Objectives Hypertension is increasingly found in children. 24 hour ambulatory blood pressure monitoring is now preferred to office blood pressure measurement for diagnosis and monitoring. Blood pressure of children tends to fluctuate widely throughout the day and night. A number of children suffer from a condition called white coat hypertension in which elevation of blood pressure is only transient and they usually have normal blood pressure on continuous monitoring. This condition is not totally benign. Some patients will evolve into hypertension over time. This retrospective case control study is to compare the demographic characteristics and blood investigations of these 2 groups namely white coat hypertension cases and a control group so as to identify factors predictive of white coat hypertension in a Chinese population to help allocate resources for timely diagnostic investigation. Method 100 patients referred from primary health care units aged 6-18 year old for suspected hypertension based on raised office blood pressure measurements were recruited as cases in the white coat hypertension group and 100 age-matched patients as a control group. The factors studied included gender, body mass index, length of gestation, birth weight, family history of hypertension, positive past medical history, blood pressure at first presentation, blood pressure of ambulatory blood pressure monitoring, serum glucose, urate and cholesterol and triglyceride level. Univariate analysis was used to detect significant difference between the cases and the controls for continuous and categorized variables. Logistic regression was used to assess the independent associations of significant predictive factors of white coat hypertension. Correlations with the scatterplots for the relation of office systolic blood pressure and diastolic blood pressure with 24 hour ambulatory blood pressure monitoring within cases was done to see if there was any significant relations. The outcome of cases was also studied for the proportion which progressed into genuine hypertension. Results Body mass index (BMI) was identified as a significant predictive factor in logistic regression with an odds ratio of 1.18 (95% CI = 1.11-1.25) with p-value <0.001. The correlation between 24 hour ambulatory blood pressure and office blood pressure measurement was not significant. None of the cases progressed into genuine hypertension upon follow up. Conclusion To conclude, this study showed that high BMI might be predictive of white coat hypertension in Chinese children in Hong Kong. This result could be act as a hypothesis for future research. Multi-centre prospective cohort studies might be of value in testing this factor together with factors which were shown to be significant in other studies. White coat hypertension is not always as benign as thought. Obesity is a condition which requires attention from patients, parents, paramedics and healthcare practitioners especially in primary healthcare settings and should be monitored more closely for the emergence of associated complications. / published_or_final_version / Public Health / Master / Master of Public Health

Thesis (M.S.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains vi, 81 p. Vita. Includes abstract. Includes bibliographical references (p. 44-48).

Thesis (Ph. D.)--University of Sydney, 2003. / Title from title screen (viewed Apr. 29, 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Public Health, Faculty of Medicine. Includes bibliography. Also available in print form.

Thesis (M.S.)--Brock University, 2009. / Includes bibliographical references (leaves 42-53).

Thesis (M.S.)--University of Texas at El Paso, 2008. / Title from title screen. Vita. CD-ROM. Includes bibliographical references. Also available online.

Hypertension afflicts one in four American adults and is a major risk factor for cardiovascular disease. Studies have shown that a family history of hypertension is an important predictor of future hypertension. Two hemodynamic factors control blood pressure (BP); cardiac output (CO) and total peripheral resistance (TPR). Although children of hypertensive parents may exhibit normal levels of these hemodynamic variables at rest, the response of these variables during exercise stress may differ. Therefore, the present study was designed to investigate whether children with a positive family history of hypertension exhibit an exaggerated BP response due to either an increased CO or an attenuated decrease in TPR during dynamic submaximal exercise compared to children of normotensive parents. Eleven children 12.2 ± 1.8 yr (M ± SE) of normotensive parents and 11 children 12.0 ± 2.4 yr of at least one hypertensive parent completed an orientation session, graded maximal cycle ergometer test, and a submaximal exercise bout consisting of 6 minutes of steady state cycling at 50 and 80% of maximal heart rate reserve. Blood pressure, CO and TPR were measured during the last 3 minutes of each submaximal exercise stage. An independent t-test was used to determine differences in the resting measures. The changes in TPR, BP and CO from rest through 80% intensity stage were examined using a twoway (group x intensity) ANOVA. The groups were evenly matched for age, weight, height, and body fatness. The children with a positive family history of hypertension had significantly higher resting systolic BP, diastolic BP (DBP), and mean arterial pressure (MAP) (p<0.05) compared to those children with a negative family history. Although there were no significant interactions among any of the variables studied, there was a tendency for TPR to be higher (p>0.05) at rest and throughout exercise in the positive history group. MAP and DBP were significantly higher in the positive family history group at rest and remained higher throughout exercise. In conclusion children of hypertensive parents exhibit a modest but significantly higher MAP and DBP at rest and during submaximal exercise. This subtle difference in BP control reflects an early trend toward increased TPR. / School of Physical Education

