Prevalence of High Blood Pressure and Association With Obesity in Macedonian Children Aged 6 Years Old
Volume 13, Issue 1 (2023)
Volume 13, Issue 1 (2023)
Prevalence of High Blood Pressure and Association With Obesity in Macedonian Children Aged 6 Years Old
Abstract:
The prevalence of high blood pressure in children is increasing worldwide, largely but not entirely, determined
by the concurrent epidemic of childhood obesity. The objectives of this study were to determine the prevalence of prehypertension
and hypertension in Macedonian children of 6 years of age and to determine the relationship between the different
components of blood pressure (BP) with different adiposity indicators. Cross-sectional study including a sample of 1200
children aged up to 6 years, drawn randomly from several schools from three regions in the Republic of North Macedonia.
To achieve the goals of the research, weight, height, the body mass index (BMI), tri-ponderal mass index (TMI), percentage
of fat tissue (%FM), systolic and diastolic BP, mean arterial pressure and pulse pressure were measured. The prevalence
estimates for prehypertension and hypertension were 6.8% and 13.2%, respectively. In both sexes, adiposity indicators
were positively and significantly related to systolic and diastolic BP (p<0.001), so students from higher categories of adiposity
had significantly higher BP levels (p<0.001). Our results show a high prevalence of high blood pressure in Macedonian
children. Moreover, high levels of adiposity are associated with high blood pressure in early childhood, confirming
that this may be associated with cardiovascular risk later in life. Taking into account also lack of exercise and pathologies
that may develop also in physiotherapeutic aspect due to this issue
Keywords:
Blood pressure, Obesity, Weight status, Children, Physical activity, BMI, Kinesiology
Full Text:
References:
Aburto. N. J.. Ziolkovska. A.. Hooper. L.. Elliott. P.. Cappuccio. F. P.. & Meerpohl. J. J. (2013). Effect of lower sodium intake on health: systematic
review and meta-analyses. Bmj. 346. f1326.
Aguirre. C. J.. Sánchez. J. C.. Hernández. N.. Aguirre. F. J.. & Andres. B. T. (2012). Prevalencia de hipertensión arterial en la población infantil
de una zona rural. Atención primaria. 44(4). e16.
Almas. A.. & Jafar. T. H. (2011). Adiposity and blood pressure in South Asian children and adolescents in Karachi. American journal of hypertension.
24(8). 876-880.
Bao. W.. Threefoot. S. A.. Srinivasan. S. R.. & Berenson. G. S. (1995). Essential hypertension predicted by tracking of elevated blood pressure
from childhood to adulthood: the Bogalusa Heart Study. American journal of hypertension. 8(7). 657-665.
Chandramohan. G.. Kalantar-Zadeh. K.. Kermah. D.. Go. S. C. M.. Vaziri. N. D.. & Norris. K. C. (2012). Relationship between obesity and
pulse pressure in children: results of the National Health and Nutrition Survey (NHANES) 1988–1994. Journal of the American Society
of Hypertension. 6(4). 277-283.
Chen. B.. & Li. H. F. (2011). Waist circumference as an indicator of high blood pressure in preschool obese children. Asia Pacific Journal of
Clinical Nutrition. 20(4). 557-562.
Chen. X.. & Wang. Y. (2008). Tracking of blood pressure from childhood to adulthood: a systematic review and meta–regression analysis.
Circulation. 117(25). 3171-3180.
Chiolero. A.. Madeleine. G.. Gabriel. A.. Burnier. M.. Paccaud. F.. & Bovet. P. (2007). Prevalence of elevated blood pressure and association
with overweight in children of a rapidly developing country. Journal of human hypertension. 21(2). 120-127.
Chiolero. A.. Paradis. G.. Madeleine. G.. Hanley. J. A.. Paccaud. F.. & Bovet. P. (2009). Discordant secular trends in elevated blood pressure
and obesity in children and adolescents in a rapidly developing country. Circulation. 119(4). 558-565.
