Global cardiovascular health promotion across the lifespan requires a comprehensive approach prioritising early life interventions. Paediatric hypertension is an increasingly recognised public health issue and an important modifiable risk factor for reducing future cardiovascular morbidity and mortality. This Review discusses the epidemiology, risk factors, diagnosis, and management of paediatric hypertension. We highlight the increasing prevalence of paediatric hypertension, its higher rates in low-income and middle-income countries (LMICs), and review its multifactorial causes globally, including genetic, environmental, and lifestyle influences. Barriers to early detection, particularly in LMICs, such as poor awareness of childhood-onset hypertension among families and health-care providers, are elucidated. Studies emphasising the short-term and long-term consequences of paediatric and youth hypertension and evidence-based diagnostic and management strategies, including non-pharmacological and pharmacological interventions, are also discussed. The management of hypertension in youth requires integrating public health strategies with clinical care to establish a robust foundation to improve lifelong health outcomes.
{"title":"Under pressure: the lifelong cardiovascular health of children and youth with primary hypertension","authors":"Rahul Chanchlani MD MSc , Prof Tammy Brady MD PhD , Prof Ruan Kruger PhD , Prof Manish D Sinha MRCP PhD","doi":"10.1016/S2352-4642(25)00302-5","DOIUrl":"10.1016/S2352-4642(25)00302-5","url":null,"abstract":"<div><div>Global cardiovascular health promotion across the lifespan requires a comprehensive approach prioritising early life interventions. Paediatric hypertension is an increasingly recognised public health issue and an important modifiable risk factor for reducing future cardiovascular morbidity and mortality. This Review discusses the epidemiology, risk factors, diagnosis, and management of paediatric hypertension. We highlight the increasing prevalence of paediatric hypertension, its higher rates in low-income and middle-income countries (LMICs), and review its multifactorial causes globally, including genetic, environmental, and lifestyle influences. Barriers to early detection, particularly in LMICs, such as poor awareness of childhood-onset hypertension among families and health-care providers, are elucidated. Studies emphasising the short-term and long-term consequences of paediatric and youth hypertension and evidence-based diagnostic and management strategies, including non-pharmacological and pharmacological interventions, are also discussed. The management of hypertension in youth requires integrating public health strategies with clinical care to establish a robust foundation to improve lifelong health outcomes.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"10 3","pages":"Pages 203-215"},"PeriodicalIF":15.5,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diagnosis of bronchopulmonary dysplasia in very low birthweight infants is often only ascertained many weeks after birth. We aimed to investigate whether trajectories of the fractions of inspired oxygen (FiO2) required to maintain O2 saturation from birth reflect distinct clusters of preterm lung disease.
Methods
In this data-driven exploratory cluster analysis, we used latent class trajectory modelling to derive clusters of FiO2 fluctuations in the first 30 days of life among neonates with a birthweight of less than 1250 g, across two multicentre, prospective cohorts: the Discovery Bronchopulmonary Dysplasia Program (D-BPD; enrolment July 30, 2013, to Jan 1, 2020; n=376) in Argentina and the Prematurity and Respiratory Outcomes Program (PROP; enrolment Aug 1, 2011, to Nov 31, 2013; n=835) in the USA, with the PROP cohort being used for external validation. Eligible participants, in both the present and original studies, included infants with birthweight of less than 1250 g in the D-BPD cohort, and infants enrolled in the PROP study born at 23–28 weeks of gestation by best obstetrical estimate. After unsupervised clustering of patients, we evaluated cluster performance against conventional bronchopulmonary dysplasia classification, using mortality as the primary outcome.