Thesis (M.Sc. (Physiology)) -- University of Limpopo, 2016 / Cardiovascular diseases (CVDs) are major public health problems nowadays in Africa. From prospective studies, it is also known that risk factors for CVDs start early in life and increase morbidity and mortality in sub-Saharan African adults. Mostly the risk factors of CVDs are malnutrition and hypertension. Economic development in South Africa leads to lifestyle changes that contribute to a high prevalence of high blood pressure (BP) and malnutrition. However, little is known about the relationship of anthropometric indicators and BP in children from the developing countries. Therefore the aim of this study was to determine the association between anthropometrics indicators and BP among rural children in Ellisras area of Limpopo province, South Africa. All 1961 children (n=1029 boys, n=932 girls) aged 5-12 years underwent anthropometric and BP measurements using standard procedure. Receiver operating characteristics (ROC) curve was used to assess the ability of anthropometric indicators to discriminate children with high BP. ROC was used to determine the area under curve (AUC), cut-off value, sensitivity and specificity for underweight in children for each age and gender. Linear regression was used to assess the relationship between anthropometric indicators and BP. ROC curve showed that height (AUC = 0.700, 95%Cl 0.581 to 0.818), SH (AUC= 0.690, 95%Cl 0.573 to 0.786) and SH/H (AUC=0.670, 95% 0.533 to 0.807) can significantly (P<0.05) identify Ellisras children with hypertension. AUC for neck circumference (NC) (0.698), mid upper arm circumference (MUAC) (0.677) and body mass index (BMI) (0.636) for boys were statistically significant (P<0.05) for high systolic blood pressure (SBP), while in girls AUC of BMI was not significant (P>0.05) for high diastolic blood pressure (DBP). The regression analysis showed a positive significant (P<0.05) association of SBP with NC (β=0.764, 95%CI 0.475 to 1.052) and MUAC (β=1.286, 95% Cl 0.990 to 1.581) for unadjusted and adjusted age and gender. NC (β=0.628 95% Cl 0.303 to 0.953) and MUAC (β=1.351 95% CI 1.004 to 1.697) showed a significant association with SBP. However, MUAC had a significant association with DBP for both unadjusted and adjusted age and gender. Sitting height (SH) was significantly associated with SBP (β = 0.134, 95% Cl 0.210 to 0.416) and DBP (β = 0.088, 95% Cl 0.086 to 0.259) for unadjusted. After adjusted for age and gender, SH was significantly associated with both SBP (β = 0.161, 95% Cl 0.220 to 0.532) and DBP (β = 0.101, 95% Cl 0.066 to 0.329). There was a positive significant association between BP and anthropometric indicators in this population study, though the association of DBP and NC disappeared after adjustments for age and gender. Furthermore, there is a positive significant association between DBP and SBP with the components of height amongst Ellisras rural children. NC and MUAC are the simplest techniques with good interrater reliability and could be used to screen underweight in children. / Vrije University, Amsterdam, The netherlands University of Limpopo National Research Foundation (NRF)