Secular trends of blood pressure and body size in a multi-ethnic adolescent population: 1986 to 1996.

Objectives: To determine the levels and time trends of blood pressure and body size in a healthy population of youth.

Study Design: Minneapolis, Minnesota, fifth through eighth grade public school children (aged 10 to 14 years) were surveyed in 1986 and 1996. Blood pressure, height, and weight were measured by technicians trained to the same rigorous protocol at each time period, and comparisons were made between the 2 groups (1986 and 1996).

Relation of weight and rate of increase in weight during childhood and adolescence to body size, blood pressure, fasting insulin, and lipids in young adults. The Minneapolis Children's Blood Pressure Study.

Background: Weight gain is of concern during early development because adult obesity and its cardiovascular consequences appear to have their origins during childhood. Insulin resistance is known to be related to obesity. Thus, weight gain beginning in childhood may influence the development of insulin-induced cardiovascular risk during adulthood.

Reduction of cardiovascular disease: what is the role of the pediatrician?

It is apparent from the results of the 1995 and 1998 surveys reported by Kimm et al in this issue of Pediatrics that pediatricians are interested in blood pressure and lipids but uncertain about the management of these coronary heart disease (CHD) risk factors. Data from longitudinal epidemiologic studies initiated in pediatric cohorts support the important role for pediatricians in the detection of children at risk for CHD, and detection should be followed by effective intervention/treatment programs. However, the latter may be difficult in most office practices, because of the intensive effort by specialized personnel required to successfully reduce CHD risk.

Relation of fasting insulin to blood pressure and lipids in adolescents and parents.

This study was intended to clarify the relation between fasting insulin, lipids, and blood pressure in adolescents before the onset of hypertension and to examine the association of these data with similar data obtained in their parents. The participants in this study were 183 adolescents 14 to 18 years old (96 girls) completing a 4-year intervention trial and their parents (164 mothers, 122 fathers). Blood pressure was measured twice on the right arm in a seated position using a random-zero sphygmomanometer.

Cystic renal lymphangiectasia: a distinctive clinicopathologic entity in the pediatric age group.

This report describes the features of unilateral cystic renal lymphangiectasia in a 2-year-old child who presented with hypertension, massive ascites, a left flank mass, and no evidence of familial renal cystic disease. The child became normotensive and is now asymptomatic more than 3 years after surgery. The clinical presentation and diffuse pathologic involvement are similar to findings for the few pediatric patients with cystic lymphangiectasia described in the literature and appear distinct from the more localized form of the disease seen in adults.

Rate of change of blood pressure in premature and full term infants from birth to 4 months.

Systolic and diastolic blood pressures were evaluated in a cohort of 61 non-hypertensive premature [very low birth weight (VLBW), n = 16; low birth weight (LBW), n = 22] and full-term [normal birth weight (NBW), n = 23] newborn infants admitted to a neonatal intensive care unit (NICU) and followed to their 4-month age-adjusted outpatient examination. All were receiving routine postnatal care by 7 days of age. Blood pressure was measured at 7 days of age, at discharge from the NICU, and at the outpatient examination.

Renal artery stenosis in infants: long-term medical treatment before surgery.

This report describes five infants (3 male, 2 female) with renal artery stenosis diagnosed in their 1st year of life. The age at initial presentation was 5 days to 10 months. All had symptoms of congestive heart failure, cardiomegaly on chest X-ray, and left ventricular hypertrophy by electrocardiogram or echocardiogram.

Glomerular disease and lung transplantation.

Three patients with lung or heart/lung transplants developed nephrotic-range proteinuria 2 to 5 years posttransplantation. Kidney biopsy showed focal segmental glomerulosclerosis in two patients and probable focal sclerosis in the third. A retrospective review of postmortem kidney specimens from 18 lung transplant recipients who died did not indicate additional cases of glomerular disease.

Comparison of serum calcium levels between junior high school children with high-normal and low-normal blood pressure. The child and adolescent blood pressure program.

The objective of this study was to compare serum calcium levels, dietary calcium intake, and urinary calcium excretion between junior high students with high-normal and low-normal blood pressure. The study was conducted in 11- to 14-year-old children recruited after blood pressure screening of 5th to 8th grade Minneapolis and St. Paul Public School students.

Treatment of hypertension in children.

This review summarizes the current approach to antihypertensive therapy in children. It focuses on newer drugs, taking into account changes in clinical practice that have occurred since publication of the second Task Force report. Non-pharmacological therapy, including weight reduction, exercise, and dietary intervention, has great potential for the effective reduction of blood pressure.

Antineutrophil cytoplasmic autoantibody-positive crescentic glomerulonephritis as a complication of treatment with propylthiouracil in children.

Propylthiouracil, which is commonly used in the treatment of hyperthyroidism, has been associated in adults with antineutrophil cytoplasmic autoantibody, a serologic marker of vasculitis. Severe renal disease has not been reported as a complication of therapy with this drug. We report severe antineutrophil cytoplasmic autoantibody-positive vasculitis in children receiving propylthiouracil, as well as rapidly progressive crescentic glomerulonephritis after administration of this drug.

Clinical pharmacology of converting enzyme inhibitors, calcium channel blockers and diuretics.

