Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Impact of growth, gonadal hormones, adiposity and the sodium-to-potassium ratio on longitudinal adolescent measures of blood pressure at puberty

Journal of Human Hypertension volume 37, pages 835–843 (2023)Cite this article

Subjects

Abstract

Blood pressure (BP) rises rapidly at puberty. While this is partly due to normal development, factors like excess adiposity and a high intake of dietary sodium relative to potassium may contribute to a true increase in hypertension risk. This study aimed to assess the relative impact of growth, gonadal hormones, adiposity and the sodium-to-potassium ratio (Na:K) on longitudinal BP measures at puberty. This study analysed data from a three-year longitudinal cohort study of pubertal adolescents. Anthropometry, body composition (bio-electrical impedance), serum testosterone and oestradiol (mass spectrometry) were measured annually. Na:K was measured from three-monthly urine samples. These variables were used to predict annual BP measures using mixed modelling and ordinal regression. Data from 325 adolescents (11.7 ± 1.0 y; 55% male) were analysed, showing typical growth patterns at puberty. Systolic BP increased over time in both sexes (p < 0.01), with boys exhibiting a significantly steeper rise compared to girls. Adiposity variables (BMI z-score, percent body fat, fat mass, waist-to-height ratio) strongly and consistently predicted systolic and diastolic BP in both sexes (all p < 0.05). Systolic BP was also significantly and positively related to height (p < 0.05). No associations with BP were identified in either sex for gonadal hormones or Na:K. Similar results were obtained when BP was classified into hypertension categories. Relative to other developmental and diet-related variables tested, adiposity was found to be the strongest most consistent predictor of BP in pubertal adolescents. Findings highlight the importance of dedicated youth obesity management interventions and policy measures for reducing long-term hypertension and cardiovascular disease risks.

Australian New Zealand Clinical Trials Registry ACTRN12617000964314.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Longitudinal measures of blood pressure separated by sex.
Fig. 2: Longitudinal measures of urinary Na:K separated by sex.

Similar content being viewed by others

Data availability

The datasets generated during and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.

References

  1. Song P, Zhang Y, Yu J, Zha M, Zhu Y, Rahimi K, et al. Global Prevalence of Hypertension in Children: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019;173:1154–63.

    Article  PubMed  PubMed Central  Google Scholar 

  2. World Health Organization. Hypertension Geneva: World Health Organization; 2022 [3 Jun 2022]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension.

  3. Ewald DR, Haldeman Ph DL. Risk Factors in Adolescent Hypertension. Glob Pediatr Health. 2016;3:2333794X15625159.

    PubMed  PubMed Central  Google Scholar 

  4. Chen X, Wang Y. Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation 2008;117:3171–80.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tu W, Eckert GJ, Saha C, Pratt JH. Synchronization of adolescent blood pressure and pubertal somatic growth. J Clin Endocrinol Metab. 2009;94:5019–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Shankar RR, Eckert GJ, Saha C, Tu W, Pratt JH. The change in blood pressure during pubertal growth. J Clin Endocrinol Metab. 2005;90:163–7.

    Article  CAS  PubMed  Google Scholar 

  7. Guzzetti C, Ibba A, Casula L, Pilia S, Casano S, Loche S. Cardiovascular Risk Factors in Children and Adolescents With Obesity: Sex-Related Differences and Effect of Puberty. Front Endocrinol (Lausanne). 2019;10:591.

    Article  PubMed  Google Scholar 

  8. ABS. Australian Health Survey: Nutrition First Results - Foods and Nutrients, 2011-12. Canberra: Commonwealth of Australia, 2015.

  9. Liu J, Rehm CD, Onopa J, Mozaffarian D. Trends in Diet Quality Among Youth in the United States, 1999-2016. JAMA 2020;323:1161–74.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Public Health England. NDNS: results from years 9 to 11 (combined) – data tables. London: 2020.

  11. Mirmiran P, Gaeini Z, Bahadoran Z, Ghasemi A, Norouzirad R, Tohidi M, et al. Urinary sodium-to-potassium ratio: a simple and useful indicator of diet quality in population-based studies. Eur J Med Res. 2021;26:3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Iwahori T, Miura K, Ueshima H. Time to Consider Use of the Sodium-to-Potassium Ratio for Practical Sodium Reduction and Potassium Increase. Nutrients. 2017;9;1–12.

