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The associations between hematological parameters and the incidence of prehypertension and hypertension in children and adolescents: a prospective cohort study

Hypertension Research volume 46, pages 2085–2099 (2023)Cite this article

Abstract

Uncontrolled pediatric hypertension may increase the risk of hypertension in adulthood. Several studies have reported an association between hematological parameters and blood pressure (BP) levels. However, epidemiologic evidence of this association in children and adolescents remains scarce. This study aims to explore the associations between hematological parameters and the incidence of prehypertension and hypertension in children and adolescents. This longitudinal study was conducted with 1368 participants aged 6–8 years from baseline visit to follow-up visit. Compared with participants from the normal blood pressure (BP) group, participants from the elevated BP group had significantly higher baseline red blood cell (RBC) counts, hemoglobin (Hb) counts and hematocrit (Hct) levels (all P < 0.001). A multilevel linear mixed model was conducted to analyze the relationship between hematological parameters and BP levels. The results suggested that SBP, DBP and MAP increased significantly with a quartile increase of levels of hematological parameters (all P < 0.05). Furthermore, a multilevel mixed logistic regression model was used to analyze the risk of per interquartile range increase in hematological parameters on the incidence of prehypertension and hypertension. The risk of prehypertension and hypertension incidence increased by (1.34 (95%CIs: 1.20, 1.50)), (1.38 (95%CIs: 1.24,1.54)), (1.33 (95%CIs: 1.19,1.50)), (1.14 (95%CIs: 1.03,1.26)) fold with a one-quartile increase in levels of RBC, Hb, Hct and Fe, respectively (all P < 0.05). This longitudinal study showed that hematological parameters were positively associated with BP levels in healthy children and adolescents, which excluded the effect of antihypertensive drugs on BP levels that often appeared in adults.

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Data availability

The datasets analyzed during the current study available from the corresponding author on a reasonable request.

References

  1. Din-Dzietham R, Liu Y, Bielo M, Shamsa F. High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation. 2007;116:1488–96.

    Article  PubMed  Google Scholar 

  2. Flynn J. The changing face of pediatric hypertension in the era of the childhood obesity epidemic. Pediatr Nephrol (Berl, Ger). 2013;28:1059–66.

    Article  Google Scholar 

  3. Liang X, Chen M, Qu P, Hao G, Huang Y, Chen J, et al. The Association of Vitamin A and Vitamin D with Hypertension in Children: A Case-Control Study. Int J Hypertens. 2018;2018:9295147.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Meng L, Liang Y, Liu J, Hu Y, Yan Y, Mi J. Prevalence and risk factors of hypertension based on repeated measurements in Chinese children and adolescents. Blood Press. 2013;22:59–64.

    Article  PubMed  Google Scholar 

  5. Hardy ST, Sakhuja S, Jaeger BC, Urbina EM, Suglia SF, Feig DI, et al. Trends in Blood Pressure and Hypertension Among US Children and Adolescents, 1999-2018. JAMA Netw Open. 2021;4:e213917.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Liang X, Chen J, An X, Liu F, Liang F, Tang X, et al. The impact of PM2.5 on children’s blood pressure growth curves: A prospective cohort study. Environ Int. 2022;158:107012.

    Article  CAS  PubMed  Google Scholar 

  7. Chen XT, Yang S, Yang YM, Zhao HL, Chen YC, Zhao XH, et al. Exploring the relationship of peripheral total bilirubin, red blood cell, and hemoglobin with blood pressure during childhood and adolescence. J Pediatr (Rio J). 2018;94:532–8.

    Article  PubMed  Google Scholar 

  8. Cirillo M, Laurenzi M, Trevisan M, Stamler J. Hematocrit, blood pressure, and hypertension. The Gubbio Population Study. Hypertension (Dallas, Tex: 1979). 1992;20::319–26.

    Article  PubMed  Google Scholar 

  9. Jeong HR, Shim YS, Lee HS, Hwang JS. Hemoglobin and hematocrit levels are positively associated with blood pressure in children and adolescents 10 to 18 years old. Sci Rep. 2021;11:19052.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Lee DH, Kang SK, Choi WJ, Kwak KM, Kang D, Lee SH, et al. Association between serum ferritin and hypertension according to the working type in Korean men: the fifth Korean National Health and nutrition examination survey 2010-2012. Ann Occup Environ Med. 2018;30:40.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Merad-Boudia H, Dali-Sahi M, Kachekouche Y, Dennouni-Medjati N. Hematologic disorders during essential hypertension. Diabetes Metab Syndr. 2019;13:1575–9.

    Article  PubMed  Google Scholar 

  12. Piperno A, Trombini P, Gelosa M, Mauri V, Pecci V, Vergani A, et al. Increased serum ferritin is common in men with essential hypertension. J Hypertens. 2002;20:1513–8.

