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Merlin Garí-Llanes MD MS, Yosvany García-Nóbrega MD, Elibet Chávez-González MD PhD, Emilio González-Rodríguez PhD, Julieta García-Sáez MD, María del Carmen Llanes-Camacho MD MS ABSTRACT INTRODUCTION Hypertension is one of the most studied risk factors for cardiovascular disease in adults; in children and adolescents, its global prevalence changes with age, from 1%–3% in children to 3.2% in adolescents. In adults, in addition to hypertension, several biochemical markers of cardiovascular risk have been identifi ed. Confi rming an association between these and hypertension in childhood and adolescence would allow for more timely diagnosis and monitoring of cardiovascular disease, since the presence of both the markers and hypertension would imply increase risk. OBJECTIVE Confirm an association between biochemical risk markers of cardiovascular disease and hypertension in children aged 8 to 11 years. METHODS A cross-sectional study of 373 children aged 8–11 years was conducted in 3 primary schools in the city of Santa Clara in central Cuba. The variables examined were age, sex, height, blood pressure, cholesterol, triglycerides, lipoproteins and apolipoproteins. The children were classified as normotensive, prehypertensive or hypertensive, based on blood pressure readings and percentiles for age, sex and height. Descriptive statistics were calculated for quantitative variables. A bivariate analysis, tests of independence for qualitative variables and a means comparison for quantitative variables (ANOVA and its nonparametric alternative, the Kruskal Wallis test) were performed. Fisher’s F-test and its associated probability value were employed. RESULTS Some 32.2% of the children were prehypertensive and 5.1% hypertensive. Cholesterol and triglyceride values were signifi cantly higher in hypertensive than in normotensive children (p = 0.028 and p = 0.047, respectively). HDL numbers were higher in normotensive children (p = 0.001), and LDL numbers and the LDL/ HDL ratio were higher in the hypertensive children, with differences between groups (p = 0.001 for both variables). There were differences between the three blood pressure categories for lipoprotein(a) and ApoA (p 45 40–45 130 mg/dL Apolipoprotein B-100 (ApoB) 90–140 mg/dL ApoB/ApoA ratio 0.8–1.2 Lipoprotein(a) >25 mg/dL TC: total cholesterol LDL: low-density lipoprotein HDL: high-density lipoprotein 12 MEDICC Review, April–July 2019, Vol 21, No 2–3 presence of the investigator and a witness, in accordance with Declaration of Helsinki and WHO guidelines.[20,21] Since schoolchildren were involved, Ministry of Education authorization for the study was also obtained as required by Cuban law. All information obtained remained confidential, and in no case was the identity of a child disclosed. Choice of diagnostic media was based on material accessibility, care to maximize benefits for participants, the ethical norm of “do no harm,” and international and domestic guidelines established for good clinical and laboratory practices. Results of physical examinations and diagnoses based on clinical and biochemical data obtained were provided to parents of participating children. When the examinations revealed health problems, appointments for medical follow-up were arranged with specialists, at the José Luis Miranda Pediatric Teaching Hospital in Santa Clara. RESULTS Although most of the children were classified as normotensive, a substantial percentage were hypertensive or prehypertensive (37.3%) (Table 3). There were significant differences among groups (normotensive, prehypertensive and hypertensive) with respect to classic biochemical markers (Table 4). With the exception of triglycerides—which were higher in normotensive than in prehypertensive children—all indicators showed a monotonically decreasing pattern for HDL and an increasing pattern for the rest of the indicators, as expected. All biochemical indicators based on the structural proteins of the lipoproteins also exhibited signifi cant differences. With the exception of ApoA, higher values were found in the hypertensive children (Table 5). DISCUSSION The proportion of hypertensive and prehypertensive children in the sample exceeds the HT prevalence reported in Cuba for 2017.[11] The high percentage of prehypertensive children is a matter of concern. The global literature reports that progression of prehypertension to HT is approximately 7% per year and that prehypertension poses a high risk for development of HT in children, [22] making it a major challenge for the health system. Lipid alterations found in the prehypertensive children magnify the importance of Original Research Table 3: Distribution of studied children by blood pressure group Blood pressure category Frequency Percentage Normotensive 234 62.7 Prehypertensive 120 32.2 Hypertensive 19 5.1 Total 373 100.0 Table 4: Comparison of classic biochemical markers by blood pressure group Variable Category n Mean Standard deviation Fisher’s F p Cholesterol mg/dL Normotensive 234 134.1 23.5 Prehypertensive 120 137.5 24.7 Hypertensive 19 149.5 39.8 Total 373 136.0 25.1 3.61 0.028 Triglycerides mg/dL Normotensive 234 85.0 36.3 Prehypertensive 120 78.4 37.1 Hypertensive 19 100.5 62.8 Total 373 83.7 38.0 3.08 0.047 HDL mg/dL Normotensive 234 45.2 9.2 Prehypertensive 120 44.4 6.9 Hypertensive 19 37.4 6.3 Total 373 44.5 8.6 7.60 0.001 LDL mg/dL Normotensive 234 73.1 20.8 Prehypertensive 120 85.7 27.4 Hypertensive 19 104.4 36.6 Total 373 78.7 25.4 22.22

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