Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2012 | Month : September | Volume : 6 | Issue : 7 | Page : 1158 - 1161

The Prevalence of Elevated Blood Pressure and the Association of Obesity in Asymptomatic Female Adolescent Offsprings of Hypertensive and Normotensive Parents

Vikram Singhal, Prashant Agal, Nutan Kamath

1. MBBS MD (Pediatrics) Senior Resident, Kasturba Medical College, Mangalore, Manipal University, India. 2. MBBS, Kasturba Medical College, Mangalore, Manipal University, India. 3. MBBS MD (Pediatrics), Professor, Kasturba Medical College, Mangalore, Manipal University, India.

Correspondence Address :
Dr. Nutan Kamath,
Department of Pediatrics,
KMC Hospital, Attavar, Manipal University
Mangalore-575001, Karnataka, India.
Phone: 09448147687
E-mail: nutankamath@yahoo.com

Abstract

Background and objectives: The measurement of the arterial Blood Pressure (BP) is an integral part of every child’s physical examination and it should be interpreted according to the age, gender and the height centiles. Hypertension runs in families and a parental history of hypertension increases the risk of developing hypertension, especially if both the parents have hypertension. The present study was conducted to test this hypothesis and also the hypothesis that hypertensive children are likely to be obese.

Methods: This case control study done on 200 adolescent girls who were aged between 12 to 17 years, who were from a higher primary school in an urban area of Mangalore and on their parents. The blood pressures in the apparently healthy children of the hypertensive and the normotensive parents were compared. The children of the hypertensive parents were defined as the cases and the children of the normotensive parents served as the controls. A calm comfortable setting was provided for the measurement of the BP. Only one researcher performed all the BP measurements and categorized them by using the 2004 fourth report on the blood pressure screening recommendations. The additional measures included the weight and the height. The obesity was determined, based on the Body Mass Index (BMI). The odds ratio (OR) was used for the evaluation of the association between the BP and the obesity, which was based on the BMI.

Results: A total of 203 adolescent girls were given proformas to be completed by their parents. Three parents did not give their consent. Two hundred children and their parents participated in this study. The prevalence rate of hypertension in this study was 11%. Among these 22 hypertensive children, 9 (40.9%) had positive family history of hypertension (the parents had high BP), while the remaining 13 (59.1%) children had normotensive parents. The mean weight and height in the cases were 45.52 ± 9.23 kg and 156.80 ± 9.19cm. The mean weight and height in the controls were 43.65 ± 8.68 kg and 155.22 ± 10.15cm. The mean systolic BP increased with the increasing body weight ( p < 0.05). The children with hypertension and without hypertension had a mean BMI of 2.06 ± 0.44 (mean ± SD) gm/cm2 and 1.76 ± 0.29 gm/cm2 respectively. Obesity was associated with hypertension (50% vs. 8.9% , p < 0.001).

Interpretation and Conclusions: This study confirmed a high prevalence of hypertension in the asymptomatic, healthy, adolescent girls. The blood pressure in the apparently healthy children of the hypertensive and the normotensive parents was comparable, thus refuting our hypothesis. Obesity was a significant predictor of hypertension, based on the BMI (OR 50.882; 95% CI: 17.25-150.091). Hence, BP measurements must be a part of the routine clinical examination.

Keywords

Blood pressure, Parents , Body mass index, Obesity, School children

How to cite this article :

Vikram Singhal, Prashant Agal, Nutan Kamath. THE PREVALENCE OF ELEVATED BLOOD PRESSURE AND THE ASSOCIATION OF OBESITY IN ASYMPTOMATIC FEMALE ADOLESCENT OFFSPRINGS OF HYPERTENSIVE AND NORMOTENSIVE PARENTS. Journal of Clinical and Diagnostic Research [serial online] 2012 September [cited: 2019 Aug 21 ]; 6:1158-1161. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=September&volume=6&issue=7&page=1158-1161&id=2492