    Article  CAS  PubMed  Google Scholar 

  13. Zhu Y, Chen G, Bo Y, Liu Y. Markers of iron status, blood pressure and incident hypertension among Chinese adults. Nutr Metab Cardiovasc Dis. 2019;29:830–6.

    Article  CAS  PubMed  Google Scholar 

  14. Merad-Boudia HN, Dali-Sahi M, Kachekouche Y, Dennouni-Medjati N. Hematologic disorders during essential hypertension. Diabetes Metab Syndr. 2019;13:1575–9.

    Article  PubMed  Google Scholar 

  15. Cirillo M, Laurenzi M, Trevisan M, Stamler J. Hematocrit, blood pressure, and hypertension. The Gubbio Population Study. Hypertension. 1992;20:319–26.

    Article  CAS  PubMed  Google Scholar 

  16. Liang X, Xiao L, Luo Y, Xu J. Prevalence and risk factors of childhood hypertension from birth through childhood: a retrospective cohort study. J Hum Hypertens. 2020;34:151–64.

    Article  PubMed  Google Scholar 

  17. Liang X, Xiao L, Luo Y, Xu J. Prevalence and Risk Factors of Childhood Hypertension in Urban-Rural Areas of China: A Cross-Sectional Study. Int J Hypertens. 2020;2020:2374231.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Patel A, Bharani A, Sharma M, Bhagwat A, Ganguli N, Chouhan D. Prevalence of hypertension and prehypertension in schoolchildren from Central India. Ann Pediatr Cardiol. 2019;12:90–6.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Liang X, Xiao L, Chen J, Qu P, Tang X, Wang Y. The Determinants of Adolescent Glycolipid Metabolism Disorder: A Cohort Study. Int J Endocrinol. 2022;2022:6214785.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lee SG, Rim JH, Kim JH. Association of hemoglobin levels with blood pressure and hypertension in a large population-based study: the Korea National Health and Nutrition Examination Surveys 2008-2011. Clin Chim Acta. 2015;438:12–8.

    Article  CAS  PubMed  Google Scholar 

  21. Liu D, Wang C, Zhang Y, Zuo H. Gender differences in the associations of circulating erythrocytes and hemoglobin with hypertension risk. Blood Press Monit. 2022;27:227–32.

    Article  PubMed  Google Scholar 

  22. Song JJ, Ma Z, Wang J, Chen LX, Zhong JC. Gender Differences in Hypertension. J Cardiovasc Transl Res. 2020;13:47–54.

    Article  PubMed  Google Scholar 

  23. Gladwin MT, Crawford JH, Patel RP. The biochemistry of nitric oxide, nitrite, and hemoglobin: role in blood flow regulation. Free Radic Biol Med. 2004;36:707–17.

    Article  CAS  PubMed  Google Scholar 

  24. Di Giosia P, Giorgini P, Stamerra CA, Petrarca M, Ferri C, Sahebkar A. Gender Differences in Epidemiology, Pathophysiology, and Treatment of Hypertension. Curr Atheroscler Rep. 2018;20:13.

    Article  PubMed  Google Scholar 

  25. Fischer M, Baessler A, Schunkert H. Renin angiotensin system and gender differences in the cardiovascular system. Cardiovasc Res. 2002;53:672–7.

    Article  CAS  PubMed  Google Scholar 

  26. Komukai K, Mochizuki S, Yoshimura M. Gender and the renin-angiotensin-aldosterone system. Fundam Clin Pharm. 2010;24:687–98.

    Article  CAS  Google Scholar 

  27. Link J, Reue K. Genetic Basis for Sex Differences in Obesity and Lipid Metabolism. Annu Rev Nutr. 2017;37:225–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Enawgaw B, Adane N, Terefe B, Asrie F, Melku M. A comparative cross-sectional study of some hematological parameters of hypertensive and normotensive individuals at the university of Gondar hospital, Northwest Ethiopia. BMC Hematol. 2017;17:21.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sileshi B, Urgessa F, Wordofa M. A comparative study of hematological parameters between hypertensive and normotensive individuals in Harar, eastern Ethiopia. PloS ONE. 2021;16:e0260751.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Tong J, An X, Zhao L, Qu P, Tang X, Chen M, et al. Combining multiaspect factors to predict the risk of childhood hypertension incidence. J Clin Hypertens (Greenwich, Conn). 2022;24:1015–25.

    Article  CAS  Google Scholar 

  31. Atsma F, Veldhuizen I, de Kort W, van Kraaij M. Pasker-de Jong P, Deinum J: Hemoglobin level is positively associated with blood pressure in a large cohort of healthy individuals. Hypertension. 2012;60:936–41.

    Article  CAS  PubMed  Google Scholar 

  32. Lee S, Rim J, Kim J. Association of hemoglobin levels with blood pressure and hypertension in a large population-based study: the Korea National Health and Nutrition Examination Surveys 2008-2011. Clin Chim Acta; Int J Clin Chem. 2015;438:12–8.