The predominant trend in pediatric antihypertensive management is towards increasing reliance on angiotensin converting enzyme (ACE) inhibitors and calcium channel blockers because of their general effectiveness, low incidence of adverse reactions and potential specific benefit in patients with renal disease. The common aetiological relationship between renal disease and elevated BP also is the reason that diuretic therapy continues to be included in many treatment regimens. A number of ACE inhibitors are available for clinical use, although only captopril has been subjected to any meaningful degree of investigation in children.

Effect of low sodium diet or potassium supplementation on adolescent blood pressure.

The roots of essential hypertension extend back into the first two decades of life, suggesting that effective intervention during those years may lead to a reduction in the incidence of adult hypertension. Decreasing the dietary sodium/potassium ratio offers a potentially effective approach to blood pressure reduction. This study tested the feasibility of 3-year sodium reduction or potassium supplementation in adolescents and the effect of these interventions on the rate of rise of blood pressure during adolescence.

Pharmacologic management of childhood hypertension.

Antihypertensive drug therapy is used in children primarily to treat secondary forms of hypertension, because the prevalence of essential hypertension in the first decade of life is considerably less than 1% of the childhood population. This prevalence increases during the second decade of life, but the percentage of teenagers with essential hypertension continues to be low. Pharmaceutical companies have been able to target drug development to specific physiologic and biochemical systems.

Cholesterol screening by primary care pediatricians: a study of attitudes and practices in the Minneapolis-St Paul metropolitan area.

A telephone survey of the 197 board-certified pediatricians actively engaged in primary care in the Minneapolis-St Paul metropolitan area was conducted to assess their cholesterol screening practices and hypercholesterolemia management. The response rate was 95%. Nearly all the pediatricians (90%) do some cholesterol screening, with the majority (58%) screening only children with a strong family history of coronary heart disease.

Drug use in the newborn. Effects on the kidney.

In the neonate, there are a number of age-related differences in drug disposition (bioavailability, distribution, metabolism, and excretion), and these are directly related to the degree of prematurity. This article discusses the use of drugs that are commonly administered to the neonatal patient, with special emphasis given to renal considerations. These drugs include diuretics, theophylline, converting enzyme inhibitors, calcium channel blockers, indomethacin, and dopamine.

Elevated blood pressure among Southeast Asian refugee children in Minnesota.

The blood pressures and body sizes of children aged 10-15 years in the Minneapolis and St. Paul, Minnesota, public schools were measured during 1986 and 1987. The sample consisted of 1,680 Southeast Asian refugees--including 219 Cambodians, 1,086 Hmong, 149 Lao, and 226 Vietnamese--and 3,424 blacks and 11,336 whites.

The Sodium-Potassium Blood Pressure Trial in Children. Design, recruitment, and randomization: the children and adolescent blood pressure program.

The Sosium-Potassium Blood Pressure Trial in Children (NaKS), is a clinical trial in a healthy, free living population of children and adolescents. It is designed to test the hypotheses that a reduction in dietary sodium and/or an increase in potassium intake will decrease the rate of rise in blood pressure during normal maturation in children and adolescents with high normal blood pressure. Screening was conducted in 19,452 students in grades 5-8 in Minneapolis and St.

Antihypertensive effect and pharmacokinetics of nitrendipine in children.

Nitrendipine, a new calcium-channel antagonist, was used to treat 25 children (aged 6 months to 17 years) with severe hypertension. Systolic and diastolic blood pressures (mean +/- SEM) fell from 148 +/- 2/99 +/- 2 mm Hg to 128 +/- 4/77 +/- 3 mm Hg after 24 hours and to 121 +/- 2/75 +/- 2 mm Hg after 2 weeks. No further reductions in systolic or diastolic blood pressure were observed after continued therapy.

Prostaglandin E biosynthesis in the Dahl rat renal papilla. Stimulus-dependent response.

The prostaglandin system influences renal sodium and water excretion and appears to be more active in the Dahl salt-resistant (DR) than salt-sensitive (DS) rat. During an investigation of renal papillary prostaglandin E (PGE) biosynthesis in DR and DS rats, it was noted that the PGE response to specific stimuli was dependent on the type of stimulus applied. Rats fed either a 0.

Diastolic fourth and fifth phase blood pressure in 10-15-year-old children. The Children and Adolescent Blood Pressure Program.

Measurement of diastolic blood pressure is complicated by the presence of two diastolic Korotkoff phases (fourth phase and fifth phase) in many children and adults. In the present study, diastolic fourth phase and diastolic fifth phase were evaluated in 1986-1987 in 19,274 Minneapolis-St. Paul school children aged 10-15 years.

Renovascular hypertension presenting with hypokalemic metabolic alkalosis.

This report describes two adolescents with severe hypertension secondary to renal artery stenosis who had evidence of a hypokalemic metabolic alkalosis in their initial laboratory evaluation. Hypokalemic metabolic alkalosis is known to occur in approximately 16% of adults with renal artery stenosis but has not been well described in the pediatric literature. It is the result of excess aldosterone secretion stimulated by renal artery stenosis-mediated activation of the renin-angiotension system and by an increase in natriuresis from the contralateral, non-stenotic kidney.