Published online December 1, 2008
PEDIATRICS Vol. 122 No. 6 December 2008, pp. 1252-1257 (doi:10.1542/10.1542/peds.2007-3162)
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ARTICLE

Elevated Blood Pressure, Race/Ethnicity, and C-Reactive Protein Levels in Children and Adolescents

Marc B. Lande, MDa, Thomas A. Pearson, MD, MPH, PhDb, Roger P. Vermilion, MDc, Peggy Auinger, MSd and Isabel D. Fernandez, MD, MPH, PhDb

a Divisions of aPediatric Nephrology
c Pediatric Cardiology
d General Pediatrics, Department of Pediatrics
b Department of Community and Preventive Medicine, University of Rochester Medical Center, Rochester, New York

OBJECTIVE. Adult hypertension is independently associated with elevated C-reactive protein levels, after controlling for obesity and other cardiovascular risk factors. The objective of this study was to determine, with a nationally representative sample of children, whether the relationship between elevated blood pressure and C-reactive protein levels may be evident before adulthood.

METHODS. Cross-sectional data for children 8 to 17 years of age who participated in the National Health and Nutrition Examination Survey between 1999 and 2004 were analyzed. Bivariate analyses compared children with C-reactive protein levels of >3 mg/L versus ≤3 mg/L with respect to blood pressure and other cardiovascular risk factors. Multivariate linear regression was used to evaluate the relationship between elevated blood pressure and C-reactive protein levels.

RESULTS. Among 6112 children, 3% had systolic blood pressure of ≥95th percentile and 1.3% had diastolic blood pressure of ≥95th percentile. Children with C-reactive protein levels of >3 mg/L had higher systolic blood pressure, compared with children with C-reactive protein levels of ≤3 mg/L (109 vs 105 mm Hg). Obesity, high-density lipoprotein cholesterol levels of <40 mg/dL, and Hispanic ethnicity were independent predictors of elevated C-reactive protein levels. Diastolic blood pressure did not differ between groups. Linear regression analyses showed that systolic blood pressure of ≥95th percentile was independently associated with C-reactive protein levels in boys but not girls. Subset analyses according to race/ethnicity demonstrated that the independent association of elevated systolic blood pressure with C-reactive protein levels was largely limited to black boys.

CONCLUSIONS. These data indicate that there is interplay between race/ethnicity, elevated systolic blood pressure, obesity, and inflammation in children, a finding that has potential implications for disparities in cardiovascular disease later in life.

Key Words: C-reactive protein • inflammation • ethnicity • hypertension • National Health and Nutrition Examination Survey

Abbreviations: CRP—C-reactive protein • SBP—systolic blood pressure • DBP—diastolic blood pressure • NHANES—National Health and Nutrition Examination Survey • HDL—high-density lipoprotein • BP—blood pressure

Accepted Mar 14, 2008.


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