Abstract 18127: The Timing and Link Between Development of Hypertension and Overweight in Children - A Cohort Study
Introduction: Cross-sectional data shows that pediatric obesity precedes pediatric hypertension, however no pediatric cohort studies exist.
Hypothesis: Cohort and cross-sectional studies may show different patterns of onset of hypertension and overweight in children.
Methods: We analyzed electronic medical record data from 1,904,526 academic healthcare system outpatient visits from July 1999 through March 2010. Our cohort consisted of patients who met the following criteria during the study period: age 2-20 years, BMI < 85th percentile and blood pressure z-score < 90th percentile on initial visit, and development of overweight (BMI ≥ 85th percentile) or hypertension (three or more visits with systolic or diastolic z-score ≥ 95th percentile).
Results: Among the cohort of 26,494 patients, 4,942 (18.7%) developed overweight and 768 (2.9%) developed hypertension. The average age of first overweight visit was 11.5 years (SD 4.6), first systolic or diastolic BP ≥95th percentile was 12.0 years (SD 4.7), and hypertension was 14.1 years (SD 4.1). This pattern follows those seen in cross sectional studies with abnormal BMI preceding abnormal blood pressure. Among the 457 (1.7%) patients who developed both overweight and hypertension, the average age of first systolic or diastolic BP ≥95th percentile was 11.4 years (SD 4.5), first overweight visit was 12.6 years (SD 4.5), and hypertension was 14.2 years (SD 4.0). Within each group the differences in onset of the three diseases (first abnormal blood pressure, overweight, and hypertension) were all statistically significant (p<0.01). Between groups the difference in age of onset of overweight was statistically significant (p<0.01) but the differences in onset of abnormal blood pressure and hypertension were not.
Conclusions: While pediatric hypertension and overweight are both increasing in prevalence, this analysis indicates that a subset of pediatric patients appear to be more susceptible to acquiring both conditions. In these patients, abnormal blood pressure precedes development of overweight. This work also demonstrates the power of electronic medical records to reveal findings that are otherwise difficult to elucidate.
- © 2010 by American Heart Association, Inc.