Four thousand three hundred and thirteen children beginning at five to fourteen years of age have been examined on three to six occasions in Muscatine, Iowa, on alternate years. To compare blood pressures throughout the period of observation each value was expressed as a percentile rank. For each subject the average percentile rank (level), the trend in rank and the variability over time were calculated. Values for height, weight, relative weight and triceps skinfold thickness measurements were expressed in the same fashion. There is a relationship between average rank of blood pressure and average rank of body size as well as between trend of blood pressure and trend of body size percentiles. These observations indicate the importance of relative rate of growth in the establishment of the rank order of blood pressure during childhood.

Adolescent↗

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Where are children's blood pressures headed?

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Blood Pressure↗

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Left ventricular hypertrophy in children with blood pressures in the upper quintile of the distribution. The Muscatine Study.

From echocardiography measurements of left heart dimensions, cardiac output was estimated in 264 school children whose systolic blood pressure persisted in the lowest, middle, or highest quintile of the distribution for their age and sex. Children with blood pressure in the upper quintile were taller, heavier, and more obese. Echocardiographically determined left ventricular wall mass, corrected for body size, was significantly greater in these children than those in the lower quintiles of blood pressure. These children displayed a continuum of cardiac output. Those with the highest cardiac output in the upper blood pressure quintile had the greatest left ventricular wall mass.

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The cardiovascular responses to exercise in children across the blood pressure distribution. The Muscatine study.

Children with elevated systolic blood pressure have a wide range of cardiac output. To better understand the mechanisms regulating resting and exercise blood pressure, we investigated the cardiovascular responses to both dynamic and isometric exercise in 264 children who were selected from the low, middle, and upper quintile of the distribution of blood pressure of an entire school population. We sought to identify patterns of response to exercise that correlated with both resting cardiac output and resting blood pressure. During isometric exercise, systolic pressure adjusted for age and body size increased in all groups. The low group's mean pressure remained significantly lower than the high group's pressure throughout the entire exercise period. Body size adjusted group systolic and diastolic blood pressure level differences exist during dynamic exercise. The product of the systolic blood pressure times the heart rate, in the high blood pressure group, was significantly higher throughout dynamic exercise than in the other two groups. Elevated resting resistance is correlated with elevated resistance during isometric exercise and elevated diastolic blood pressure during dynamic exercise. Cardiac index had a significant negative correlation to age (r = -0.58) at all levels of blood pressure. This observation, in children, lends some support to the concept of the evolution from a hyperkinetic circulation in early childhood to a circulation with lower cardiac output and more elevated systemic vascular resistance at an older age.

Adolescent↗

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Factors related to tracking of blood pressure in children. U.S. National Center for Health Statistics Health Examination Surveys Cycles II and III.

In this paper we examine the relationship of growth, obesity, and the degree of sexual and bone maturation to blood pressure in a U.S. national probability sample of 2165 children examined by the U.S. National Center for Health Statistics on two occasions, approximately 4 years apart. Subjects who maintained, increased, or decreased their peer rank order of blood pressure are described. Children who maintained their blood pressure in the upper quintile were taller, heavier, more obese, had greater bone age, greater numbers of permanent teeth, and were more sexually mature than their peers, while those maintaining their blood pressure in the lowest quintile of blood pressure were shorter, lighter, less obese, had lesser bone age, fewer permanent teeth, and were less sexually mature. Subjects whose blood pressures were initially in the lowest four quintiles and then rose to the top quintile were also taller, heavier, more obese, and had greater bone age, while those with blood pressures falling to the lowest quintile from the upper four quintiles were shorter, lighter, less obese, and had lesser bone age. Thus, the level at which blood pressure tracks during childhood is related to growth, obesity, and to the degree of maturation acquired. In addition, children whose blood pressures are rising or falling in relation to their peers have body growth and maturation characteristics similar to those who maintain their rank order high or low respectively.

Adolescent↗

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Obesity in childhood: the Muscatine Study.

Beginning in 1971 children in grades kindergarten through the 12th grade were examined on alternate years until 1992 in Muscatine, Iowa, in these examinations the following variables were assessed: height, weight, skinfold thickness, lipids, lipoproteins, smoking behaviors, as well other variables. In order to lend relevance to risk factors in childhood a number strategies have been used. These include: 1) Examination of familial aggregation and mortality; 2) Segregation analysis of genetic mechanisms; 3) Relationship of obesity in childhood to other established risk factors; 4) Examination of the relationship of childhood obesity to the development of coronary artery calcification as assessed by electron beam computed tomography. In these studies we have shown that obese children's siblings, mothers, fathers, aunts and uncles have significant greater body mass indices than leaner children. Children who are obese have significantly higher systolic and diastolic blood pressure, higher plasma triglycerides and lower HDL-cholesterol levels. The first and second degree relatives of obese hypertensive children have a higher mortality rate from cardiovascular disease than leaner children's relatives. From complex segregation analyses about 35% of the population of Muscatine appear to carry a gene for obesity and 6% appear homozygous. Over the past decade we have observed that the children in Muscatine, Iowa have become more obese than previously. Our longitudinal observations indicate that obesity acquired in childhood is predictive of adult obesity and is also predictive of the development of coronary artery calcification. Thus obesity in childhood is not only an important risk factor in children but also a growing public health problem for children and adolescents.

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