Incidence of high blood pressure in children — Effects of physical activity and sedentary behaviors: The IDEFICS study High blood pressure, lifestyle and children Augusto César Ferreira de Moraes a,b,c, ⁎, Heráclito Barbosa Carvalho a,c , Alfonso Siani d , Gianvincezo Barba d,1 , Toomas Veidebaum e , Michael Tornaritis f , Denes Molnar g , Wolfgang Ahrens h , Norman Wirsik h , Stefaan De Henauw i , Staffan Mårild j , Lauren Lissner k , Kenn Konstabel e , Yannis Pitsiladis l , Luis A. Moreno b,m a School of Medicine of the University of São Paulo, FMUSP, São Paulo, Brazil b Universidad de Zaragoza, Facultad de Ciencias de la Salud, GENUD Research Group (Growth, Exercise, Nutrition and Development) Zaragoza, Spain c YCARE (Youth/Child and Cardiovascular Risk and Environmental) Research Group, FMUSP, Brazil d Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy e Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia f Research and Education Foundation of Child Health, Strovolos, Cyprus g Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary h Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany i Department of Public Health, Ghent University, Ghent, Belgium j Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden k Department of Public Health and Community Medicine, University of Gothenburg, Sweden l University of Glasgow, Faculty of Biomedical and Life Sciences, Glasgow, Scotland, United Kingdom m School of Medicine of the University of São Paulo, Department of Preventive Medicine, São Paulo, Brazil abstract article info Article history: Received 29 October 2014 Accepted 23 November 2014 Available online 26 November 2014 Keywords: Hypertension Lifestyle behaviors Cohort study Multicenter study Children Background/objectives: High blood pressure (HBP) is one of the most important risk factors for cardiovascular diseases and it has a high prevalence in pediatric populations. However, the determinants of the incidence of Pre-HBP and HBP in children are not well known. i) To describe the incidence of HBP in European children; and ii) to evaluate the effect of physical activity (PA) and sedentary behavior (SB) on the Pre-HBP and HBP. Methods: The IDEFICS cohort study. A total of 16,228 children 2–9 years at baseline were recruited by complex sampling population-based survey in eight European countries. At baseline (T0), 5221 children were selected for accelerometer measurements; 5061 children were re-examined 2 years later (T1). We estimated the inci- dence of Pre-HBP and HBP and evaluate the effect of PA and SB on the Pre-HBP and HBP, by computing relative risks and the corresponding 95% confidence intervals (RR, 95% CI). Results: Incidences of Pre-HBP and HBP per year were: 121/1000 children and 110/1000 children, respectively. We found that children maintaining SB N 2 h/d during the two year follow-up showed a RR of having HBP of 1.28 (1.03–1.60). Children in T1 not performing the recommended amount of PA (b 60 min/d) have a RR of HBP of 1.53 (1.12 to 2.09). We found no association between pre-HBP and the behaviors. Conclusion: The incidence of pre-HBP and HBP is high in European children. Maintaining sedentary behaviors during childhood increases the risk of developing HBP after two years of follow-up. © 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Chronic non-communicable diseases are the main source of disease burden worldwide and are thus a major public health problem [1]. Among non-communicable diseases, hypertension has been shown to have the highest prevalence in adults [2], and studies have shown that blood pressure (BP) levels in childhood and adolescence greatly impact the development of hypertension in adulthood [3]. Among the factors that may influence blood pressure levels (e.g. genetics, intrauterine development, socioeconomic status, tobacco use, total and abdominal obesity), physical activity (PA) and sedentary behaviors (SB) have been shown inverse [4] and direct associations [5,6], respectively, with blood pressure in children. International Journal of Cardiology 180 (2015) 165–170 ⁎ Corresponding author at: Faculdade de Medicina da USP, Departamento de Medicina Preventiva, 2° andar, sala 2162, Secretaria de Pós-Graduação, Av. Dr. Arnaldo, 455, Cerqueira César, CEP: 01246-903 São Paulo, Brazil. E-mail address: augustocesar.demoraes@usp.br (A.C.F. de Moraes). 1 In memoriam. http://dx.doi.org/10.1016/j.ijcard.2014.11.175 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard