deficition, mechanism, treatment

1. Obesity Related Hypertension in Children
Nakysa Hooman
Professor
Pediatric Nephrology
Iran University of Medical Sciences
2021

2. Objective
• Definitions
• Incidence /prevalence HTN
• Pathophysiology
• Risk factors CVD
• Prevention
• Treatment

4. Definition of HTN age 1-18yr

6. Definition
Weight Status Category Percentile Range
Underweight Less than the 5th percentile
Normal or Healthy Weight
5th percentile to less than the 85th
percentile
Overweight 85th to less than the 95th percentile
Obese 95th percentile or greater
Overweight BMI >= 25 kg/m2
Obesity BMI>=30 kg/m2
Morbid obesity BMI>=35kg/m2

7. Prevalence
• Front. Pediatr., 21 December 2018 | https://doi.org/10.3389/fped.2018.00393
• doi: 10.3389/fped.2017.00197
0
2
4
6
8
10
12
14
16
18
overweight obese
percentile
Iran
USA

8. Global Prevalence of Hypertension in Children
(SR-MA, N=47 articles, Participant=36614)
0
2
4
6
8
10
12
14
16
18
Pooled Prevalemce
Normal
Overweight
Obesce
JAMA Pediatr. 2019;173(12):1154-1163. doi:10.1001/jamapediatrics.2019.3310

12. Mechanism

15. NHANES (n=1300,3-19yr, 1999-2000)
7
0.4
0
1
2
3
4
5
6
7
8
large adult cuff size tight cuff
percentage
Routine assessment/measurement of the mid-arm circumference in all patients prior to BP
measurement to ensure the proper-sized cuff is applied

16. The difference between the proximal and the distal circumferences of the upper arm
ranged from 1 to 20 cm, with an average value of 8.7 cm.

18. • Non-Pharmacologic
– Prevention
– Structured Weight management
– 2-4 week follow up

19. HTN
– ACEI/ARB
– CCB
Obesity
– Orlistat
– Metformin
Bariartic Surgery

20. • The most recognized factors connecting
obesity and hypertension are
– altered hemodynamics, impaired sodium
homeostasis, renal dysfunction, autonomic
nervous system imbalance, endocrine alterations,
oxidative stress and inflammation, and vascular
injury.
• Specific considerations should apply in
planning therapeutic approaches to treat