Findings
Of the 376 D-BPD infants, 190 (51%) were female (mean birthweight 968·1 g [SD 181·2]; mean gestational age 28·9 weeks [SD 2·3]) and 186 (49%) were male (mean birthweight 976·2 g [188·3]; mean gestational age 28·6 weeks [2·3]). Four clusters based on FiO2 requirements were identified: persistently low requirement (PLR; 218 [58%] of 376), early high with subsequent improvement (EHRI; 60 [16%] of 376), late-onset high requirement (LOHR; 31 [8%] of 376), and persistently high requirement (PHR; 67 [18%] of 376). Mortality was more frequent in LOHR (six [19%] of 31) and PHR (ten [15%] of 67) clusters, with no deaths in PLR and one death in EHRI (one [2%] of 60; p<0·0001). Nine (53%) of 17 fatal cases occurred before 36 weeks' gestational age, precluding conventional bronchopulmonary dysplasia diagnosis; among infants who died later, most had severe bronchopulmonary dysplasia (six [67%] of nine). Results from the PROP cohort closely mirrored those of D-BPD, yielding the same number of clusters with similar trajectories and replicating patterns of mortality.
Interpretation
Current bronchopulmonary dysplasia definitions might not fully capture the trajectories of lung disease of preterm infants. Data-driven approaches offer opportunities to identify infants at high risk earlier and to implement more precise interventions.
Funding
US National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, and the UK MRC.
{"title":"Diagnostic labels and clusters based on oxygen requirements in preterm infants with chronic lung disease: a data-driven exploratory cluster analysis in two independent cohorts","authors":"Damian Alvarez-Paggi PhD , Anhar Ullah PhD , Gaston Ofman MD , Sadia Haider PhD , Florencia Nowogrodzki MD , Sara Fontanella PhD , Jacqui Marzec MSc , Jorge Digregorio MD , Guillermo Colantonio MD , Mariana Sorgetti MD , Mariangeles Quiros MD , Andrea Brum MD , Silvia Garcia MD , Cristina Osio MD , Santiago Lopez Garcia MD , Gonzalo Mariani MD MSc , Maria Fernanda Galletti MD MSc , Silvina Coviello MSc , Clarice R Weinberg PhD , Nestor Vain MD , Judith Voynow MD","doi":"10.1016/S2352-4642(25)00314-1","DOIUrl":"10.1016/S2352-4642(25)00314-1","url":null,"abstract":"<div><h3>Background</h3><div>Diagnosis of bronchopulmonary dysplasia in very low birthweight infants is often only ascertained many weeks after birth. We aimed to investigate whether trajectories of the fractions of inspired oxygen (FiO<sub>2</sub>) required to maintain O<sub>2</sub> saturation from birth reflect distinct clusters of preterm lung disease.</div></div><div><h3>Methods</h3><div>In this data-driven exploratory cluster analysis, we used latent class trajectory modelling to derive clusters of FiO<sub>2</sub> fluctuations in the first 30 days of life among neonates with a birthweight of less than 1250 g, across two multicentre, prospective cohorts: the Discovery Bronchopulmonary Dysplasia Program (D-BPD; enrolment July 30, 2013, to Jan 1, 2020; n=376) in Argentina and the Prematurity and Respiratory Outcomes Program (PROP; enrolment Aug 1, 2011, to Nov 31, 2013; n=835) in the USA, with the PROP cohort being used for external validation. Eligible participants, in both the present and original studies, included infants with birthweight of less than 1250 g in the D-BPD cohort, and infants enrolled in the PROP study born at 23–28 weeks of gestation by best obstetrical estimate. After unsupervised clustering of patients, we evaluated cluster performance against conventional bronchopulmonary dysplasia classification, using mortality as the primary outcome.</div></div><div><h3>Findings</h3><div>Of the 376 D-BPD infants, 190 (51%) were female (mean birthweight 968·1 g [SD 181·2]; mean gestational age 28·9 weeks [SD 2·3]) and 186 (49%) were male (mean birthweight 976·2 g [188·3]; mean gestational age 28·6 weeks [2·3]). Four clusters based on FiO<sub>2</sub> requirements were identified: persistently low requirement (PLR; 218 [58%] of 376), early high with subsequent improvement (EHRI; 60 [16%] of 376), late-onset high requirement (LOHR; 31 [8%] of 376), and persistently high requirement (PHR; 67 [18%] of 376). Mortality was more frequent in LOHR (six [19%] of 31) and PHR (ten [15%] of 67) clusters, with no deaths in PLR and one death in EHRI (one [2%] of 60; p<0·0001). Nine (53%) of 17 fatal cases occurred before 36 weeks' gestational age, precluding conventional bronchopulmonary dysplasia diagnosis; among infants who died later, most had severe bronchopulmonary dysplasia (six [67%] of nine). Results from the PROP cohort closely mirrored those of D-BPD, yielding the same number of clusters with similar trajectories and replicating patterns of mortality.