Influence Factor of Childhood Essential Hypertension: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

XU Ruiwei ¹ , YAN Kai ¹ ,  YAN Weili ²

1. School of Public Health, Xinjiang Medical University, Urumqi 830054, China;2. Department of Clinical Epidemiology, Children’s Hospital of Fudan University, Shanghai 201102, China;

Corresponding author：

YAN Weili, Email: yanwl@fudan.edu.cn

Keywords：

Essential hypertension; Children; Meta-analysis; Influence factor

DOI：

10.7507/1672-2531.20130100

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To investigate influence factors of childhood essential hypertension and provide scientific evidence for prevention and management of the disease.
Methods 　Relevant studies were searched using PubMed, ISI Web of Knowledge, Ovid, CNKI and VIP from January 2007 to December 2011. STATA 11 was applied for meta-analysis. After heterogeneity analysis, influence factors (OR with 95%CI) were estimated using fixed or random effect models. Sensitivity analyses were used for evaluating the robustness of the results. Publication bias was assessed by Egger’s test and funnel plot.
Results 　A total of 13 studies involving 4 278 cases and 37 230 controls were included. The pooled OR and its 95%CI of different factors associated with hypertension among children were: gender (male) 1.283 (1.063 to 1.549), age 1.013 (0.975 to 1.052), overweight 2.622 (1.985 to 3.464), obesity 3.730 (2.299 to 6.051), waist circumstance 1.060 (1.036 to 1.085), family history 1.189 (0.956 to 1.480), and frequency of physical activities 0.584 (0.460 to 0.742).
Conclusion 　Current results indicate that gender (male), overweight, obesity, waist circumstance are risk factors of hypertension among children, while frequency of physical activities is protective factor.

Citation： XU Ruiwei,YAN Kai,YAN Weili. Influence Factor of Childhood Essential Hypertension: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(5): 564-573. doi: 10.7507/1672-2531.20130100 Copy