Introduction
Hypertension, which occurs in approximately 3-6% of the adult population, places the affected individuals at an increased risk of cerebrovascular accidents, ischaemic heart disease and renal failure (1) and these complications can be prevented by an early detection and an effective controlling of the Blood Pressure (BP). Further, the long, slow and steady course of hypertension in adults also suggests that it perhaps had its origin in childhood, but had probably gone undetected during this period, only to manifest itself during adulthood (2),(3). In the recent years, the prevalence of hypertension in the school-aged children appears to be increasing, perhaps as a result of the increased prevalence of obesity. Hypertension runs in families and a parental history of hypertension increases the risk of developing hypertension, especially if both the parents are hypertensives (2),(4),(5),(6). Therefore, it is important to identify the children and the adolescents who are at an increased risk of developing essential hypertension as adults. However, the measurement of BP is not routinely employed in our country in the various health check-up programs and the studies which pertain to the BP of the school going Indian children are limited.

Aims
The present study was conducted to test the hypothesis that hypertensive parents are more likely to have children with hypertension; and that hypertensive children are obese.

Material and Methods

A case control study was conducted on 203 adolescent girls who were approached through their school, who were aged between 12 to 17 years and on their parents, in an urban area of Mangalore, over a period of 2 months, in the year 2007-08. The inclusion criteria were healthy children, without any underlying disease andtheir hypertensive or normotensive parents. An informed written consent was taken from the parents before involving their children in the study. Two hundred parents gave their consent for the study. This study had the prior approval of the institutional ethics committee. Every child in the study was given a predesigned questionnaire which was to be recorded by either parent, to obtain the information with reference to their last blood pressure readings and a history of hypertension, myocardial infarction and/or stroke. The following day, the proformas were collected and analyzed. The children of the hypertensive parents were taken as the cases and those of the normotensive parents were taken as the controls. A thorough physical examination was done to rule out the presence of any disease. The ages of the children were recorded in complete years. The weight (kg) was taken by using a standardized floor weighing machine to the nearest 0.5kg, with the subject being lightly dressed and barefoot. The height was measured with the subject being without footwear, by using a standard vertical calibrated bar and a sliding pointer with an accuracy of up to 0.5 cm. The obesity was defined, based on the body mass index (BMI), which was calculated by 2 methods: the Davanport index (6) and the CDC growth charts (the BMI for the age percentiles) (7).

The blood pressure measurements were done by a single researcher to avoid interobserver variability by using a mercury sphygmomanometer, as per the recommendations of the American Heart Association (8). The measurements of the BP of the children were taken in a quiet room after each child was seated for 5 minutes with the right arm resting on the table, and with the cubital fossa at the heart level. The length of the upper arm was the distance between the acromion and the olecranon, which was measured when the arm of the child was in a relaxed position and when it was bent at 90 degrees at the elbow. The circumference of the upper arm was measured with a tape, without indenting the skin at the midpoint of the relaxed hanging upper arm. All the BP cuffs were commercially available and the sizes were chosen to select a bladder width of at least 40% of the length of the upper arm and a length which was greater than the circumference of the upper arm. The manometer readings at the first and at the onset of the fifth korotkoff phases were taken as the systolic and the diastolic BP, respectively. Three readings were taken at intervals of 5 minutes for each child and the average was taken for the final analysis. It was corrected for age and sex in the form of centile bands and compared with the US National Childhood Blood Pressure Standards (9).

For the children, hypertension was defined as the systolic blood pressure or the diastolic blood pressure above the 95th percentile for that age and gender, after adjusting for the height (10) (by using the CDC growth chart-stature for the age percentiles). A parent with an average BP of >140/90 mm Hg or who was on antihypertensive drugs at the time of the study, was classified as a hypertensive (11). The children were divided into 2 groups; those with hypertensive parents (either or both) were taken as the cases and those with normotensive parents were taken as the controls. The prevalence rates of hypertension in both the groups were calculated and compared. The data was analyzed by using the SPSS (version 15.0) statistical package by using the Students ‘t’ test and linear and logistic regression analyses. The ANOVA statistical package and the Chi Square test were also applied. A ‘p’ value of <0.05 was considered as significant. The Odd’s Ratio (OR) and the Confidence Interval (CI)calculator were used to calculate the OR and the 95% confidence interval.

Results

A total of 203 adolescent girls were given the proformas to be completed by their parents. Three parents did not give their consent. Two hundred children and their parents participated in this study. 22 subjects had hypertension, with a prevalence rate of 11%. 9 (40.9%) had a positive family history of hypertension in the parents, while the remaining 13 (59.1%) children had normotensive parents. Among the nine hypertensive children, six (66.7%) had hypertensive fathers, while only one (11.1%) had hypertension in the mother and two (22.2%) children had both parents as hypertensives. The mean systolic and the diastolic BP in the children of the hypertensive parents were 111.04 ± 13.16 (mean ± standard deviation) mm of Hg and 72.60 ± 9.60 mm of Hg respectively, while they were 111.14 ± 11.13 mm of Hg and 72.81 ± 9.98 mm of Hg respectively in the children of the normotensive parents. There was no statistically significant correlation between the BP (systolic/diastolic) of the children of the hypertensive parents and the BP of the children of the non hypertensive parents. The mean weight and height in the cases were 45.52 ± 9.23 kg and 156.80 ± 9.19 cm and 43.65 ± 8.68 kg and 155.22 ± 10.15cm in the control group. The mean systolic BP increased with the increasing body weight and it was statistically significant. There was no relationship between the mean diastolic BP and an increase in the body weight. The systolic BP showed a gradual rise with increasing height, while the diastolic BP did not show any definitive pattern. There was no statistically significant association between the systolic or the diastolic BP and the height.

The children with hypertension had a mean BMI of 2.06 ± 0.44 (mean ± SD) gm/cm2. The children without hypertension showed a mean BMI of 1.76 ± 0.29 gm/cm2. The mean systolic BP in the obese group was 122.0 ± 11.86 (mean ± SD) mm of Hg, while it was 110.06 ± 11.25 mm of Hg in the non-obese children, which was statistically significant. The mean diastolic BP was 76.6 ± 13.59 and 72.38 ± 9.39 in the obese and the non-obese groups respectively, which did not show any significant association with the obesity. The mean systolic BP showed an increasing trend with an increase in the BMI and it was statistically significant. (p <0.05) However, for the diastolic BP, there was a trend for the mean value to increase with an increase in the BMI, but this was not statistically significant (Table/Fig 1). The prevalence of hypertension in the obese children was 50% (as was calculated by the Davanport index) as compared to that in the non-obese children, which was 8.9% (p < 0.001) (95% CI: 2.67 to 38.70) (Table/Fig 2) whereas in the obese children ( as was calculated by the CDC BMI charts), it was 75%, as compared to 9.7% in the non obese children ( p < 0.05) (95% CI: 2.77-60.2) (Table/Fig 3).

Discussion

Hypertension is the most potent universal contributor to the cardiovascular mortality. An elevated BP, labile or fixed, systolic or diastolic, at any age, in either sex, is a contributor to all forms of cardiovascular diseases (1),(2). BP measurements must be a part of every clinical examination in children (9). By taking the criteria of the 95th percentile of BP for defining hypertension, for that age and sex group, after adjusting for theheight; the prevalence of hypertension in our study was found to be 11%; 3% for the systolic BP, 6% for the diastolic BP and 2% for both the systolic and the diastolic BP. The prevalence of essential hypertension in children has been reported to vary from 2.2% to11% (Table/Fig 4). This diversity in the prevalence was due to the varying age groups which were taken for the study, the different criteria which were adopted for defining hypertension and the basic differences between the racial subgroups which were related to geographic, dietary and cultural factors. The familial aggregation of BP, the unidentified genetic factors and the anatomical variants of the regional circulation may also change the demographic pattern from time to time. In the recent years, the prevalence of hypertension in theschool-aged children appears to be increasing, perhaps as a result of the increased prevalence of obesity and stress, a lack of physical activity and an over active sympathetic nervous system (22).

