title: Blood pressure and associated factors in a North African adolescent population. a national cross-sectional study in Tunisia [Determinants of risk of cardiovascular diseases in schoolchildren]. Contribution of body fat and fat pattern to blood pressure level in school children. Blood pressure and BMI in adolescents in Aracaju, Brazil. Cardiovascular risk factors in children and adolescents living in an urban area of Southeast of Brazil: Ouro Preto Study College athletes with an elevated body mass index often have a high upper arm muscle area, but not elevated triceps and subscapular skinfolds. Variations of adolescent blood pressure by multifactorial analysis in an urban slum of Kolkata. Blood pressure and related cardiovascular disease risk factors in 6-18 year-old students in Italy. Obesity paradox in patients with hypertension and coronary artery disease.
abstract: Background In southern and eastern Mediterranean countries , changes in lifestyle and the increasing prevalence of excess weight in childhood are risk factors for high blood pressure ( BP ) during adolescence and adulthood . The aim of this study was to evaluate the BP status of Tunisian adolescents and to identify associated factors . Methods A cross-sectional study in 2005 , based on a national , stratified , r and om cluster sample of 1294 boys and 1576 girls aged 15 - 19 surveyed in home visits . The socio-economic and behavioral characteristics of the adolescents were recorded . Overweight/obesity were assessed by Body Mass Index ( BMI ) from measured height and weight ( WHO , 2007 ) , abdominal obesity by waist circumference ( WC ) . BP was measured twice during the same visit  . Elevated BP was systolic ( SBP ) or diastolic blood pressure ( DBP ) ≥ 90th of the international reference or ≥ 120/80 mm Hg for 15 - 17 y. , and SBP/DBP ≥ 120/80 mm Hg for 18 - 19 y. ; hypertension was SBP/DBP ≥ 95th for 15 - 17 y. and ≥ 140/90 mm Hg for 18 - 19 y. Adjusted associations were assessed by logistic regression . Results The prevalence of elevated BP was 35.1%[32.9 - 37.4 ] : higher among boys ( 46.1 % vs. 33.3 % ; P < 0.0001 ) ; 4.7%[3.8 - 5.9 ] of adolescents had hypertension . Associations adjusted for all covariates showed independent relationships with BMI and WC : - obesity vs. no excess weight increased elevated BP ( boys OR = 2.1[1.0 - 4.2 ] , girls OR = 2.3[1.3 - 3.9 ] ) and hypertension ( boys OR = 3.5[1.4 - 8.9 ] , girls OR = 5.4[2.2 - 13.4 ] ) , - abdominal obesity ( WC ) was also associated with elevated BP in both genders ( for boys : 2nd vs. 1st tertile OR = 1.7[1.3 - 2.3 ] , 3rd vs.1st tertile OR = 2.8[1.9 - 4.2 ] ; for girls : 2nd vs. 1st tertile OR = 1.6[1.2 - 2.1 ] , 3rd vs.1st tertile OR = 2.1[1.5 - 3.0 ] ) but only among boys for hypertension . Associations with other covariates were weaker : for boys , hypertension increased somewhat with sedentary lifestyle , while elevated BP was slightly more prevalent among urban girls and those not attending school . Conclusion Within the limits of BP measurement on one visit only , these results suggest that Tunisian adolescents of both genders are likely not spared from early elevated BP . Though further assessment is likely needed , the strong association with overweight/obesity observed suggests that interventions aim ed at changing lifestyles to reduce this main risk factor may also be appropriate for the prevention of elevated BP OBJECTIVE To investigate the occurrence and association of arterial hypertension with several lifestyle variables . METHODS Transversal population -based study with a r and om sample of students ( 7 to 14 years of age ) of public and private schools . Variables investigated were nutritional status , blood pressure , and lifestyle ( tobacco use , alcohol intake , physical activity and eating habits ) . RESULTS Out of the 3,169 schoolchildren assessed , 5.0 % had arterial hypertension and 6.2 % had normal-high blood pressure . Classification by gender shows boys 6.4 % and girls 6.0 % with normal-high blood pressure , and boys 4.3 % and girls 5.7 % with arterial hypertension . Body mass index ( BMI ) measurements identified 16.0 % excess weight students , 4.9 % of whom were obese . A significant association ( p = 0.01 ) between arterial hypertension and excess weight was observed . Among the students participating in the study , 11.6 % did not attend physical education classes and 37.8 % had sedentary leisure habits . Twenty students ( 0.6 % ) were smokers and 32.7 % had already experimented with alcohol . None of these variables showed statistical significance as to blood pressure values and nutritional status . CONCLUSION In light of the findings in this study which show schoolchildren with a higher than expected frequency of mean blood pressure and BMI values , associated with a lifestyle that tends to favour the development of cardiovascular diseases , we felt led to propose interventional measures focused on the school as an agent of change and capable of conveying information to family units . This possibility encourages us to propose that schools be partners in promoting health OBJECTIVE The study aims are investigating the effect of body fat and fat localization on blood pressure . DESIGN Case-control study . SETTING The study was carried out in the school health primary care . SUBJECTS The case-control study included 220 obese and 220 non-obese children aged 7 - 18 years from Al Ain city , United Arab Emirates between September 1992 to May 1993 inclusive . Each group consisted of 120 males and 100 females . Two schools were r and omly selected from each of the three educational stages : primary , junior and secondary . The inclusion criterion for cases comprised children with body mass index ( BMI ; Quetelet index ) , > 90th percentile of age and sex-specific reference data of the French population . Non-obese healthy controls were r and omly selected from the same classes from where obese children were identified in order to ascertain that cases and controls were matched by age and sex . MEASUREMENTS Anthropometric measures ( weight , height , waist and hip circumferences ) , systolic and diastolic blood pressure were measured . To minimize inter-observer error , blood pressure was measured by one physician . We also collected information about other confounding social variables ( family history of obesity and mother 's education ) and behavioural variables ( preferred diet and physical activity ) . RESULTS There was significant difference of systolic and diastolic blood pressure means between obese and non-obese children ( P < 0.001 ) in both males and females . Applying the multiple linear regression analysis to fix the confounding effect of age , sex , social and behavioural factors , the fatness index , BMI , was significantly related to systolic ( P < 0.0004 ) and diastolic ( P < 0.0001 ) ; while waist-to-hip circumference ratio ( WHR ) was not significant ( P = 0.803 in systolic and P = 0.648 in diastolic blood pressure respectively ) . CONCLUSIONS Systolic and diastolic blood pressure showed a positive relationship with the fatness index BMI , but not with WHR , in both boys and girls . This is an evidence that WHR may not be a reliable indicator of body fat distribution in children OBJECTIVE To assess the prevalence of high blood pressure ( BP ) and the association of overweight and obesity with  high BP among adolescents in Aracaju , Brazil . DESIGN Cross-sectional study . The main outcome measure was the proportion of adolescents with high BP ( sex- , age- and height-specific ≥ 95th percentile ) . The main predictor variables were overweight and obesity defined according to the criteria of the International Obesity Task Force . Other covariates included age , socio-economic status and leisure-time physical activity . SETTING Aracaju , Brazil , capital city of Sergipe State , north-eastern Brazil . SUBJECTS A r and om sample of 1002 adolescents ( 442 boys and 560 girls ) aged 12 - 17 years selected from twenty public schools and ten private schools were studied . RESULTS The prevalence of high BP was 16.9 % ( 95 % CI 13.1 , 21.7 ) in boys and 12.9 % ( 95 % CI 9.0 , 18.0 ) in girls . After adjusting for age , socio-economic status and leisure-time physical activity in both boys and girls , overweight ( prevalence ratio ( PR ) = 1.93 , 95 % CI 1.08 , 3.48 ; PR = 4.34 , 95 % CI 2.58 , 7.30 , respectively ) and obesity ( PR = 4.87 , 95 % CI 2.35 , 10.11 ; PR = 5.18 , 95 % CI 2.67 , 10.06 , respectively ) were found to be associated with high BP . CONCLUSIONS These findings indicate a high prevalence of high BP in both boys and girls in Aracaju , Brazil . Overweight and obesity were strongly associated with high BP . These findings underscore the urgent need for public health measures to prevent increasing high BP  in adolescents in Brazil .  Targeting intervention in adolescence may be a critical method for preventing high BP in later life This study aims to identify risk factors for cardiovascular disorders in schoolchildren living in Ouro Preto City , Brazil . A cross-sectional study was carried out in a  population -based sampling of schoolchildren ( 6–14 years old ) , r and omly selected and stratified by the proportion of students according to age and gender in each schools of the city .  Biochemical , clinical and anthropometric variables as well as physical activity and family history were used in a logistic regression model for obesity or arterial hypertension . Out of 780 schoolchildren sample d , the risk of obesity was greater in subjects presenting high triglyceride and low high density lipoprotein-cholesterol levels , and those whose parents were obese , whilst the risk of hypertension was high in obese subjects and those who presented low birth weight . It was observed that 44.4 % of the schoolchildren were exposed to two or three cardiovascular disease ( CVD ) risk factors and 8.2 % were exposed to four or six factors . These findings should be considered in preventive measures to reduce the future risk for CVD among schoolchildren in Brazil Body mass index ( BMI , calculated as kg/m 2 ) is increased by high amounts of both lean and fat tissue . Therefore , a very muscular individual with low body fat could be classified as overweight by BMI . To evaluate this problem , the relationship between  BMI  ,  body fat  as indicated by the sum of triceps and subscapular skinfolds , and muscle mass as indicated by upper arm muscle area ( UAMA ) was studied in 107 male and 106 female National Collegiate Athletic Association Division III athletes . Sex , the sum of triceps and subscapular skinfolds , and UAMA were significantly related to BMI ( overall P < .0001 , R 2 = 0.617 ) , although the relationship was nonlinear and more complex in females than in males . Thirty-eight athletes had a  BMI of 25 or higher , indicating overweight or obesity . Of these , only four had excess body fat , as indicated by a sum of triceps and subscapular skinfolds greater than the 85th percentile , but 27 had high muscle mass , indicated by a UAMA greater than the 85th percentile . In the nonr and om sample of athletes we studied , BMI frequently classified muscular individuals who did not have high skinfold measurements as overweight To find out the factors responsible for variations of  adolescent