diet recalls. Adolescents in DASH versus routine care had a greater improvement in systolic BP (–2.7 mm Hg, P = 0.03, –0.3 z-score, P =0.03), flow-mediated dilation (2.5%, P =0.05), and DASH score (13.3 points, P <0.0001) from baseline to post-treatment and a greater improvement in flow-mediated dilation (3.1%, P =0.03) and DASH score (7.4 points, P =0.01) to 18 months. The DASH intervention proved more effective than routine care in initial systolic BP improvement and longer term improvement in endothelial function and diet quality in adolescents with elevated BP and hypertension. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00585832.

Análise dos desfechos materno-fetais em gestantes com ganho ponderal inadequado atendidas no ambulatório de pré-natal da Universidade Brasil, em Fernandópolis, São Paulo, Brasil

Sendo o peso pré-gestacional reconhecido com um dos principais determinantes do ganho ponderal na gestação e o acompanhamento do ganho ponderal nesse período um procedimento acessível e de baixo custo, é de grande utilidade sua análise e controle para possíveis intervenções primárias de prevenção, com promoção à saúde do binômio mãe-feto. Considerando as implicações da obesidade na gestação, esse trabalho objetivou analisar o histórico pré-natal do estado nutricional e possíveis correlações com intercorrências para a saúde materna e a via de parto no Ambulatório de Pré-natal da Universidade Brasil, Fernandópolis, São Paulo, Brasil. Forma avaliados 356 prontuários, considerando as variáveis: índice de massa corpórea na primeira consulta do pré-natal; diagnóstico de diabetes mellitus gestacional; síndromes hipertensivas gestacionais; e a via de parto no período de maio de 2015 a fevereiro de 2017. Dentre a amostra selecionada, 34,2% das gestantes encontravam-se em estado de sobrepeso e 11% de obesidade. A prevalência de diabetes mellitus gestacional foi de 4,2%, dentre as quais 33,3% foram classificadas em sobrepeso e 53,8% em obesidade. Em relação a síndromes hipertensivas gestacionais, o diagnóstico ocorreu em 10,1% da amostra, sendo que desta, 47,2% estavam acima do peso. Já sobre a via de parto, houve prevalência de 46% de partos operatórios, dentre os quais 56% ocorreram em gestantes com sobrepeso ou obesidade. Mediante a transversalidade desta temática, já que o excesso de peso na gestação se correlaciona com o aumento de problemas de saúde materna, além do seu impacto econômico para o país, pode-se concluir que atingir ou permanecer em estado nutricional de eutrofia é fundamental para o desenvolvimento saudável do binômio mão-feto e uma boa assistência pré-natal.Descritores: Gravidez; Peso Corporal; Diabetes Mellitus; Hipertensão; Parto.ReferênciasSilva LS, Pessoa FB, Pessoa DTC. Análise das mudanças fisiológicas durante a gestação: desvendando mitos. Rev FMB. 2015;8(1):1-16.Santos AL, Radovanovic CAT, Marcon SS. Assistência pré-natal: satisfação e expectativas. Rev Rene. 2010;11(Esp.):61-71.Sawada M, Masuyama H, Hayata K, Kamada Y, Nakamura K, Hiramatsu Y. Pregnancy complications and glucose intolerance in women with polycystic ovary syndrome. Endocr J. 2015;62(11):1.017-2.Laporte-Pinfildi ASC, Zangirolani LTO, Spina N, Martins PA, Medeiros MAT. Atenção nutricional no pré-natal e no puerpério: percepção dos gestores da Atenção Básica à Saúde. Rev Nutr. 2016;29(1):109-23.Gonçalves CV, Mendoza-Sassi RA, Cesar JA, Castro NB, Bortolomedi AP. Índice de massa corporal e ganho de peso gestacional como fatores preditores de complicações e do desfecho da gravidez. Rev Bras Ginecol Obstet. 2012;34(7):304-9.Santos JGC, Silva JMC, Passos AMPR, Monteiro BKSM, Maia MM, Silva RA et al. Peso materno em gestantes de baixo risco na atenção pré-natal. Int J Nutrology. 2017;10(2):5-15.Lima EM. Assistência nutricional no pré-natal: avaliação do processo nas Unidades de Saúde da família no município de Vitória de Santo Antão, PE. Vitória de Santo Antão: Universidade Federal de Pernambuco; 2015.Asbee SM, Jenkins TR, Butler JR, White J, Elliot M, Rutledge A. Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling. Obstet Gynecol. 2009;113(2 Pt 1):305-12.Godoy AC. Ganho de peso gestacional – recomendações e adequação entre mulheres brasileiras [dissertação] . Campinas: Universidade Estadual de Campinas, UNICAMP; 2015.World Health Organization. Obesity: Preventing and managing the global epidemic: report of a WHO Consultation. Geneva: WHO Consultation on Obesity; 2000.National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;183(1):S1-22.Santos EMF, Amorim LP, Costa OLN, Oliveira N, Guimarães AC. Perfil de risco gestacional e metabólico no serviço de pré-natal de maternidade pública do Nordeste do Brasil. Rev Bras Ginecol Obstet. 2012;34(3):102-6.Valladares CG, Konka SB. Prevalência de diabetes mellitus gestacional em gestantes de um centro de saúde de Brasília - DF. Comun Ciênc Saúde. 2008;19(1):11-7.Maganha CA, Vanni DG, Bernadini MA, Zugaib M. Tratamento do diabetes mellito gestacional. Rev Assoc Med Bras. 2003;49(3):330-34.Assis TR, Viana FP, Rassi S. Estudo dos principais fatores de risco maternos nas síndromes hipertensivas da gestação. Arq Bras Cardiol. 2008;91(1):11-7.Melo ASO, Assunção PL, Gondim SSR, Carvalho DF, Amorim MMR, Benicio MHD'A et al. Estado nutricional materno, ganho de peso gestacional e peso ao nascer. Rev Bras Epidemiol. 2007;10(2):249-57.Vettore MV, Dias M, Domingues RMSM, Vettore MV, Leal MC. Cuidados pré-natais e avaliação do manejo da hipertensão arterial em gestantes do SUS no Município do Rio de Janeiro, Brasil. Cad Saúde Pública. 2011;27(5):1.021-34.Job HGC, Passini R Jr; Pereira BG. Obesidade e gravidez: avaliação de um programa assistencial. Rev Ciênc Méd. 2005;14(6):503-14.Brasil. Ministério da Saúde. Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher – PNDS 2006: dimensões do processo reprodutivo e da saúde da criança. Brasília, DF: Ministério da Saúde; 2009 [citado 2019 Set 26]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/pnds_crianca_mulher.pdfCarneiro JRI, Braga FO, Cabizuca CA, Abi-Abib RC, Cobas RA, Gomes MB. Gestação e obesidade: um problema emergente. Rev HUPE. 2014;13(3):17-24.Chu SY, Bachman DJ, Callaghan WM, Whitlock EP, Dietz PM, Berg CJ et al. Association between obesity during pregnancy and increased use of health care. N Engl J Med. 2008;358(14):1444-53.