1.	Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet, 2005, 365(9455): 217-223.
2.	Lawes CMM, Hoorn SV, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet, 2008, 371(9623): 1513-1518.
3.	Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA, 2007, 298(8): 874-879.
4.	McNiece KL, Poffenbarger TS, Turner JL, et al. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr, 2007, 150(6): 640-644. e641.
5.	Sorof JM, Lai D, Turner J, et al. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics, 2004, 113(3): 475-482.
6.	鞠红, 刘启贵. 大连市某区6-17岁儿童高血压患病率的调查分析. 中国公共卫生, 2010, (6): 677-678.
7.	张勤, 叶艳, 任修勤, 等. 个旧地区学龄前儿童高血压检出率及其影响因素. 中国儿童保健杂志, 2004, 12(4): 310-312.
8.	National High Blood Pressure Education Program Working Groupon High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics, 2004, 114(2Suppl 4th Report): 556-576.
9.	Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2007. URL: http://www.ohri ca/programs/clinical epidemiology/oxford htm.2008.
10.	Greenland S. Quantitative methods in the review of epidemiologic literature. Epidemiol Rev, 1987, 9: 1-30.
11.	Higgins J, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
12.	Pardee PE, Norman GJ, Lustig RH, et al. Television viewing and hypertension in obese children. Am J Prev Med, 2007, 33(6): 439-443.
13.	Haysom L, Williams RE, Hodson EM, et al. Cardiovascular risk factors in Australian indigenous and non‐indigenous children: A population‐based study. J Paediatr Child Health, 2009, 45(1-2): 20-27.
14.	Colín-Ramírez E, Castillo-Martínez L, Orea-Tejeda A, et al. Waist circumference and fat intake are associated with high blood pressure in Mexican children aged 8 to 10 years. J Am Diet Assoc, 2009, 109(6): 996-1003.
15.	So HK, Sung RYT, Li AM, Choi KC, et al. Higher exercise frequency associated with lower blood pressure in Hong Kong adolescents: a population-based study. J Hum Hypertens, 2010, 24(10): 646-651.
16.	Maldonado J, Pereira T, Fernandes R, et al. An approach of hypertension prevalence in a sample of 5381 Portuguese children and adolescents. The AVELEIRA registry. “Hypertension in Children”. Blood Press, 2011, 20(3): 153-157.
17.	Ovbiagele B, Hutchison P, Handschumacher L, et al. Impact of an urban community hypertension screening program on participating high school students. Ethn Dis, 2011, 21(1): 68-73.
18.	Siklar Z, Berberoglu M, Erdeve SS, et al. Contribution of clinical, metabolic, and genetic factors on hypertension in obese children and adolescents. J Pediatr Endocrinol Metab, 2011, 24(1-2): 21-24.
19.	李伟荣, 翟屹, 沈冲, 等. 我国三省7～13岁儿童血压升高影响因素的初步分析. 中华疾病控制杂志, 2011, 15(11): 931-934.
20.	沈谨, 施小明, 赵启慧, 等. 儿童青少年血压升高影响因素分析. 中国公共卫生, 2010, (10): 1220-1221.
21.	Leung LCK, Sung RYT, So HK, et al. Prevalence and risk factors for hypertension in Hong Kong Chinese adolescents: waist circumference predicts hypertension, exercise decreases risk. Arch Dis Child, 2011, 96(9): 804-809.
22.	邓晓娟, 晏晓颖, 徐亮, 等. 广州市中学生血压偏高状况及其相关因素分析. 中国学校卫生, 2010, 31(7): 816-817.
23.	赵仁兵, 王予川, 崔玉霞, 等. 贵阳市儿童高血压危险因素流行病学调查. 中华医学会第五次全国儿科中青年学术交流大会论文汇编(上册). 2008.
24.	Akış N, Pala K, Meriç-Utku A, et al. Hypertension in children (12–14 years)–a case–control study in Bursa, Turkey. Turk J Pediatr, 2009, 51(5): 437-443.
25.	陈耀龙, 李幼平, 杜亮, 等. 医学研究中证据分级和推荐强度的演进. 中国循证医学杂志, 2008, 8(2): 127-133.
26.	Raj M. Essential hypertension in adolescents and children: Recent advances in causative mechanisms. Indian J Endocrinol Metab, 2011, 15 Suppl 4: S367-373.
27.	Raj M, Sundaram KR, Paul M, et al. Obesity in Indian children: time trends and relationship with hypertension. Natl Med J India, 2007, 20(6): 288-293.
28.	Uno K, Yamada T, Ishigaki Y, et al. Hepatic peroxisome proliferator-activated receptor-gamma-fat-specific protein 27 pathway contributes to obesity-related hypertension via afferent vagal signals. Eur Heart J, 2012, 33(10): 1279-1289.
29.	Chen J, Gu D, Huang J, et al. Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: a dietary intervention study. Lancet, 2009, 373(9666): 829-835.
30.	Cruz ML, Huang TT, Johnson MS, et al. Insulin sensitivity and blood pressure in black and white children. Hypertension, 2002, 40(1): 18-22.
31.	Kotchen TA. Obesity-related hypertension: epidemiology, pathophysiology, and clinical management. Am J Hypertens, 2010, 23(11): 1170-1178.
32.	Engeli S, Bohnke J, Gorzelniak K, et al. Weight loss and the renin-angiotensin-aldosterone system. Hypertension, 2005, 45(3): 356-362.
33.	Hajjar I, Kotchen JM, Kotchen TA. Hypertension: trends in prevalence, incidence, and control. Annu Rev Public Health, 2006, 27(1): 465-490.
34.	孟玲慧, 米杰. 北京市学龄儿童腰围、腰围身高比分类标准对心血管代谢危险因素的筛查效度. 中国循证儿科杂志, 2009, 3(5): 324-332.
35.	张世伟, 马军, 张衡, 等. 儿童青少年体质量指数和腰围与血压的关系. 中国学校卫生, 2008, 29(5): 437-439.
36.	Katzmarzyk PT, Srinivasan SR, Chen W, et al. Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics, 2004, 114(2): e198-205.
37.	Maximova K, O’Loughlin J, Paradis G, et al. Declines in physical activity and higher systolic blood pressure in adolescence. Am J Epidemiol, 2009, 170(9): 1084-1094.
38.	Kelley GA, Kelley KS, Tran ZV. The Effects of Exercise on Resting Blood Pressure in Children and Adolescents: A Meta‐Analysis of Randomized Controlled Trials. Preventive cardiology, 2003, 6(1): 8-16.
39.	Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al. CDC growth charts: United States advance data from vital and health statistics. Hyattsville MD: National Center for Health Statistics, No. 314. 2000.
40.	Greenacre P. Height and Weight Standard Deviation Score Calculator. New South Wales, Australia: The Children’s Hospital at Westmead, 2145, 1997.
41.	Cole T, Bellizzi M, Flegal K, et al. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ, 2000, 320: 1-6.
42.	中国肥胖问题工作组. 中国学龄儿童青少年超重、肥胖筛查体重指数值分类标准. 中华流行病学杂志, 2004, 25(2): 97-102.
43.	L eung S S, Lau JT, Tse LY, et al. Weight-for-age and weight-for-height references for Hong Kong children from birth to 18 years. J Paediatr Child Health, 1996, 32: 103-109.
44.	季成叶, 马军, 何忠虎, 等. 中国汉族学龄儿童青少年腰围正常值. 中国学校卫生, 2010, 31(3): 257-259.

1. Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet, 2005, 365(9455): 217-223.
2. Lawes CMM, Hoorn SV, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet, 2008, 371(9623): 1513-1518.
3. Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA, 2007, 298(8): 874-879.
4. McNiece KL, Poffenbarger TS, Turner JL, et al. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr, 2007, 150(6): 640-644. e641.
5. Sorof JM, Lai D, Turner J, et al. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics, 2004, 113(3): 475-482.
6. 鞠红, 刘启贵. 大连市某区6-17岁儿童高血压患病率的调查分析. 中国公共卫生, 2010, (6): 677-678.
7. 张勤, 叶艳, 任修勤, 等. 个旧地区学龄前儿童高血压检出率及其影响因素. 中国儿童保健杂志, 2004, 12(4): 310-312.
8. National High Blood Pressure Education Program Working Groupon High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics, 2004, 114(2Suppl 4th Report): 556-576.
9. Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2007. URL: http://www.ohri ca/programs/clinical epidemiology/oxford htm.2008.
10. Greenland S. Quantitative methods in the review of epidemiologic literature. Epidemiol Rev, 1987, 9: 1-30.
11. Higgins J, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
12. Pardee PE, Norman GJ, Lustig RH, et al. Television viewing and hypertension in obese children. Am J Prev Med, 2007, 33(6): 439-443.
13. Haysom L, Williams RE, Hodson EM, et al. Cardiovascular risk factors in Australian indigenous and non‐indigenous children: A population‐based study. J Paediatr Child Health, 2009, 45(1-2): 20-27.
14. Colín-Ramírez E, Castillo-Martínez L, Orea-Tejeda A, et al. Waist circumference and fat intake are associated with high blood pressure in Mexican children aged 8 to 10 years. J Am Diet Assoc, 2009, 109(6): 996-1003.
15. So HK, Sung RYT, Li AM, Choi KC, et al. Higher exercise frequency associated with lower blood pressure in Hong Kong adolescents: a population-based study. J Hum Hypertens, 2010, 24(10): 646-651.
16. Maldonado J, Pereira T, Fernandes R, et al. An approach of hypertension prevalence in a sample of 5381 Portuguese children and adolescents. The AVELEIRA registry. “Hypertension in Children”. Blood Press, 2011, 20(3): 153-157.
17. Ovbiagele B, Hutchison P, Handschumacher L, et al. Impact of an urban community hypertension screening program on participating high school students. Ethn Dis, 2011, 21(1): 68-73.
18. Siklar Z, Berberoglu M, Erdeve SS, et al. Contribution of clinical, metabolic, and genetic factors on hypertension in obese children and adolescents. J Pediatr Endocrinol Metab, 2011, 24(1-2): 21-24.
19. 李伟荣, 翟屹, 沈冲, 等. 我国三省7～13岁儿童血压升高影响因素的初步分析. 中华疾病控制杂志, 2011, 15(11): 931-934.
20. 沈谨, 施小明, 赵启慧, 等. 儿童青少年血压升高影响因素分析. 中国公共卫生, 2010, (10): 1220-1221.
21. Leung LCK, Sung RYT, So HK, et al. Prevalence and risk factors for hypertension in Hong Kong Chinese adolescents: waist circumference predicts hypertension, exercise decreases risk. Arch Dis Child, 2011, 96(9): 804-809.
22. 邓晓娟, 晏晓颖, 徐亮, 等. 广州市中学生血压偏高状况及其相关因素分析. 中国学校卫生, 2010, 31(7): 816-817.
23. 赵仁兵, 王予川, 崔玉霞, 等. 贵阳市儿童高血压危险因素流行病学调查. 中华医学会第五次全国儿科中青年学术交流大会论文汇编(上册). 2008.