Christofaro. D. G.. Fernandes. R. A.. Gerage. A. M.. Alves. M. J.. Polito. M. D.. & Oliveira. A. R. (2009). Validation of the Omron HEM 742
blood pressure monitoring device in adolescents. Arq Bras Cardiol. 92(1). 10-5.
Cole. T. J.. & Lobstein. T. (2012). Extended international (IOTF) body mass index cut‐offs for thinness. overweight and obesity. Pediatric
obesity. 7(4). 284-294.
Crispim. P. A. A.. Peixoto. M. D. R. G.. & Jardim. P. C. B. V. (2014). Risk factors associated with high blood pressure in two-to five-year-old
children. Arquivos brasileiros de cardiologia. 102. 39-46.
De Lorenzo. A.. Romano. L.. Di Renzo. L.. Gualtieri. P.. Salimei. C.. Carrano. E.. ... & de Miranda. R. C. (2019). Tri-ponderal mass index rather
than body mass index: An indicator of high adiposity in Italian children and adolescents. Nutrition. 60. 41-47.
Din-Dzietham. R.. Liu. Y.. Bielo. M. V.. & Shamsa. F. (2007). High blood pressure trends in children and adolescents in national surveys. 1963
to 2002. Circulation. 116(13). 1488-1496.
Dorresteijn. J. A. N.. Visseren. F. L. J.. & Spiering. W. (2012). Mechanisms linking obesity to hypertension. Obesity Reviews. 13(1). 17-26.
Drozdz. D.. Kwinta. P.. Korohoda. P.. Pietrzyk. J. A.. Drozdz. M.. & Sancewicz-Pach. K. (2009). Correlation between fat mass and blood pressure
in healthy children. Pediatric Nephrology. 24(9). 1735-1740.
Eisenmann. J. C.. Wrede. J.. & Heelan. K. A. (2005). Associations between adiposity. family history of CHD and blood pressure in 3–8 year-old
children. Journal of human hypertension. 19(9). 675-681.
Emini. B.. Saiti. A.. Gontarev. S.. Baftiu. S.. & Cemena. Y. (2022). Anthropometric Characteristics And Physical Fitness Level In Relation To
Body Weight Status In Six-Year-Old Macedonian Children. Research in Physical Education. Sport & Health. 11(1).
Falkner. B.. Gidding. S. S.. Ramirez-Garnica. G.. Wiltrout. S. A.. West. D.. & Rappaport. E. B. (2006). The relationship of body mass index and
blood pressure in primary care pediatric patients. The Journal of pediatrics. 148(2). 195-200.
Flores-Huerta. S.. Klünder-Klünder. M.. de la Cruz. L. R.. & Santos. J. I. (2009). Increase in body mass index and waist circumference is associated
with high blood pressure in children and adolescents in Mexico City. Archives of Medical Research. 40(3). 208-215.
Franklin. S. S.. Lopez. V. A.. Wong. N. D.. Mitchell. G. F.. Larson. M. G.. Vasan. R. S.. & Levy. D. (2009). Single versus combined blood
pressure components and risk for cardiovascular disease: the Framingham Heart Study. Circulation. 119(2). 243-250.
Freedman. D. S. Goodman. A.. Contreras. O. A.. DasMahapatra. P.. Srinivasan. S. R.. & Berenson. G. S. (2012). Secular trends in BMI and
blood pressure among children and adolescents: the Bogalusa Heart Study. Pediatrics. 130(1). e159-e166.
Freedman. D. S. Katzmarzyk. P. T. Dietz. W. H.. Srinivasan. S. R.. & Berenson. G. S. (2009). Relation of body mass index and skinfold thicknesses
to cardiovascular disease risk factors in children: the Bogalusa Heart Study. The American journal of clinical nutrition. 90(1).
210-216.
Gontarev. S.. & Ruzdija. K. (2014). The relationship between overweight. obesity and physical fitness among eleven and twelve-year-old Macedonian
adolescents. Journal of Physical Education and Sport. 14(2). 178.
