NewsMakers
Children with high blood pressure often become adults with high blood pressure
An estimated 2-5% of children have hypertension, or high blood pressure, and primary hypertension—indicating it is not due to an underlying medical condition—is now the most common type of high blood pressure in kids, especially in adolescents.
High blood pressure in children is not uncommon, and research shows it may lead to high blood pressure in adulthood, as well as problems with the heart, blood vessels and kidneys, according to a new scientific statement from the American Heart Association published in the Association’s Hypertension journal. An American Heart Association scientific statement is an expert analysis of current research and may inform future guidelines.
An estimated 2-5% of children have hypertension, or high blood pressure, and primary hypertension—indicating it is not due to an underlying medical condition—is now the most common type of high blood pressure in kids, especially in adolescents. The new scientific statement reviews current evidence of what leads to high blood pressure in children and adolescents, and highlights clinical and public health implications for health care professionals, researchers and the public.
“Primary hypertension onset in childhood is not a benign condition,” said Bonita Falkner, M.D., FAHA, chair of the scientific statement writing committee and an emeritus professor of medicine and pediatrics at Thomas Jefferson University in Philadelphia. ”This is a health problem that is often amplified by lifestyle and behaviors, many of which are modifiable. Since kids with high blood pressure levels tend to maintain high blood pressure into adulthood, diagnosing and appropriately addressing high blood pressure in youth is imperative to ensure improved lifetime health as early as possible.”
Blood pressure is recorded using two numbers: the systolic blood pressure (the top number in a blood pressure reading) indicates the pressure blood is exerting against the artery walls when the heart beats; and the diastolic blood pressure (the bottom number in a blood pressure reading) indicates the pressure blood is exerting against the artery walls while the heart is resting between beats. High blood pressure occurs when the force of blood flowing through the blood vessels is consistently too high. Damage from high blood pressure may lead to heart disease potentially leading to heart attack, stroke, kidney disease, peripheral artery disease, vision loss, angina (chest pain) and more.
Some factors that may contribute to high blood pressure in children are not modifiable, such as genetics, low birth weight and even environmental exposures. One large study in China evaluated children ages 7 through 18 and found an association between air pollution from industrial and vehicle emissions and other pollutants and an increased risk of abnormal blood pressure.
There are some significant risk factors for high blood pressure that may be modified to improve blood pressure levels, including obesity, physical activity and a key factor—nutrition. A recent meta-analysis of 18 studies with high-quality data on sodium intake and blood pressure found that systolic blood pressure readings increased by 0.8 mm Hg and diastolic blood pressure levels increased by 0.7 mm Hg for every additional one gram of daily sodium intake. This is concerning because dietary sodium intake in the U.S. among children is above recommended nutritional guidelines, according to the 2019 report from the National Academies of Sciences, Engineering and Medicine.
“A healthy lifestyle in childhood may be extremely helpful in mitigating the risk of developing hypertension in youth,” said Falkner. “Preventive measures for families that promote healthy lifestyles in children are important, such as eating healthy food, encouraging physical activity that leads to improved physical fitness and healthy sleep, and avoiding the development of obesity. Regular blood pressure monitoring by a health care clinician is also essential so that if high blood pressure is present, it can be quickly detected and addressed.”
Recognizing high blood pressure in children and adolescents who are otherwise healthy and without symptoms may be challenging. Health care professionals should be trained on the specific techniques to measure pediatric blood pressure more accurately, and if levels are elevated, the child’s blood pressure should be checked on at least three different days using appropriate measurement techniques, as outlined in the scientific statement.
Current pediatric guidelines from the American Academy of Pediatrics, European Society of Hypertension and Hypertension Canada define a diagnosis of childhood-onset high blood pressure to be systolic and/or diastolic blood pressure levels that are greater than the 95th percentile of blood pressure values in healthy children, based on age, sex and height. There is currently a lack of data on specific blood pressure levels in childhood that may predict later cardiovascular conditions, such as heart failure, kidney failure, stroke or cardiovascular death, and thus the use of the 95th percentile guidelines rather than measures for high blood pressure in adults.
When high blood pressure is diagnosed in youth, treatment may include dietary changes, increased physical activity, a reduction in screen time (television or other digital devices) and in some cases medication. Studies on medication recommendations for high blood pressure in youth are somewhat lacking. There is only one long-term randomized clinical trial that examined high blood pressure medication in children, and it was specifically in children with chronic kidney disease. Since primary hypertension is now known to be the main type of high blood pressure in youth, trials are needed focusing on medications for children with high blood pressure not related to another medical cause.
The statement authors note that public health efforts to study and improve high blood pressure in children may be difficult for numerous reasons, yet it may be useful to gather information from pediatric databases to calculate and monitor trends in blood pressure in children relative to population-based variations in obesity, physical activity, nutrition, unmet social needs and adverse childhood experiences. Additionally, broader interventions, such as lowering sodium content in food in the U.S. and providing healthier food choices in schools, may be helpful in improving cardiovascular health particularly during childhood.