24. Akış N, Pala K, Meriç-Utku A, et al. Hypertension in children (12–14 years)–a case–control study in Bursa, Turkey. Turk J Pediatr, 2009, 51(5): 437-443.
25. 陈耀龙, 李幼平, 杜亮, 等. 医学研究中证据分级和推荐强度的演进. 中国循证医学杂志, 2008, 8(2): 127-133.
26. Raj M. Essential hypertension in adolescents and children: Recent advances in causative mechanisms. Indian J Endocrinol Metab, 2011, 15 Suppl 4: S367-373.
27. Raj M, Sundaram KR, Paul M, et al. Obesity in Indian children: time trends and relationship with hypertension. Natl Med J India, 2007, 20(6): 288-293.
28. Uno K, Yamada T, Ishigaki Y, et al. Hepatic peroxisome proliferator-activated receptor-gamma-fat-specific protein 27 pathway contributes to obesity-related hypertension via afferent vagal signals. Eur Heart J, 2012, 33(10): 1279-1289.
29. Chen J, Gu D, Huang J, et al. Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: a dietary intervention study. Lancet, 2009, 373(9666): 829-835.
30. Cruz ML, Huang TT, Johnson MS, et al. Insulin sensitivity and blood pressure in black and white children. Hypertension, 2002, 40(1): 18-22.
31. Kotchen TA. Obesity-related hypertension: epidemiology, pathophysiology, and clinical management. Am J Hypertens, 2010, 23(11): 1170-1178.
32. Engeli S, Bohnke J, Gorzelniak K, et al. Weight loss and the renin-angiotensin-aldosterone system. Hypertension, 2005, 45(3): 356-362.
33. Hajjar I, Kotchen JM, Kotchen TA. Hypertension: trends in prevalence, incidence, and control. Annu Rev Public Health, 2006, 27(1): 465-490.
34. 孟玲慧, 米杰. 北京市学龄儿童腰围、腰围身高比分类标准对心血管代谢危险因素的筛查效度. 中国循证儿科杂志, 2009, 3(5): 324-332.
35. 张世伟, 马军, 张衡, 等. 儿童青少年体质量指数和腰围与血压的关系. 中国学校卫生, 2008, 29(5): 437-439.
36. Katzmarzyk PT, Srinivasan SR, Chen W, et al. Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics, 2004, 114(2): e198-205.
37. Maximova K, O’Loughlin J, Paradis G, et al. Declines in physical activity and higher systolic blood pressure in adolescence. Am J Epidemiol, 2009, 170(9): 1084-1094.
38. Kelley GA, Kelley KS, Tran ZV. The Effects of Exercise on Resting Blood Pressure in Children and Adolescents: A Meta‐Analysis of Randomized Controlled Trials. Preventive cardiology, 2003, 6(1): 8-16.
39. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al. CDC growth charts: United States advance data from vital and health statistics. Hyattsville MD: National Center for Health Statistics, No. 314. 2000.
40. Greenacre P. Height and Weight Standard Deviation Score Calculator. New South Wales, Australia: The Children’s Hospital at Westmead, 2145, 1997.
41. Cole T, Bellizzi M, Flegal K, et al. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ, 2000, 320: 1-6.
42. 中国肥胖问题工作组. 中国学龄儿童青少年超重、肥胖筛查体重指数值分类标准. 中华流行病学杂志, 2004, 25(2): 97-102.
43. L eung S S, Lau JT, Tse LY, et al. Weight-for-age and weight-for-height references for Hong Kong children from birth to 18 years. J Paediatr Child Health, 1996, 32: 103-109.
44. 季成叶, 马军, 何忠虎, 等. 中国汉族学龄儿童青少年腰围正常值. 中国学校卫生, 2010, 31(3): 257-259.

Chinese Journal of Evidence-Based Medicine

Influence Factor of Childhood Essential Hypertension: A Meta-Analysis

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