Wendy S. Post, MD, is associate professor of medicine and epidemiology, Division of Cardiology, The Johns Hopkins University, Baltimore, Maryland.

Dasgupta has demonstrated that adolescent Canadian boys experience an increased risk of hypertension during longitudinal follow-up compared with girls. Adolescents who were overweight or had a sedentary lifestyle were more likely to develop hypertension. The sex disparities identified in this study are interesting, but do not appear to necessarily translate to sex differences in hypertensive adults. In the 2003-2004 population-based National Health and Nutrition Examination Survey (NHANES), there was no remarkable difference in the prevalence of hypertension based on sex; however, among those with hypertension, women were more likely to be treated and, if treated, were more likely to have controlled hypertension compared with men.¹ One limitation of the Dasgupta analysis was the lack of information about the racial/ethnic makeup of the study population. It is well known that racial/ethnic minorities are at increased risk for hypertension, as demonstrated in the NHANES survey and the Multi-Ethnic Study of Atherosclerosis (MESA).²

Dasgupta's study reinforces the known association between lifestyle factors, such as diet, exercise, and hypertension, and demonstrates these associations in adolescents. There is an alarming epidemic of obesity in the United States among adults and children. Unfortunately, modern society has fostered behaviors that are detrimental to cardiovascular health, including physical inactivity and poor diet. Children are spending more time watching television and playing computer and video games, and less time being physically active. Their diets include high-calorie sugary drinks and fat-laden fast food.

Dasgupta's study and others have led to public health initiatives to improve society's high-risk behaviors. One example is some regions of the country banning the use of trans fats, which are known to increase the risk of cardiovascular disease. It is imperative that the trends in obesity and physical inactivity be controlled and reversed, especially in children, because they are resulting in an epidemic of the metabolic syndrome and diabetes. We should be advocating the Dietary Approaches to Stop Hypertension (DASH) diet, which has been demonstrated to lower blood pressure.³ This diet has been incorporated into the latest American Heart Association recommendations and is high in fruits, vegetables, whole grains, and calcium, but low in saturated fats. The study by Dasgupta demonstrates that particular attention must be focused on adolescent boys, who apparently develop hypertension at a faster rate than girls during the adolescent years.

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