Seasonal variation of blood pressure in children
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EDUCATIONAL REVIEW
Seasonal variation of blood pressure in children Niels Ziegelasch 1 & Mandy Vogel 1,2 & Werner Siekmeyer 1 & Heiko Billing 1 & Ingo Dähnert 3 & Wieland Kiess 1,2,4 Received: 15 May 2020 / Revised: 20 September 2020 / Accepted: 13 October 2020 # The Author(s) 2020
Abstract Seasonal blood pressure (BP) variation is mostly found between the summer and winter months. Guidelines for diagnosis and treatment of hypertension in children have not considered this variation until recently. This review aims to present an overview of seasonal BP variation in childhood along with potential underlying pathophysiological mechanisms and long-term implications as well as conclusions for future studies. In pediatric cohorts, seven studies investigated seasonal changes in BP. These changes amount to 3.4–5.9 mmHg (or 0.5–1.5 mmHg per − 1 °C difference in environmental temperature) in systolic BP with a peak in fall or winter. Potential mechanisms and mediators of seasonal BP variation include sympathetic activation of the nervous system with an increase of urinary and plasma norepinephrine levels in the winter season. Additionally, the physical activity among children and adolescents was inversely correlated with BP levels. Temperature sensitivity of BP and pediatric BP levels predict future systolic BP and target-organ damage. Therefore, cardiovascular events may even be long-term complications of seasonal BP variation in pediatric hypertensive patients. Overall, these data strongly suggest an important effect of ambient temperature on BP in children. Additional studies in pediatric cohorts are needed to define how best to incorporate such variation into clinical practice. Keywords Seasonal variation . Blood pressure . Children . Temperature . Climate . Pediatrics
Introduction Seasonal blood pressure (BP) variation is an omnipresent occurrence in the world [1, 2]. The BP differences are mostly found between the summer and winter months. Even in tropical regions, BP varies with outdoor temperature [2]. In 2017, the “Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents” updated the “Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents” from 2004, including 30 key action statements and 27 additional recommendations on * Niels Ziegelasch [email protected]
diagnosis and treatment. New definitions of elevated BP and hypertension were proposed [3, 4]. However, none of these consensus documents and guidelines considered seasonal changes of BP. Nevertheless, medical scientists recommend the consideration of potential seasonal influences in hypertensive as well as normal- and high-risk patients in clinical practice [5]. This review aims to present an overview of seasonal BP variation in childhood along with current recommendations for diagnosis and management of elevated BP in children. Furthermore, potential underlying pathophysiological mechanisms are discussed. In consideration of long-te
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