Hypertension and prehypertension: prevalence and associated factors in Gabonese Youth and Adolescents

Background : Early detection of hypertension is necessary to reduce subsequent morbidity and mortality. The aim of our study was to determine the prevalence of hypertension and prehypertension in high school students from the capital city of Gabon and to identify their associated factors. Methods : This was a cross-sectional and analytical study carried out on a population of students enrolled in two establishments in Libreville during the 2018-2019 year school. Information on hypertension family history, eating habits, alcohol and/or tobacco consumption, oral contraception, age, gender, body mass index and blood pressure were collected. The National High Blood Pressure and European Cardiology Society 2013 classifications were used for the analysis of blood pressure in children and young adults respectively. Results : A total of 613 students with mean age of 20.3 ± 2.5 years were included. Sex ratio was 2.3. Prevalence of hypertension was 19.4% and the following factors were found to be independently associated with hypertension: overweight (aOR: 2.77 [1.29-9.99]) and male gender (aOR: 2.10, [1.22-3.62]) or not independently: overweight (OR: 2.52, [1.30-4.89] and obesity (OR: 2.62, [1.30-5.27]) (p<00.1). The prevalence of prehypertension was 23.0%, obesity (aOR:3,93 [1.02-15.2]) was independently associated with prehypertension, while overweight (OR: 2.16, [1.03-4.53]) and male sex (OR: 1.72, [1.10-2.78]) (p<00.1) were dependent factors. Conclusions : Hypertension and prehypertension are not unfrequent in school students from Libreville. Awareness of associated factors and screening campaigns within school establishments are necessary to reduce complications in adulthood.

