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The association between blood pressure and carotid intima-media thickness in children: a systematic review

Published online by Cambridge University Press:  05 April 2017

Thomas G. Day Open the ORCID record for Thomas G. Day [Opens in a new window] ,
MinHae Park  and
Sanjay Kinra
Thomas G. Day*
Affiliation:
Department of Cardiology, Great Ormond Street Hospital NHS Trust, London, United Kingdom
MinHae Park
Affiliation:
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
Sanjay Kinra
Affiliation:
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
*
Correspondence to: Dr T. Day, Department of Cardiology, Great Ormond Street Hospital NHS Trust, Great Ormond Street, London, United Kingdom. Tel: +447944326254; Fax: +447944326254; E-mail:tomgeorgeday@gmail.com
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Abstract

High blood pressure is a risk factor for atherosclerosis in adults, but whether the same is true in children and young people is not known. This is important to guide management of high blood pressure in children and young people. We aimed to investigate the association in children and young people between blood pressure and carotid intima-media thickness, a non-invasive marker of atherosclerosis, through a systematic review. Studies were retrieved from MEDLINE and EMBASE. Articles were eligible for inclusion if they included at least one measurement of blood pressure and at least one measurement of ultrasound-derived carotid intima-media thickness, both measured during childhood (0–19 years), and a measure of effect size or correlation between the two measurements. A total of 3748 studies were identified in the initial search, of which 28 studies were included in this review. The results were mixed, but the largest and highest-quality studies suggested an independent positive association between blood pressure and carotid intima-media thickness in children and young people, even after adjustment for other cardiovascular risk factors. There was no indication of a clear threshold level for the effect of blood pressure on carotid intima-media thickness, hence there are insufficient data to support a pharmacological treatment threshold for the treatment of high blood pressure in children and young people to prevent future cardiovascular disease. The studies included varied widely in terms of quality and design, and it was not possible to combine the data in a meta-analysis. There is likely to be an independent association between blood pressure and carotid intima-media thickness in childhood, but it is not clear at what point this should be treated.

Keywords

Hypertensionchildhoodcarotid intima-media thicknessatherosclerosis
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 7 , September 2017 , pp. 1295 - 1305
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Copyright
© Cambridge University Press 2017 

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