Six (66.7%) out of the 9 hypertensive children had hypertensive fathers. One (11.1%) out of the 9 hypertensive children had hypertension in the mother. Only 2 (22.2%) children had both parents as hypertensives. Although the exposure rate was higher in the cases (18%) than in the controls (8.6%), the association between the hypertension in the children and the family history of the hypertensive parents was not significant statistically (P>0.05), thus refuting our hypothesis that hypertensive parents have a higher risk of having children with hypertension. However, a family history of hypertension played an important role in the development of high BP in the children in this study (6),(22). Hypertension in both the mothers and the fathers had a strong independent association with the elevated BP levels and with the incident hypertension over the course of the adult life, in a longitudinal cohort of 1160 male former medical students with 54 years of follow-up (2). The vagal withdrawal plays a critical role in the development of the Sympathovagal Imbalance (SVI) in the prehypertensive offsprings of the hypertensive parents. The intensity of the SVI was more in the offsprings of the two parents who were hypertensives as compared to those of a single parent who was hypertensive (5). The body size is an important determinant of the BP in children. The BP standards depend on the age, sex, weight and height. The second Task Force Report, in 1987, stressed that the BP values must be evaluated with the height and the weight. These BP values were reanalyzed, considering the height in 1996 and the height specific systolic and diastolic BP percentiles were determined in the fourth Task Force Report (10). The prevalence of obesity was found to be 5% by the Davanport index and to be 2% by using the CDC growth charts (the body mass index-for-age percentiles). The BP was much higher in the obese children as compared to that in the non-obese, (50% vs. 8.9%) and a highly significant correlation was noted, both by the Davanport index and by the CDC growth chart, as was also observed in similar studies (6),(14),(19),(23),(24). Obesity was strongly associated with the systolic hypertension in the adolescent girls (25),(26), as was also found in our study. Some of the physiologic changes which have been proposed to explain the relationship between the excess body weight and the blood pressure, are overactivation of the sympathetic nervous and the renin–angiotensin systems, the elevated levels of the inflammatory pathways and insulin resistance (27). A follow up study on adolescents was done for 31.5 years, where a BMI above the 95th centile in adolescence predicted increased adult mortality rates, and a 10 kg higher body weight was associated with a 3.0 mmHg higher systolic and a 2.3 mmHg higher diastolic blood pressure. These increases translate into an estimated 12% increased risk for coronary heart disease and into a 24% increased risk for stroke (28). Hence, it would be logical to advise the families with obese children to change their lifestyles with respect to the diet, exercise and the reduced salt intake, to get their children accustomed to the life styles which are favourable for the maintenance of normal blood pressures.

Limitations of the study
While it has been recommended to use the average of the multiple BP measurements which were taken for weeks to months to characterize an individual’s BP level, limited resources and time restricted the researcher in this study from doing so. The BP is alsoinfluenced by various other factors such as the time of the day, ambience and the fasting vs. the non-fasting state of the subject, that could not be controlled in this study. A further classification could not be done due to a lack of investigations on secondary hypertension. The small sample size and the determination of BP in a single sex were also our limitations, but the increased prevalence of hypertension emphasizes the importance of the BP monitoring in children.

Conclusion

The blood pressures in the apparently healthy children of the hypertensive and the normotensive parents were comparable; however, this study confirmed a high prevalence of hypertension in adolescent girls. 50% of the hypertensive children were obese, in comparison to the children without hypertension. Obesity was a significant predictor of hypertension, based on the BMI (OR 50.882; 95% CI: 17.25-150.091). All the paediatricians should measure and monitor the BP. The children in the high risk group should be identified and treated with an individualized approach.

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ID: JCDR/2012/4269:2492

Date of Submission: Mar 12, 2012
Date of Peer Review: Apr 21, 2012
Date of Acceptance: Aug 22, 2012
Date of Publishing: Sep 30, 2012

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