Whole-Blood Capillary Tube Clotting Time as a Possible Predictor of Hypertensive Disorders in Pregnancy

Background: Hypertensive disorders in pregnancy (HDP) are associated with coagulation abnormalities. However, results of standard coagulation tests in patients with HDP have been inconsistent. Aim: The aim of this study was to determine mean clotting time (CT) in subjects with HDP attending antenatal clinic at Murtala Muhammad specialist Hospital Kano, Nigeria and to assess CT as a possible predictor of HDP. Materials and Methods: Eighty-four HDP subjects and equal number of normotensive pregnant women were recruited for the study. Blood pressure was measured according to standard protocol. Urinalysis was performed using urine test strips (Medi-Test Combi 9®). Whole-blood CT was determined using capillary tube method. Hypertensive disorders in pregnancy were defined according to the report of National high blood pressure education program working group on high blood pressure in pregnancy. Data were analyzed using IBM SPSS version 23.0. Chi-square test of association and independent t test were used to determine association and difference between categorical and quantitative variables respectively. Pearson’s correlation was used to determine relationship between quantitative variables.

Prevalence of overweight, obesity and hypertension among school going children in District Kanpur, Uttar Pradesh, India: a longitudinal study

Background: India is undergoing a rapid epidemiological transition with increased urbanization and socio-economic development which has resulted in a dramatic change in lifestyle, consisting of physical inactivity, diet rich in fat, sugar and salt coupled with a high level of mental stress. Obesity is one of the most common diseases worldwide and the prevalence in school aged children appears to be increasing. Thus, the present study was planned to establish an association between body mass index (BMI) with hypertension among 10-16 years children.Methods: Present longitudinal study was conducted on 350 children in private schools of District Kanpur and children 12-16yrs of age have included in the study. BMI for age charts was used to assess the obesity and blood pressure was measured by sphygmomanometer and Blood pressure values were compared to the values given by the update of 1987 task force report of the National high blood pressure Education Programme Co-ordinating Committee and children who were found prehypertensive or hypertensive were followed up after 4 weeks duration.Results: In present study the prevalence of overweight and obesity was found 4%,2% respectively. Prevalence of Pre-hypertension and hypertension was found 1.14%, 2.57% respectively and pre-hypertension and hypertension were found more in overweight and obese participants.Conclusions: Prevalence of pre-hypertension and hypertension is more among overweight and obese children. Overweight and obesity are not only risk factor for hypertension but also other diseases, so health education should regularly give about the obesity and its deleterious effects in later part of life.

Maternal serum selenium as a predictor of preeclampsia

Background: Preeclampsia (PE) is a hypertension disorder condition occurring in 7-10% of all pregnancies. Preeclampsia if unidentified and left untreated is associated with poor maternal and fetal adverse outcomes. The objective of the present study was to characterize maternal serum selenium levels as a predictor of preeclampsia and to correlate dietary selenium intake with serum selenium levels in first trimester of pregnancyMethods: A retrospective case-control study of 107 pregnant women was conducted over 1.5 years at St. John’s Medical College Hospital. On screening for inclusion criteria, at baseline, information on maternal socio-demography, anthropometry, dietary intake and clinical examination was collected. A venous blood sample at baseline and 2nd or 3rdtrimester of pregnancy was collected for estimation of selenium concentrations. Blood pressure was measured at baseline and followed up during pregnancy to select cases and controls. Pregnant women were termed ‘cases’ based on NHBPEP (National High Blood Pressure Education Program) classification and subsequent 22 women with normal blood pressure controlled for age were termed as ‘controls.Results: No statistically significant differences were observed for baseline characteristics, biochemical parameters and blood pressure at recruitment among cases and controls. Cases had significant lower levels of energy (P=0.032) and micronutrients like zinc (P=0.027), selenium (P=0.022), magnesium (P=0.047) at first trimester. The serum selenium levels were significantly higher in cases as compared to the controls (69.2±13.7 vs. 59.6±12.9; P=0.021) at baseline.Conclusions: Our findings suggest that serum selenium levels may not be an independent predictor of preeclampsia. Assessment of other micronutrients, oxidative stress markers and other complementary elements may be useful in predicting preeclampsia.