    Article  CAS  Google Scholar 

  33. Shimizu Y, Nakazato M, Sekita T, Kadota K, Arima K, Yamasaki H, et al. Association between the hemoglobin levels and hypertension in relation to the BMI status in a rural Japanese population: the Nagasaki Islands Study. Intern Med. 2014;53:435–40.

    Article  PubMed  Google Scholar 

  34. Kim NH, Lee JM, Kim HC, Lee JY, Yeom H, Lee JH, et al. Cross-sectional and longitudinal association between hemoglobin concentration and hypertension: A population-based cohort study. Med (Baltim). 2016;95:e5041.

    Article  CAS  Google Scholar 

  35. Bian K, Doursout MF, Murad F. Vascular system: role of nitric oxide in cardiovascular diseases. J Clin Hypertens (Greenwich). 2008;10:304–10.

    Article  CAS  PubMed  Google Scholar 

  36. Cabrales P, Han G, Nacharaju P, Friedman AJ, Friedman JM. Reversal of hemoglobin-induced vasoconstriction with sustained release of nitric oxide. Am J Physiol Heart Circ Physiol. 2011;300:H49–56.

    Article  CAS  PubMed  Google Scholar 

  37. Devereux R, Case D, Alderman M, Pickering T, Chien S, Laragh J. Possible role of increased blood viscosity in the hemodynamics of systemic hypertension. Am J Cardiol. 2000;85:1265–8.

    Article  CAS  PubMed  Google Scholar 

  38. Kawamoto R, Tabara Y, Kohara K, Miki T, Kusunoki T, Katoh T, et al. A slightly low hemoglobin level is beneficially associated with arterial stiffness in Japanese community-dwelling women. Clin Exp Hypertens. 2012;34:92–8.

    Article  CAS  PubMed  Google Scholar 

  39. Emamian M, Hasanian SM, Tayefi M, Bijari M, Movahedian Far F, Shafiee M, et al. Association of hematocrit with blood pressure and hypertension. J Clin Lab Anal. 2017;31:e22124.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Nakanishi N, Yoshida H, Okamoto M, Nakamura K, Uzura S, Suzuki K, et al. Hematocrit and risk for hypertension in middle-aged Japanese male office workers. Ind Health. 2001;39:17–20.

    Article  CAS  PubMed  Google Scholar 

  41. Soranzo N, Spector TD, Mangino M, Kühnel B, Rendon A, Teumer A, et al. A genome-wide meta-analysis identifies 22 loci associated with eight hematological parameters in the HaemGen consortium. Nat Genet. 2009;41:1182–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Kato N. Ethnic differences in genetic predisposition to hypertension. Hypertens Res. 2012;35:574–81.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the Ministry of Education Key Laboratory of Child Development and Disorders and all of the staff members of the six elementary schools in the two regions of the study for their support.

Funding

This work was supported by, National Clinical Research Center for Child Health and Disorders (No. NCRCCHD-2022-GP-01, NCRC-2020-GP-13, NCRCCHD-2020-GP-10), the Research and Innovation Team of Chongqing Medical University (No. W0088), Chongqing Science and Technology Bureau (No. CSTC2021jscx-gksb-N0001), Young and Middle-aged Medical Outstanding Expert Project of Chongqing Municipal Health Commission (No. 78), National Key Research and Development Project (No. 2017YFC0211705), Intelligent Medicine Project (No. ZHYX202109), Natural Science Foundation of Youth Project (No. 81502826), Key project of Innovation and Development united Fund of Chongqing Natural Science Foundation (CSTB2022NSCQ-LZX0029) and Education Commission of Chongqing Municipality (No. KJQN201900443). The funders had no role in the study design, the data collection and analysis, the decision to publish, or the preparation of the paper.

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Author notes

  1. These authors contributed equally: Lan Huang, Cui Song, Qing Liu

Authors and Affiliations

  1. Department of Clinical Epidemiology and Biostatistics, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, 400014, Chongqing, China

    Lan Huang, Qin Liu, Xiaoyue Liang, Yanling Ren, Daochao Huang, Xianmin Guan, Xizhou An & Xiaohua Liang

  2. Department of Endocrinology and Genetic Metabolism disease, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, 400014, Chongqing, China

    Cui Song

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Contributions

XHL conceived and designed the experiments; LH, XYL, CS and QL participated the data analysis and drafted the paper; DCH, XMG, and XZA participated in the epidemiological investigation; YLR, LH, and QL participated in the data collection. All authors read and approved the final paper.

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Correspondence to Xiaohua Liang.

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The Institutional Review Board of the Children’s Hospital of Chongqing Medical University approved this study. Informed consent to participate in this study was provided by all of the subjects and their parents/guardians.

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Huang, L., Song, C., Liu, Q. et al. The associations between hematological parameters and the incidence of prehypertension and hypertension in children and adolescents: a prospective cohort study. Hypertens Res 46, 2085–2099 (2023). https://doi.org/10.1038/s41440-023-01304-z

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