“There is a need for increased understanding and greater research surrounding high blood pressure in youth,” said Falkner. “Future studies to improve both the recognition and diagnosis of high blood pressure in this age group, as well as clinical trials to evaluate medical treatment and recommend public health initiatives, are all vital to improving the increase we are seeing in hypertension in children.“
This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Council on Hypertension; the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; the Council on Kidney in Cardiovascular Disease; the Council on Lifestyle and Cardiometabolic Health; and the Council on Cardiovascular and Stroke Nursing. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.
Co-authors and members of the writing committee are Vice Chair Samuel S. Gidding, M.D., FAHA; Carissa M. Baker-Smith, M.D., M.P.H., FAHA; Tammy M. Brady, M.D., Ph.D., FAHA; Joseph T. Flynn, M.D., M.S., FAHA; Leslie M. Malle, M.S.N., FAHA; Andrew M. South, M.D., M.S., FAHA; Andrew H. Tran, M.D., M.S., FAHA; and Elaine M. Urbina, M.D., M.S., FAHA. Authors’ disclosures are listed in the manuscript.
NewsMakers
Study finds low-dose eye drops successful in managing adult myopia for 24 hours
A single low-dose atropine eye drop can produce daylong effects in managing myopia, or nearsightedness.
Groundbreaking research from the University of Houston shows that a single low-dose atropine eye drop can produce daylong effects in managing myopia, or nearsightedness, which affects roughly one-third of U.S. adults.
Professor of Optometry Lisa Ostrin and postdoctoral researcher Barsha Lal are reporting that even one drop in the eye of low-dose atropine (0.01%–0.1%) produces clear changes in pupil size and focusing ability that persist for at least 24 hours. Importantly, they also found that the drop shows no short-term structural effects on the eye, with only temporary changes in blood flow inside the retina.
Ostrin’s latest research is published in the journal Eye and Vision. It adds to a growing body of vision research from David Berntsen, Golden-Golden Professor of Optometry at the University of Houston, who is co-leading a national $25 million NIH-funded clinical trial to delay the development of myopia in children by using the atropine drops.
Low concentration atropine is widely prescribed to slow myopia progression in children, yet its short-term retinal and choroidal effects remain incompletely understood. Ostrin’s new study evaluated short-term effects of a range of low atropine concentrations on the length of the eye, the blood vessels in the retina and the thickness of the retina and choroid, which sits just behind the retina. These are important measurements because longer eye length is associated with myopia and as it gets longer, the retina and choroid are stretched.
“These findings indicate that a single instillation of atropine does not alter axial length or retinal or choroidal thickness over 24 hours but may transiently affect superficial retinal perfusion in a time-dependent manner,” said Ostrin.
In the double-masked, randomized study, twenty healthy adults received a single instillation of either a placebo or atropine in the right eye during five separate sessions. Researchers then checked the eye structure, thickness, and length in the central retina both one-hour and 24-hours later.
“Characterizing these short-term effects is important for a better understanding of the physiological responses to atropine in clinical and research settings,” said Ostrin who previously published research results of a study investigating the short-term effects of a range of low-dose atropine concentrations on the pupils of young adults. In that study, she found similar results with a single drop of atropine inducing significant changes in the pupils.
Together, the studies indicate that atropine induces early functional and vascular effects in the eye, in the absence of structural change.
“By linking objective ocular responses with subjective visual experience, this work advances our understanding of how atropine works and supports more precise, evidence-based, and individualized approaches to myopia management,” said Ostrin.
NewsMakers
Study: Egg consumption is associated with a lower risk of Alzheimer’s Disease
Compared to never eating eggs, eating at least five eggs per week can decrease risk of Alzheimer’s.
Consumption of eggs is associated with a lower risk of being diagnosed with Alzheimer’s Disease for those 65 years and older, according to researchers at Loma Linda University Health
Eating one egg per day for at least five days a week reduces risk of Alzheimer’s by up to 27%, researchers found.
“Compared to never eating eggs, eating at least five eggs per week can decrease risk of Alzheimer’s,” said Joan Sabaté, MD, DrPH, a professor at Loma Linda University School of Public Health and the study’s principal investigator.
Even less frequent consumption of eggs significantly reduced the risk of Alzheimer’s. Researchers found that eating eggs 1 to 3 times per month had a 17% decrease in risk, while eating eggs 2 to 4 times per week had a 20% decrease in risk, Sabaté said.
The study, Egg intake and the incidence of Alzheimer’s disease in the Adventist Health Study-2 cohort linked with Medicare data, was published last week in the Journal of Nutrition.
Researchers said they embarked on the study because of a substantial knowledge gap in the relationship between modifiable dietary factors and risk of Alzheimer’s disease risk.
