The Role of Obesity, Salt and Exercise on Blood Pressure in Children and Adolescents

From Expert Review of Cardiovascular Therapy Stella Stabouli; Sofia Papakatsika; Vasilios Kotsis Posted: 08/16/2011; Expert Rev Cardiovasc Ther. 2011;9(6):753-761. © 2011 Expert Reviews Ltd. Abstract and Introduction Definition of Pediatric HTN Childhood Obesity & BP Regulation Dietary Salt Intake & BP in Childhood Exercise & Prevention of HTN in Children & Adolescents Expert Commentary Five-year View Abstract The increasing trends of blood pressure (BP) in children and adolescents pose great concern for the burden of hypertension-related cardiovascular disease. Although primary hypertension in childhood is commonly associated with obesity, it seems that other factors, such as dietary sodium and exercise, also influence BP levels in children and adolescents. Several studies support that sympathetic nervous system imbalance, impairment of the physiological mechanism of pressure natriuresis, hyperinsulinemia and early vascular changes are involved in the mechanisms causing elevated BP in obese children and adolescents. Under the current evidence on the association of salt intake and BP, dietary sodium restriction appears to be a rational step in the prevention of hypertension in genetically predisposed children and adolescents. Finally, interventional studies show that regular aerobic exercise can significantly reduce BP and restore vascular changes in obese with hypertensive pediatric patients. This article aims to summarize previous studies on the role of obesity, salt intake and exercise on BP in children and adolescents. Introduction The prevalence of primary hypertension (HTN) in children and adolescents has been reported to have increased during the last few decades. HTN awareness is currently increased, due to the easier detection and improved classification of HTN in the young. Despite the difficulty in estimating the exact percentage of children with elevated blood pressure (BP), pediatric primary HTN is present in 1–5% of children and adolescents of all age groups. Differences in race/ethnicity, variance in secondary HTN, sex-related changes, environmental and nutritional influences are all confounding factors in the estimation of prevalence. The most important aspect of identifying HTN in the pediatric population is 'BP tracking', that means the association of high BP in childhood with elevated BP in adulthood. With this concept, factors that affect BP in childhood, are likely to further influence the burden of HTN and cardiovascular disease in adults. The documented increasing prevalence of childhood obesity has accounted for the trends of elevated BP in children and adolescents. However, in the recent National Health and Nutrition Examination Survey (NHANES; 1988/1994 and 1999/2000), adjustment for obesity explain only 29% of the increase in systolic BP (SBP) and 12% in diastolic BP (DBP), suggesting that other factors, such as increased salt intake and low physical activity, may also affect BP trends over time. This article aims to summarize previous studies on the role of obesity, salt intake and exercise on BP in children and adolescents. http://www.medscape.com/viewarticle/746947_4