    Google Scholar 

  13. Iwahori T, Miura K, Ueshima H, Chan Q, Dyer AR, Elliott P, et al. Estimating 24-h urinary sodium/potassium ratio from casual (‘spot’) urinary sodium/potassium ratio: the INTERSALT Study. Int J Epidemiol. 2017;46:1564–72.

    PubMed  Google Scholar 

  14. Cook NR, Obarzanek E, Cutler JA, Buring JE, Rexrode KM, Kumanyika SK, et al. Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study. Arch Intern Med. 2009;169:32–40.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Geleijnse JM, Grobbee DE, Hofman A. Sodium and potassium intake and blood pressure change in childhood. BMJ. 1990;300:899–902.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Cooper R, Liu K, Trevisan M, Miller W, Stamler J. Urinary sodium excretion and blood pressure in children: absence of a reproducible association. Hypertension. 1983;5:135–9.

    Article  CAS  PubMed  Google Scholar 

  17. Luscombe GM, Cheng HL, Balzer BWR, Chow CM, Paxton K, Steinbeck KS, et al. The ARCHER study of health and wellbeing in young rural Australians. 14th National Rural Health Conference; Cairns, Australia 2017.

  18. Steinbeck K, Hazell P, Cumming RG, Skinner SR, Ivers R, Booy R, et al. The study design and methodology for the ARCHER study - adolescent rural cohort study of hormones, health, education, environments and relationships. BMC Pediatrics. 2012;12:143.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140:1–72.

    Article  Google Scholar 

  20. Canadian Pediatric Endocrine Group. Calculator: AAP 2017 pediatric blood pressure percentiles: Canadian Pediatric Endocrine Group; [4 Jan 2022]. Available from: https://cpeg-gcep.shinyapps.io/BPz_cpeg/.

  21. Cole TJ, Lobstein T. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes. 2012;7:284–94.

    Article  CAS  PubMed  Google Scholar 

  22. Garnett SP, Baur LA, Cowell CT. Waist-to-height ratio: a simple option for determining excess central adiposity in young people. Int J Obes. 2008;32:1028–30.

    Article  CAS  Google Scholar 

  23. Harwood DT, Handelsman DJ. Development and validation of a sensitive liquid chromatography-tandem mass spectrometry assay to simultaneously measure androgens and estrogens in serum without derivatization. Clin Chim acta; Int J Clin Chem. 2009;409:78–84.

    Article  CAS  Google Scholar 

  24. Hu FB, Stampfer MJ, Rimm E, Ascherio A, Rosner BA, Spiegelman D, et al. Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol. 1999;149:531–40.

    Article  CAS  PubMed  Google Scholar 

  25. Kushnir MM, Blamires T, Rockwood AL, Roberts WL, Yue B, Erdogan E, et al. Liquid chromatography-tandem mass spectrometry assay for androstenedione, dehydroepiandrosterone, and testosterone with pediatric and adult reference intervals. Clin Chem. 2010;56:1138–47.

    Article  CAS  PubMed  Google Scholar 

  26. Kushnir MM, Rockwood AL, Bergquist J, Varshavsky M, Roberts WL, Yue B, et al. High-sensitivity tandem mass spectrometry assay for serum estrone and estradiol. Am J Clin Pathol. 2008;129:530–9.

    Article  CAS  PubMed  Google Scholar 

  27. Centre for Health Advancement Population Health Division. NSW Schools Physical Activity and Nutrition Survey (SPANS) 2010. North Sydney: 2011.

  28. Dasgupta K, O’Loughlin J, Chen S, Karp I, Paradis G, Tremblay J, et al. Emergence of sex differences in prevalence of high systolic blood pressure: analysis of a longitudinal adolescent cohort. Circulation 2006;114:2663–70.

    Article  PubMed  Google Scholar 

  29. Jiang X, Srinivasan SR, Dalferes ER Jr., Berenson GS. Plasma insulin-like growth factor 1 distribution and its relation to blood pressure in adolescents: the Bogalusa Heart Study. Am J Hypertens. 1997;10:714–9.