Growth achieved and correlation with blood pressure levels in schoolchildren

SUMMARY INTRODUCTION: The prevalence of systemic arterial hypertension in childhood has increased progressively OBJECTIVE: To analyze blood pressure and height reached by children in public schools in the South of Brazil. METHODS: This is a sectional study of a randomized sample of 1,082 students of six to seven and nine to ten years old used to evaluate blood pressure and height. Blood pressure levels were classified by percentile for gender, age and stature according to the North American reference of National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. RESULTS: Schoolchildren presented adequate growth, which was, on average, higher than the WHO reference values. Blood pressure levels were altered in 13.8% of children, with a higher frequency in the nine and ten year olds (17.6%). The isolated analysis of systolic and diastolic Blood pressure revealed a similar trend, with blood pressure levels higher than the greater the value of the Z-score for stature. CONCLUSION: The schoolchildren in the study evidenced adequate growth and an elevated prevalence of pre-hypertension and arterial hypertension, which tended to be higher in older children and/or those that achieved a greater stature growth.

Blood pressure-to-height ratio for diagnosing hypertension in adolescents

Background Diagnosing hypertension in children and adolescents is not always straightforward. The blood pressure-to-height ratio (BPHR) has been reported as a screening tool for diagnosing hypertension.Objective To evaluate the diagnostic value of blood pressure-to-height ratio for evaluating hypertension in adolescents.Methods A cross-sectional study was conducted among 432 healthy adolescents aged 12-17 years in Singkuang, North Sumatera from April to May 2016. Blood pressure tables from the National High Blood Pressure Education Program (NHBPEP) Working Group on High Blood Pressure in Children and Adolescents were used as our standard of comparison. Sex-specific systolic and diastolic blood pressure-to-height ratios (SBPHR and DBPHR) were calculated. ROC curve analyses were performed to assess the accuracy of BPHR for discriminating between hypertensive and non-hypertensive adolescents. Optimal thresholds of BPHR were determined and validated using 2x2 table analyses.Results The accuracies of BPHR for diagnosing hypertension were > 90% (P<0.001), for both males and females. Optimal SBPHR and DBPHR thresholds for defining hypertension were 0.787 and 0.507 in boys, respectively, and 0.836 and 0.541 in girls, respectively. The sensitivities of SBPHR and DBPHR in both sexes were all >93%, and specificities in both sexes were all >81%. Positive predictive values for SBPHR and DBPHR were 38.7% and 45.2% in boys, respectively; and 55.9% and 42.4% in girls, respectively; negative predictive values in both sexes were all >97%, positive likelihood ratios in both sexes were all >5, and negative likelihood ratios in both sexes were all <1.Conclusion Blood pressure-to-height ratio is a simple screening tool with high sensitivity and specificity for diagnosing hypertension in adolescents.

NUTRICIÓN EN EL NIÑO HIPERTENSO

La Hipertensión Arterial (HTA) en niños es un problema creciente en salud. Con una frecuencia estimada en niños del 1-13%, dependiendo de la metodología usada, es uno de los factores de riesgo más importantes para el desarrollo de enfermedad cardiovascular y renal crónica. En 2004, el Cuarto Informe, establece que los valores normales de la presión arterial en niños dependen del género, edad, percentil de talla y para su clasificación se utilizan actualmente las tablas de la National High Blood Pressure Education Program Working Group on High Blood Pressure Children and Adolescents, con los percentiles 50, 90, 95 y 99 de presión arterial sistólica y diastólica. Entre los factores en la patogenia de la HTA primaria ó esencial en pediatría está la obesidad, relacionada con el aumento del gasto cardíaco y del volumen intravascular, aumento de la actividad del sistema simpático, lesión endotelial por radicales libres, aumento de la generación de angiotensina a partir del tejido adiposo, hiperinsulinemia con aumento en la reabsorción de sodio y del tono simpático, de la leptina, además de aterosclerosis temprana, trastornos del sueño relacionados con síndromes de apnea e hipopnea. En los niños, las diferentes guías de manejo incluyendo las de la Organización Mundial de la Salud y de la Sociedad Internacional de Hipertensión (OMS/ISH), se plantean como objetivo terapéutico reconocido ampliamente, que una disminución en el consumo de sodio en niños y adolescentes se ha asociado con reducción en la PA, entre 1 a 3 mmHg. Por lo anterior, teniendo en cuenta las complicaciones en edades tardías de consumo de sal de la dieta desde la infancia y la aparición más frecuente de niños pequeños se debe determinar las necesidades de sodio en la dieta y dentro de las recomendaciones se debe preferir alimentos de origen natural y en lo posible no se debe agregar sal a las preparaciones en el niño menor de 2 años.