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Overweight, air and noise pollution: Universal risk factors for pediatric pre-hypertension
Roya Kelishadi1, Parinaz Poursafa, Kasra Keramatian
1Professor, Department of Paediatrics, Child Health Promotion Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Pediatric pre-hypertension (pre-HTN) is influenced by gene-environment interactions and escalating environmental factors like pollution and obesity. Early prevention targeting modifiable risks from prenatal stages is crucial for long-term health.
Area of Science:
- Pediatric Cardiology
- Environmental Health
- Public Health
Background:
- Pediatric pre-hypertension (pre-HTN) presents a complex, multifactorial etiology.
- While often secondary, a significant portion of pediatric pre-HTN is essential, involving gene-gene and gene-environment interactions.
- Escalating prevalence is anticipated due to strong links with environmental factors like air/noise pollution, passive smoking, and obesity.
Purpose of the Study:
- To review the diagnosis, prevalence, and etiology of pediatric pre-hypertension.
- To highlight the impact of environmental factors and obesity on pediatric blood pressure.
- To outline practical measures for the prevention and control of pediatric pre-HTN.
Main Methods:
- Literature review focusing on pediatric pre-hypertension etiology and risk factors.
- Analysis of biological pathways linking environmental exposures to blood pressure elevation.
- Examination of the role of obesity and associated metabolic changes in pediatric pre-HTN development.
Main Results:
- Exposure to ambient particulate matter can acutely increase blood pressure via autonomic imbalance, oxidative stress, and inflammation.
- Maternal and parental smoking are associated with increased systolic blood pressure in infants and young children.
- Noise exposure is linked to elevated blood pressure and pre-HTN states in preschoolers.
- Excess weight contributes to adipose tissue dysfunction, vascular inflammation, oxidative stress, and activation of the renin-angiotensin-aldosterone system, leading to pre-HTN.
Conclusions:
- Environmental factors (pollution, smoking, noise) and obesity are significant contributors to pediatric pre-hypertension.
- Interventions targeting modifiable risk factors from the prenatal period onwards are essential for primordial and primary prevention.
- Early management of pediatric pre-HTN can mitigate the long-term risk of chronic non-communicable diseases.
Abstract:
Pediatric pre-hypertension (pre-HTN) has a complex multifactorial etiology. Although most cases are secondary to other disorders, a substantial number of children and adolescents have primary or essential HTN and pre-HTN. The gene-gene and gene-environment interactions should be considered in this context. The strong relationship of pre-HTN with environmental factors such as air pollution, noise pollution and passive smoking and obesity suggest that its prevalence will be escalating.Exposure to ambient particulate matters may increase blood pressure (BP) within hours to days. The underlying biologic pathways include autonomic nervous system imbalance and arterial vascular dysfunction or vasoconstriction because of systemic oxidative stress and inflammation. Likewise, tobacco smoke exposure of pregnant mothers increases systolic BP of their offspring in early infancy. Parental smoking also independently affects systolic BP among healthy preschool children. Noise exposure, notably in night, is associated with catecholamine secretion, increased BP and a pre-HTN state even in pre-school age children.Excess weight is associated with dysfunction of the adipose tissue, consisting of enlarged hypertrophied adipocytes, increased infiltration by macrophages and variations in secretion of adipokines and free fatty acids. These changes would result in chronic vascular inflammation, oxidative stress, activation of the renin-angiotensin-aldosterone system and sympathetic response, and ultimately to pre-HTN from childhood.Prevention and control of the modifiable risk factors of pre-HTN from prenatal period can have long-term health impact on primordial and primary prevention of chronic non-communicable diseases. This review presents a general view on the diagnosis, prevalence and etiology of pre-HTN along with practical measures for its prevention and control.
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