Gontarev. S.. Kalac. R.. Velickovska. L.. Stojmanovska. D.. Misovski. A.. & Milenkovski. J. (2018). Health-related physical fitness of normal.
stunted and overweight children aged 6-14 years in Macedonia. Nutrición Hospitalaria
Gontarev. S.. Zivkovic. V.. Telai. B.. Kalac. R.. & Velickovska. L. A. (2017). The association between high blood pressure. physical fitness and
fatness in adolescents. Nutrición Hospitalaria. 34(1). 35-40.
Gontarev. S.. Zivkovic. V.. Telai. B.. Kalac. R.. & Velickovska. L. A. (2017). The association between high blood pressure. physical fitness and
fatness in adolescents. Nutrición Hospitalaria. 34(1). 35-40.
Gopinath. B.. Baur. L. A.. Garnett. S.. Pfund. N.. Burlutsky. G.. & Mitchell. P. (2011). Body mass index and waist circumference are associated
with blood pressure in preschool-aged children. Annals of epidemiology. 21(5). 351-357.
Guo. X.. Zhang. X.. Guo. L.. Li. Z.. Zheng. L.. Yu. S.. ... & Sun. Y. (2013). Association between pre-hypertension and cardiovascular outcomes:
a systematic review and meta-analysis of prospective studies. Current hypertension reports. 15(6). 703-716.
Hansen. M. L.. Gunn. P. W.. & Kaelber. D. C. (2007). Underdiagnosis of hypertension in children and adolescents. Jama. 298(8). 874-879.
Kelishadi. R.. Ardalan. G.. Gheiratmand. R.. Majdzadeh. R.. Delavari. A.. Heshmat. R.. ... & for the CASPIAN Study Group. (2006). Blood
pressure and its influencing factors in a national representative sample of Iranian children and adolescents: the CASPIAN Study. European
Journal of Preventive Cardiology. 13(6). 956-963.
Khoshhali. M.. Heidari-Beni. M.. Qorbani. M.. Motlagh. M. E.. Ziaodini. H.. Heshmat. R.. & Kelishadi. R. (2020). Tri-ponderal mass index and
body mass index in prediction of pediatric metabolic syndrome: the CASPIAN-V study. Archives of endocrinology and metabolism.
64. 171-178.
LA de Hoog. M.. van Eijsden. M.. Stronks. K.. Gemke. R. J.. & Vrijkotte. T. G. (2012). Association between body size and blood pressure in
children from different ethnic origins. Cardiovascular diabetology. 11(1). 1-10.
Lo. J. C.. Sinaiko. A.. Chandra. M.. Daley. M. F.. Greenspan. L. C.. Parker. E. D.. & O’Connor. P. J. (2013). Prehypertension and hypertension
in community-based pediatric practice. Pediatrics. 131(2). e415-e424.
Martín. S.. García-Aranda. V. L.. & Almendro. M. (2005). Prevalencia de factores de riesgo cardiovascular en la infancia y adolescencia: estudio
Carmona. Clínica e Investigación en Arteriosclerosis. 17(3). 112-121.
McNiece. K. L.. Poffenbarger. T. S.. Turner. J. L.. Franco. K. D.. Sorof. J. M.. & Portman. R. J. (2007). Prevalence of hypertension and
pre-hypertension among adolescents. The Journal of pediatrics. 150(6). 640-644.
Myrtaj. N.. Maliqi. A.. Gontarev. S.. Kalac. R.. Georgiev. G.. & Stojanoska. B. B. (2018). Antropometría y Composición Corporal de Adolescentes
en Macedonia. International Journal of Morphology. 36(4). 1398-1406.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) American
Academy of Pediatrics. The Fourth Report on the Diagnosis. Evaluation. and Treatment of High Blood Pressure in Children and Adolescents.
Pediatrics. 114. 555–76.
Onagbiye. S.. & Toriola. O. (2022). Association between Selected Body Composition. Blood Pressure. and Musculoskeletal Fitness in Nigerian
Children. Annals of Applied Sport Science. 10(3). 0-0.