blood pressure  , a  community-based cross-sectional study was undertaken among 1081 adolescents , aged 10 - 19 years , selected by simple r and om sampling in an urban slum of Kolkata , Chetla in 2003 - 04 . Age , educational status , additional ghee/butter intake with diet , family history of hypertension , weight , height and body mass index were found to be associated with blood pressure in unifactorial analysis , hence these variables were considered for multifactorial analysis . All these independent variables were correlated with both systolic and diastolic blood pressure except additional ghee/butter intake with food . In stepwise multiple regression analysis , age , education , family history of hypertension , weight , height and body mass index contributed 64.6 % of the total variation of systolic blood pressure , where weight alone contributed to 62.6 % while 35.4 % of variations remained unexplained . In case of diastolic blood pressure , 56.8 % of the total variations were due to age , education , family history of hypertension , weight , height and body mass index , out of which weight alone contributed 56 % while remaining 43.2 % of total variations remained unexplained . Since single most important predictor of blood pressure was weight , regular aerobic physical activity , dietary modification , behavioral changes and health education are recommended for weight reduction and prevention of obesity OBJECTIVES The aims of this study were to provide data on blood pressure ( BP ) levels , to measure prevalence of high-normal or high BP and to identify a set of conditions that may predict high BP ( HBP ) in a population of children and adolescents in Italy . METHODS A r and om sample of students 6 - 18 years old attending r and omly selected schools in Catanzaro , Italy , was recruited . All students completed a question naire on their health and on health behaviours , such as physical activity , diet , drinking and smoking . Blood pressure , heart rate , height , weight and body mass index ( BMI ) were recorded . RESULTS Of the 603 subjects examined , 12.8 % had high-normal BP , 3.5 % hypertension ( HTN ) and 11.1 % were obese . High-normal or high diastolic BP ( DBP ) was significantly more likely in older subjects with a higher BMI , in those with a smoker mother and in preterm children , whereas high-normal or high systolic BP ( SBP ) was significantly more likely to be found in older subjects with a higher BMI and in those who had at least one parent with HTN . High-normal or high DBP or SBP were significantly predicted by BMI and age . CONCLUSIONS Interventions should focus at reducing obesity and encouraging proper dietary habits , sufficient exercise and cessation of smoking habit in parents too , especially in children with a family history of HTN PURPOSE An obesity paradox , a " paradoxical " decrease in morbidity and mortality with increasing body mass index ( BMI ) , has been shown in patients with heart failure and those undergoing percutaneous coronary intervention . However , whether this phenomenon exists in patients with hypertension and coronary artery disease is not known . METHODS A total of 22,576 hypertensive patients with coronary artery disease ( follow-up 61,835 patient years , mean age 66+/-9.8 years ) were r and omized to a verapamil-SR or atenolol strategy . Dose titration and additional drugs ( tr and olapril and /or hydrochlorothiazide ) were added to achieve target blood pressure control according to the Sixth Joint National Committee on Prevention , Detection , Evaluation , and Treatment of High Blood Pressure targets . Patients were classified into 5 groups according to baseline BMI : less than 20 kg/m2 ( thin ) , 20 to 25 kg/m2 ( normal weight ) , 25 to 30 kg/m2 ( overweight ) , 30 to 35 kg/m2 ( class I obesity ) , and 35 kg/m2 or more ( class II-III obesity ) . The primary outcome was first occurrence of death , nonfatal myocardial infa rct ion , or nonfatal stroke . RESULTS With patients of normal weight ( BMI 20 to<25 kg/m2 ) as the reference group , the risk of primary outcome was lower in the overweight patients ( adjusted hazard ratio [ HR ] 0.77 , 95 % confidence interval [ CI ] , 0.70 - 0.86 , P<.001 ) , class I obese patients ( adjusted HR 0.68 , 95 % CI , 0.59 - 0.78 , P<.001 ) , and class II to III obese patients ( adjusted HR 0.76 , 95 % CI , 0.65 - 0.88 , P < .001 ) . Class I obese patients had the lowest rate of primary outcome and death despite having smaller blood pressure reduction compared with patients of normal weight at 24 months ( -17.5+/-21.9 mm Hg/-9.8+/-12.4 mm Hg vs -20.7+/-23.1 mm Hg /-10.6+/-12.5 mm Hg , P<.001 ) . CONCLUSION In a population with hypertension and coronary artery disease , overweight and obese patients had a decreased risk of primary outcome compared with patients of normal weight , which was driven primarily by a decreased risk of all-cause mortality . Our results further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention
target: The results suggest that despite the existence of hegemonic thinking to guide these relationships , BP and physical activity do not always have negative associations , and BP and obesity do not always have positive associations .
background: In the light of the importance of the impacts that obesity and physical activity may have on  blood pressure ( BP ) among adolescents , and the suggestion that abnormal pressure levels at young ages are maintained into more mature stages of these individuals ' lives , the scope of this study is to conduct a systematic review of the associations between obesity and BP and between physical activity and BP among adolescents .