    Article  CAS  PubMed  Google Scholar 

  30. Lofqvist C, Andersson E, Gelander L, Rosberg S, Blum WF, Albertsson, et al. Reference values for IGF-I throughout childhood and adolescence: a model that accounts simultaneously for the effect of gender, age, and puberty. J Clin Endocrinol Metab. 2001;86:5870–6.

    Article  CAS  PubMed  Google Scholar 

  31. Yanes LL, Romero DG. Dihydrotestosterone stimulates aldosterone secretion by H295R human adrenocortical cells. Mol Cell Endocrinol. 2009;303:50–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Boschitsch E, Mayerhofer S, Magometschnigg D. Hypertension in women: the role of progesterone and aldosterone. Climacteric 2010;13:307–13.

    Article  CAS  PubMed  Google Scholar 

  33. Iwahori T, Miura K, Ueshima H, Tanaka-Mizuno S, Chan Q, Arima H, et al. Urinary sodium-to-potassium ratio and intake of sodium and potassium among men and women from multiethnic general populations: the INTERSALT Study. Hypertens Res. 2019;42:1590–8.

    Article  CAS  PubMed  Google Scholar 

  34. Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, et al. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens. 2009;27:1719–42.

    Article  CAS  PubMed  Google Scholar 

  35. Jebeile H, Lister NB, Baur LA, Garnett SP, Paxton SJ. Eating disorder risk in adolescents with obesity. Obes Rev. 2021;22:e13173.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the ARCHER study participants and their families, and research assistants Lisa Riley and Janet Symons. Thank you to the schools and communities of Central Western NSW that were key to the recruitment of this cohort.

Funding

The ARCHER study, including this secondary analysis, was supported by the National Health and Medical Research Council of Australia (GNT1003312 & GNT1165070), the Thyne Reid Foundation, the Children’s Hospital at Westmead Clinical School and Kids Research. Initial feasibility studies that led to the ARCHER study were supported by the Sydney Medical School Foundation and Australian Rotary Health.

Author information

Authors and Affiliations

  1. The Children’s Hospital at Westmead, Academic Department of Adolescent Medicine, Westmead, NSW, Australia

    Hoi Lun Cheng & Katharine S. Steinbeck

  2. The University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Specialty of Child and Adolescent Health, Westmead, NSW, Australia

    Hoi Lun Cheng & Katharine S. Steinbeck

  3. The University of Sydney, Faculty of Medicine and Health, The Boden Initiative, Charles Perkins Centre, Camperdown, NSW, Australia

    Hoi Lun Cheng, Michael R. Skilton & Katharine S. Steinbeck

  4. University of New South Wales, School of Clinical Medicine, South West Sydney Clinical Campuses, Liverpool, NSW, Australia

    Frances L. Garden

  5. Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia

    Frances L. Garden

  6. University of New South Wales, The George Institute for Global Health, Sydney, NSW, Australia

    Claire Johnson, Jacqui Webster & Rebecca Q. Ivers

  7. University of New South Wales, School of Population Health, Sydney, NSW, Australia

    Claire Johnson, Jacqui Webster & Rebecca Q. Ivers

  8. Deakin University, Institute for Physical Activity and Nutrition, Geelong, VIC, Australia

    Carley A. Grimes

Authors
  1. Hoi Lun Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frances L. Garden
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael R. Skilton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Claire Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jacqui Webster
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carley A. Grimes
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rebecca Q. Ivers
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Katharine S. Steinbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HLC, CJ, JW and KSS designed research; HLC and KSS conducted research; HLC and FLG analysed data and wrote paper; all authors interpreted data and critically reviewed manuscript; HLC had primary responsibility for final content; all authors read and approved the final manuscript.

Corresponding author

Correspondence to Hoi Lun Cheng.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cheng, H.L., Garden, F.L., Skilton, M.R. et al. Impact of growth, gonadal hormones, adiposity and the sodium-to-potassium ratio on longitudinal adolescent measures of blood pressure at puberty. J Hum Hypertens 37, 835–843 (2023). https://doi.org/10.1038/s41371-022-00774-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-022-00774-x

This article is cited by

Search

Advanced search

Quick links