Ortega. F. B.. Leskošek. B.. Gil-Cosano. J. J.. Mäestu. J.. Tomkinson. G. R.. Ruiz. J. R.. ... & Jurak. G. (2023). European fitness landscape for
children and adolescents: updated reference values. fitness maps and country rankings based on nearly 8 million test results from 34
countries gathered by the FitBack network. British journal of sports medicine.
Ostrowska-Nawarycz. L.. & Nawarycz. T. (2007). Original article Prevalence of excessive body weight and high blood pressure in children and
adolescents in the city of Łódź. Kardiologia Polska (Polish Heart Journal). 65(9). 1079-1087.
Peters. H.. Whincup. P. H.. Cook. D. G.. Law. C.. & Li. L. (2012). Trends in blood pressure in 9 to 11-year-old children in the United Kingdom
1980–2008: the impact of obesity. Journal of hypertension. 30(9). 1708-1717.
Peterson. C. M.. Su. H.. Thomas. D. M.. Heo. M.. Golnabi. A. H.. Pietrobelli. A.. & Heymsfield. S. B. (2017). Tri-ponderal mass index vs body
mass index in estimating body fat during adolescence. JAMA pediatrics. 171(7). 629-636.
Pireva. A.. Selimi. M.. Gontarev. S.. & Georgiev. G. (2018). Association between aerobic fitness and high blood pressure in adolescents in
Macedonia evidence for criterion-referenced cut-points. Journal of Physical Education and Sport.
Plachta-Danielzik. S.. Landsberg. B.. Johannsen. M.. Lange. D.. & Müller. M. J. (2008). Association of different obesity indices with blood
pressure and blood lipids in children and adolescents. British journal of nutrition. 100(1). 208-218.
Rademacher. E. R.. Jacobs Jr. D. R.. Moran. A.. Steinberger. J.. Prineas. R. J.. & Sinaiko. A. (2009). Relation of blood pressure and body mass
index during childhood to cardiovascular risk factor levels in young adults. Journal of hypertension. 27(9). 1766.
Raj. M.. Sundaram. K. R.. Paul. M.. Deepa. A. S.. & Kumar. R. K. (2007). Obesity in Indian children: time trends and relationship with hypertension.
National Medical Journal of India. 20(6). 288.
Safar. M. E. (2001). Systolic blood pressure. pulse pressure and arterial stiffness as cardiovascular risk factors. Current opinion in nephrology
and hypertension. 10(2). 257-261.
Salvadori. M.. Sontrop. J. M.. Garg. A. X.. Truong. J.. Suri. R. S.. Mahmud. F. H.. ... & Clark. W. F. (2008). Elevated blood pressure in relation
to overweight and obesity among children in a rural Canadian community. Pediatrics. 122(4). e821-e827.
Shim. Y. S. (2019). The relationship between tri-ponderal mass index and metabolic syndrome and its components in youth aged 10–20 years.
Scientific reports. 9(1). 1-10.
Sorof. J. M.. Lai. D.. Turner. J.. Poffenbarger. T.. & Portman. R. J. (2004). Overweight. ethnicity. and the prevalence of hypertension in school-
aged children. Pediatrics. 113(3). 475-482.
Stankovska. Z.. Stojanoska. B. B.. Gontarev. S.. & Kostovski. Ž. (2021). Body Adiposity is Associated With a Risk of High Blood Pressure in
Macedonian Children. Sports Science & Health/Sportske Nauke i Zdravlje. 11(2).
Urbina. E. M.. Khoury. P. R.. McCoy. C.. Daniels. S. R.. Kimball. T. R.. & Dolan. L. M. (2011). Cardiac and vascular consequences of prehypertension
in youth. The Journal of Clinical Hypertension. 13(5). 332-342.
Xi. B.. Zhang. T.. Zhang. M.. Liu. F.. Zong. X.. Zhao. M.. & Wang. Y. (2016). Trends in elevated blood pressure among US children and adolescents:
1999–2012. American journal of hypertension. 29(2). 217-225.
