ABC | Volume 115, Nº1, July 2020

Original Article Tozo et al. Hypertensive measures and childhood obesity Arq Bras Cardiol. 2020; 115(1):42-49 as to the location of adiposity and blood pressure (BP) in this population. In addition, evidence on the practice of physical activities with moderate-to-vigorous intensity (AF-mv) and BP is still limited, as well as the relationship between anthropometric measures and AF-mv as protectors of AH in children and adolescents. Thus, it is important to identify the risk of AH in adolescence to prevent the advancement of this condition in adulthood, which can increase the efficiency of treatment. Therefore, the present study aims to verify the association between AF-mv and anthropometric indicators of obesity with the diagnosis of AH in children and adolescents. Methods This is a descriptive cross-sectional quantitative study carried out in the city of São José dos Pinhais, Paraná (southern region of Brazil). The sample consisted of conglomerates, chosen for convenience, in which each private elementary and high school institution in the city was considered a conglomerate. Of the six institutions located in the central region that were invited, only two private schools agreed to participate in the study, to which all elementary and high school students were invited. In the city, approximately 55,289 students were attending the final grades of elementary school and high school in 2018. 17 The prevalence of 12.5% of hypertensive children and adolescents in the southern region of Brazil was stipulated. 18 Based on the probabilistic sample selection, the total number of 111 adolescents for inference of the student population in the stipulated age range was obtained. 1.5x subjects were included regarding the design effect, taking into account a 5% sample error, and an additional 30% were included for possible dropouts, resulting in a total of 217 individuals aged between 11 and 17. The study included 336 volunteer children and adolescents aged 11 to 17, of both sexes (173 girls). Pregnant women, individuals with limitations that prevented them from participating in any study procedure, and those who did not have signed the Free and Informed Consent Term (FICT) and the Free and Informed Consent Term for minors of age (TALE) were excluded from the study. All procedures were approved by the Research Ethics Committee of Pontifícia Universidade Católica do Paraná, PUC – PR, CAAE (71324017.1.0000.0020/2017). Anthropometric measurements were collected at school, in a standardized manner, following the procedures recommended by the Anthropometric Standardization Reference Manual. 19 Height was measured using a portable stadiometer, with a resolution of 0.1 centimeters (cm); height was expressed in cm. Body weight was assessed with a portable scale model PLENA, with resolution of up to 100 grams and capacity of 150 kg. BMI z-score (BMI-z) 20 was calculated using WHO Anthro Plus® version 1.0.4. Participants with BMI-z between ≥ -2 and <+1 were classified as overweight; between ≥ 1 and <2, obese; those with ≥2 were classified as eutrophic according to age and sex. Adolescents classified as overweight and obese (BMI-z ≥1) were considered with general obesity. In order to measure WC, an inelastic measuring tape was used at the midpoint between the last upper arch of the iliac crest and the outer face of the last rib. Adolescents with a ≥75 percentile were considered with central obesity according to sex and age group. 21 Measurement of systolic blood pressure (SBP) and diastolic blood pressure (DBP) followed the recommendations of the 7 th Brazilian Guideline on Hypertension 13 and were collected in a quiet isolated classroom using the automatic pressure device OMRON705-IT. 22 Two measurements of SBP and DBP were performed on the subject’s right arm by volunteer nurses with an interval of five minutes between them. These measurements were classified according to age, sex and height percentile. 13 Thus, the criteria for classification were: values below the 90 th percentile were considered adequate (normotensive), since they were lower than 120/80 mmHg; the percentiles between 90 and 95 were considered as prehypertensive (borderline); and equal to or greater than the 95 th percentile were considered hypertensive. The level of physical activity was assessed by the International Physical Activity Questionnaire — short form — (IPAQ). 23 The questions refer to the physical activities practiced in the week prior to the application of the questionnaire. The individuals were classified as sufficiently active (active or very active) or insufficiently active (irregularly active A, B or sedentary). 23 Statistical analysis Statistical analysis was performed using the Statistical Package for the Social Science (SPSS), v. 24. The normality of the data was assessed by the ShapiroWilk test. For comparison between sexes, nutritional status, WC classification and AF-mv, the independent Student’s t test was used for parametric variables, and the Mann-Witney test for non- parametric variables. The Chi-square test was used to assess the proportions among students considered adequate, pre- hypertensive, hypertensive according to high SBP and DBP. The analysis of odd ratios for individuals considered adequate and hypertensive, based on anthropometric variables and AF- mv through binary logistic regression. The significance level of p<0.05 was considered for all analyses. Results Excess weight was found in 35.11% of the 336 schoolchildren evaluated, with 12.5% being classified as obese. Central obesity was present in 13.39% of the students; 59.8% were classified as sufficiently active in PA-mv practices and 52.97% had high BP; 12.5% were pre-hypertensive and 40.5% hypertensive. The sample distribution according to sex and age group is shown in table 1. It was observed that mean SBP (p <0.001), BMI-Z (p = 0.034), body mass (p=0.001) andWC (p<0.001) were higher in boys than in girls. On the other hand, girls showed higher PAD (p=0.009). In addition, boys participated for longer in light and vigorous physical activities than girls (p=0.007; p=0.009) (Table 2). 43