</div></div><div><h3>Interpretation</h3><div>Current bronchopulmonary dysplasia definitions might not fully capture the trajectories of lung disease of preterm infants. Data-driven approaches offer opportunities to identify infants at high risk earlier and to implement more precise interventions.</div></div><div><h3>Funding</h3><div>US National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, and the UK MRC.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"10 2","pages":"Pages 83-93"},"PeriodicalIF":15.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145777484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/S2352-4642(25)00301-3
Prof Rashida A Ferrand PhD , Nyasha V Dzavakwa MSc , Tsitsi Bandason MSc , Molly Chisenga MSc , Prof Suzanne Filteau PhD , Prof Katharina Kranzer PhD , Hildah Banda Mabuda Diploma , Grace Mchugh MD , Prof Hilda Mujuru MSc , Nicol Redzo MSc , Prof Sarah L Rowland-Jones DM , Prof Ulrich E Schaible Dr rer nat , Victoria Simms PhD , Jonathan C Y Tang PhD , Lackson Kasonka MMed , Prof Celia L Gregson FRCP
<div><h3>Background</h3><div>HIV has adverse impact on skeletal development in children despite antiretroviral therapy (ART). We investigated the effect of high-dose (20 000 IU) weekly vitamin D<sub>3</sub> and daily calcium carbonate (500 mg) supplementation for 48 weeks on bone density and muscle strength and power among peripubertal individuals (11–19 years) with perinatally acquired HIV.</div></div><div><h3>Methods</h3><div>We conducted an individually randomised, double-blind, placebo-controlled trial. Individuals taking ART for at least 6 months who had a defined caregiver, and knew their HIV status (in those aged >12 years) were recruited from HIV clinics in Harare, Zimbabwe and Lusaka, Zambia. The primary outcome was total body less-head bone mineral density (TBLH-BMD) Z score and secondary outcome was lumbar spine bone mineral apparent density (LS-BMAD) Z score (both measured by dual-energy x-ray absorptiometry). Linear regression was used to compare arms adjusting for country and baseline value of the measure. Pre-specified subgroup analyses by country, age-group, sex, pubertal stage, calcium intake, tenofovir disproxil fumarate use, and baseline vitamin D insufficiency (defined as 25[OH]D <75 nmol/L), and a post-hoc subgroup analysis by viral suppression, were performed. A Participant Advisory Board that included adolescents with HIV, their guardians, and health providers guided study conduct. The trial is registered with the Pan African Clinical Trials Registry, PACTR20200989766029.</div></div><div><h3>Findings</h3><div>Of 842 participants (median age 15 years [IQR 13–17], 448 [53%] female and 394 [47%] male) enrolled between Feb 4 to Nov 23, 2021, 639 (76%) were vitamin D insufficient. At 48 weeks, outcomes were available for 751 (89%) participants. There was no difference by arm in TBLH-BMD Z score (intervention <em>vs</em> control: mean –1·53 [SD 1·18] <em>vs</em> –1·56 [1·12], adjusted mean difference –0·04 [95% CI –0·01 to 0·09]) or in LS-BMAD Z score (intervention <em>vs</em> control: –0·64 [1·17] <em>vs</em> –0·71 [SD 1·16], adjusted mean difference –0·05 [95% CI –0·01 to 0·12]). However, among participants with vitamin D insufficiency at baseline, there was a significantly higher LS-BMAD Z score (adjusted mean difference 0·09 [95% CI 0·02 to 0·16], p<sub>interaction</sub>=0·025) in the intervention arm than in the control arm. The corresponding adjusted mean difference in TBLH-BMD Z score was 0·06 (0·00–0·11), p<sub>interaction</sub>=0·15. There was no statistical evidence of interaction in other subgroups. No drug-related severe adverse events were observed.</div></div><div><h3>Interpretation</h3><div>There was no difference in bone density between arms overall, but among those with vitamin D insufficiency the intervention improved bone density. High-dose vitamin D<sub>3</sub> and calcium supplementation, a safe and cheap intervention, during adolescence might promote bone accrual and mineralisation in those with vitami
