Hipertensão arterial e fatores de risco cardiometabólicos associados em crianças e adolescentes.

Abstract

Introduction: Childhood is an important phase of the organism's development, as well as a child's life habits. Hypertension in children and adolescents deserves attention from scientific research, since it is possible to diagnose the epidemiological situation and decisively influence the onset of this risk factor. Purpose: Describe the incidence of arterial hypertension in children and adolescents followed for a period of three years, as well as assess cardiometabolic risk factors and associated sociodemographic factors. Paper I: Objective: To compare cardiometabolic risk factors of Brazilian children and adolescents with international reference values. Methods: This is a cross-sectional study that included 2,250 randomly selected children and adolescents (55.6% girls), aged six to 17 years. Cardiometabolic risk factors, such as body mass index (BMI), waist circumference (WC), systolic and diastolic blood pressures (SBP and DBP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol to high-density lipoprotein-cholesterol ratio (TC:HDL-C), triglycerides levels (TG), glucose and cardiorespiratory fitness (CRF) were compared to international age-and sex-specific reference values. Results: The clustered risk score, considering the all ages sample, was better in the boys (-0.20[-0.41;0.01] and -0.18[-0.37;0.01], with and without the inclusion of CRF, respectively) but not significantly, and worse in the girls (0.24[0.05;0.43] and 0.28[0.11;0.44], with and without the inclusion of CRF, respectively) than the international reference. Additionally, Brazilian youth had a statistically better profile in TC, LDL-C, HDL-C, TC:HDL-C ratio, and CRF (just in girls), as well a worse profile in BMI, WC, SBP, DBP, TG (just in girls), and CRF (just in boys). Conclusions: The clustered cardiometabolic risk score (including or excluding CRF), considering the all ages sample, was better in the Brazilian sample of boys, but not significantly, and worse in the girls compared to the international standard reference. Paper II: Objective: To identify the incidence of hypertension in children and adolescents followed for three years, as well as to assess the associated cardiometabolic (nutritional status, cardiorespiratory fitness [CRF] and biochemical profile), and genetic aspects. Methods: This retrospective cohort research followed a group of 469 children and adolescents, aged 7-17 years old (43.1% boys). We evaluated systolic blood pressure (SBP), diastolic blood pressure (DBP), with cardiometabolic risk factors associated: waist circumference (WC), Body Mass Index (BMI), Body Fat percentage (%BF), triglycerides, total cholesterol, high and low-density lipoproteins cholesterol, glucose, CRF, and genetic aspects. It was calculated the cumulative incidence of hypertension and multinomial logistic regression model was constructed with the hypertension as the dependent variable (normotensive maintaining as reference category; normotensive to borderline and normotensive to hypertensive as outcomes). BMI, WC, %BF, glucose, dyslipidemia, FTO genotype, and CRF as independent variables. Results: After three years, 12.8% of normotensive subjects at baseline became borderline, 11.5% changed their category to hypertensive, and 1.3% who were categorized as borderline became hypertensive. For BMI, children and adolescents who were overweight or obese at baseline had more chances to become borderline, while those who were obese had higher chances to become hypertensive. For WC, the high risk associated with hypertension development. For %BF, an inappropriate level associated with both borderline and hypertensive development. Conclusions: A high incidence of hypertension in children and adolescents was verified. Worse levels of BMI, WC, or %BF at baseline had more chances to develop hypertension throughout three years. Final Considerations: The hypertension incidence identified in the children and adolescents sample studied was 11.5%; children and adolescents classified according to BMI as overweight has more chances of change their category from normotensive to borderline and to hypertensive; children and adolescents classified as obese had higher chances to change their category from normotensive to hypertensive; children and adolescents classified as high risk according to WC and inappropriate levels of %BF had more chances to development hypertension; the clustered cardiometabolic risk score (including or excluding CRF), considering the all ages sample, was better in the Brazilian sample of boys, but not significantly, and worse in the girls compared to the international standard reference.