Isolated systolic hypertension, obesity, and hyperkinetic hemodynamic states in children

Objective: To determine the factors that contribute to the pathogenesis of isolated systolic hypertension in children. Methods: School-based measurement was performed of blood pressure (BP), heart rate, weight, and height in 2460 students (49% Hispanic, 31% black, 13% white) 12 to 16 years of age in 8 urban public schools. Air independent group of 71 untreated children underwent 24-hour ambulatory BP monitoring (ABPM) to confirm clinic hypertension and assess circadian BP patterns. Results: Hypertension and obesity were found in 170,6 and 23% of students, respectively. Among hypertensive students, 88% (363/413) had isolated systolic hypertension. Hypertension was more prevalent in obese than nonobese students (33% vs 11%, P < .0001). Obese hypertensive students had higher resting heart rate than nonobese normotensive patients (85.9 vs 79.6 beats/min, P < .001). Among patients who underwent ABPM, isolated systolic hypertension was found in 510/0 (36171) by clinic BP and in 62% (18/29) with confirmed hypertension by ABPM. Blood pressure variability during daytime and sleep periods was higher in obese than nonobese patients for systolic BP (P < .01) and diastolic BP (P < .05). Conclusions: The findings of increased heart rate and BP variability in obese children with isolated systolic hypertension suggest that Sympathetic nervous system hyperactivity may contribute to its pathogenesis.