{"title":"Impact of high-dose vitamin D and calcium carbonate supplementation on bone density in adolescents living with HIV: a randomised, placebo-controlled trial","authors":"Prof Rashida A Ferrand PhD , Nyasha V Dzavakwa MSc , Tsitsi Bandason MSc , Molly Chisenga MSc , Prof Suzanne Filteau PhD , Prof Katharina Kranzer PhD , Hildah Banda Mabuda Diploma , Grace Mchugh MD , Prof Hilda Mujuru MSc , Nicol Redzo MSc , Prof Sarah L Rowland-Jones DM , Prof Ulrich E Schaible Dr rer nat , Victoria Simms PhD , Jonathan C Y Tang PhD , Lackson Kasonka MMed , Prof Celia L Gregson FRCP","doi":"10.1016/S2352-4642(25)00301-3","DOIUrl":"10.1016/S2352-4642(25)00301-3","url":null,"abstract":"<div><h3>Background</h3><div>HIV has adverse impact on skeletal development in children despite antiretroviral therapy (ART). We investigated the effect of high-dose (20 000 IU) weekly vitamin D<sub>3</sub> and daily calcium carbonate (500 mg) supplementation for 48 weeks on bone density and muscle strength and power among peripubertal individuals (11–19 years) with perinatally acquired HIV.</div></div><div><h3>Methods</h3><div>We conducted an individually randomised, double-blind, placebo-controlled trial. Individuals taking ART for at least 6 months who had a defined caregiver, and knew their HIV status (in those aged >12 years) were recruited from HIV clinics in Harare, Zimbabwe and Lusaka, Zambia. The primary outcome was total body less-head bone mineral density (TBLH-BMD) Z score and secondary outcome was lumbar spine bone mineral apparent density (LS-BMAD) Z score (both measured by dual-energy x-ray absorptiometry). Linear regression was used to compare arms adjusting for country and baseline value of the measure. Pre-specified subgroup analyses by country, age-group, sex, pubertal stage, calcium intake, tenofovir disproxil fumarate use, and baseline vitamin D insufficiency (defined as 25[OH]D <75 nmol/L), and a post-hoc subgroup analysis by viral suppression, were performed. A Participant Advisory Board that included adolescents with HIV, their guardians, and health providers guided study conduct. The trial is registered with the Pan African Clinical Trials Registry, PACTR20200989766029.</div></div><div><h3>Findings</h3><div>Of 842 participants (median age 15 years [IQR 13–17], 448 [53%] female and 394 [47%] male) enrolled between Feb 4 to Nov 23, 2021, 639 (76%) were vitamin D insufficient. At 48 weeks, outcomes were available for 751 (89%) participants. There was no difference by arm in TBLH-BMD Z score (intervention <em>vs</em> control: mean –1·53 [SD 1·18] <em>vs</em> –1·56 [1·12], adjusted mean difference –0·04 [95% CI –0·01 to 0·09]) or in LS-BMAD Z score (intervention <em>vs</em> control: –0·64 [1·17] <em>vs</em> –0·71 [SD 1·16], adjusted mean difference –0·05 [95% CI –0·01 to 0·12]). However, among participants with vitamin D insufficiency at baseline, there was a significantly higher LS-BMAD Z score (adjusted mean difference 0·09 [95% CI 0·02 to 0·16], p<sub>interaction</sub>=0·025) in the intervention arm than in the control arm. The corresponding adjusted mean difference in TBLH-BMD Z score was 0·06 (0·00–0·11), p<sub>interaction</sub>=0·15. There was no statistical evidence of interaction in other subgroups. No drug-related severe adverse events were observed.</div></div><div><h3>Interpretation</h3><div>There was no difference in bone density between arms overall, but among those with vitamin D insufficiency the intervention improved bone density. High-dose vitamin D<sub>3</sub> and calcium supplementation, a safe and cheap intervention, during adolescence might promote bone accrual and mineralisation in those with vitami","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"10 2","pages":"Pages 111-121"},"PeriodicalIF":15.5,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145731757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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