Eggs are known to be a source of key nutrients that support brain health. Sabaté said. Eggs provide choline, a precursor to acetylcholine and phosphatidylcholine, both of which are critical for memory and synaptic function, the study stated. Eggs also contain lutein and zeaxanthin—carotenoids that accumulate in brain tissue and are associated with improved cognitive performance and reduced oxidative stress. Eggs also contain key omega-3 fatty acids, and yolks are particularly rich in phospholipids, which constitute nearly 30% of total egg lipids and are essential for neurotransmitter receptor function.
Researchers said they studied the consumption of eggs in visible ways — such as eating eggs in various forms, like scrambled, fried, boiled, etc. — and hidden ways, such as eggs included in baked goods and packaged foods.
The cases of Alzheimer’s Disease in the Adventist Health Study 2 cohort were diagnosed by physicians, according to Medicare records, among the study population of 40,000 subjects. Eligibility was determined using the Medicare Master Beneficiary Summary Files. The average follow-up period was 15.3 years.
The team emphasized that moderate egg consumption should be part of a balanced diet.
“Research supports eggs as part of a healthy diet,” said Jisoo Oh, DrPH, MPH, an associate professor of epidemiology at Loma Linda University School of Public Health and the study’s lead author. “Seventh-day Adventists do eat a healthier diet than the general public, and we want people to focus on overall health along with this knowledge about the benefit of eggs.”
NewsMakers
Telling people they might lose motivates more than telling them they might win, research shows
How managers choose to frame problems directly influences employees’ motivation to speak up at work. For managers, this is an insightful approach for building more open and collaborative teams.
Athletes say they hate to lose more than they love to win. New research finds the same sentiment is shared in organizations.
A Virginia Tech researcher and his colleagues discovered that when managers frame work problems as a potential loss, employees are more likely to take action than when those problems are framed as potential gains. The research also revealed that when the potential loss impacts a larger group, employees are more likely to take action in the form of speaking up to a supervisor in hopes of finding a solution. The findings were recently published in the Journal of Applied Psychology.
For managers, this research suggests that framing work problems as potential losses can influence employees to speak up more.
“Employee voice occurs when suggestions are made to improve organizational functioning,” said Phil Thompson, associate professor in the Pamplin College of Business Department of Management. “From an organizational perspective, the positive outcomes of employee voice include improved performance, effectiveness, and workplace safety. From an employee level, speaking up is positively related to creativity, innovation, engagement, and ethical behavior.”
At its core, this research shows that how managers choose to frame problems directly influences employees’ motivation to speak up at work. For managers, this is an insightful approach for building more open and collaborative teams.
“When managers say, ‘If we don’t get this done, not only will you lose the $5,000 bonus, but everybody in this work group is going to lose a $5,000 bonus,’ it magnifies an employee’s motivation to act in a proactive way,” said Thompson. “This suggests that framing work problems as what will be collectively lost – compared to what can be individually lost – makes employees want to speak up more.”
Thompson was part of a research team led by Jeffery Thomas and Jonathan Booth from The London School of Economics and Mark Bolino from Oklahoma University. Together they analyzed responses from nearly 2,000 full-time employees, MBA students, and employee-supervisor pairs for their experience in situations where work problems were framed as either a gain or a loss. Across three different studies, framing something as a loss yielded employees to voice a work suggestion more.
For example, a manager dealing with a reputational crisis of their team, such as a product quality issue, can frame the problem in a way to spark helpful employee suggestions on how to resolve the issue. For example, instead of saying “if this product has great quality, our company will look really good” a manager saying “if this product is not up to quality standards, our reputation will be damaged” carries more weight for the team. When this reputational risk is shared by everyone, employees are more willing to step forward to help the problem.
In the first study, participants were asked to think about a problem at work that was significant for them. From there, they were randomly assigned to write about the potential losses or gains from that problem. They were also asked to indicate how likely they were to talk about these problems to their supervisor. Participants who reflected on their potential losses showed a 16 percent higher willingness to speak up compared to those who focused on the potential gains.
When it came to the MBA students, they read a fictional performance review scenario where a workplace problem was described. They then rated how willing they would be to speak up about that scenario if they were in the situation. One example suggested that the entire team might fall short of its goals if an issue was not addressed. This specific scenario yielded the most likelihood of speaking up 35 percent more than the scenario’s suggesting that only they would miss their goal, supporting the research’s findings that an employee is more likely to speak up when the loss impacts more people.
The third study looked at employee-supervisor pairings to understand how these relationships play out in the real world. Using pairings from across three industries, employees reported a workplace problem they encountered and their supervisor rated how often that employee spoke up on the job. While the first two studies involved hypothetical scenarios, this real-world evidence showed that employees were 8-10 times more likely to speak up when issues were framed as a potential collective loss compared with a potential collective gain.
“This research is really geared toward managers so they can facilitate and understand how and why their employees will speak up,” said Thompson. “You can talk about the issue, but it always ends in terms of how we frame things.”
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