Exploring the relationship of peripheral total bilirubin, red blood cell, and hemoglobin with blood pressure during childhood and adolescence

Chen, Xiao-tian; Yang, Song; Yang, Ya-ming; Zhao, Hai-long; Chen, Yan-chun; Zhao, Xiang-hai; Wen, Jin-bo; Tian, Yuan-rui; Yan, Wei-li; Shen, Chong

doi:10.1016/j.jped.2017.07.018

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Original articles • J. Pediatr. (Rio J.) 94 (5) • Sep-Oct 2018 • https://doi.org/10.1016/j.jped.2017.07.018 copy

Exploring the relationship of peripheral total bilirubin, red blood cell, and hemoglobin with blood pressure during childhood and adolescence^☆ ☆ Please cite this article as: Chen X-t, Yang S, Yang Y-m, Zhao H-l, Chen Y-c, Zhao X-h, et al. Exploring the relationship of peripheral total bilirubin, red blood cell, and hemoglobin with blood pressure during childhood and adolescence. J Pediatr (Rio J). 2018;94:532-8.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

Total bilirubin is beneficial for protecting cardiovascular diseases in adults. The authors aimed to investigate the association of total bilirubin, red blood cell, and hemoglobin levels with the prevalence of high blood pressure in children and adolescents.

Methods:

A total of 3776 students (aged from 6 to 16 years old) were examined using cluster sampling. Pre-high blood pressure and high blood pressure were respectively defined as the point of 90th and 95th percentiles based on the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Both systolic and diastolic blood pressure were standardized into z-scores.

Results:

Peripheral total bilirubin, red blood cell and hemoglobin levels were significantly correlated with age, and also varied with gender. Peripheral total bilirubin was negatively correlated with systolic blood pressure in 6- and 9-year-old boys, whilst positively correlated with diastolic blood pressure in the 12-year-old boys and 13- to 15-year-old girls (p < 0.05). Higher levels of red blood cell and hemoglobin were observed in pre-high blood pressure and high blood pressure students when compared with their normotensive peers (p < 0.01). The increases in red blood cell and hemoglobin were significantly associated with high blood pressure after adjusting for confounding factors. The ORs (95% CI) of each of the increases were 2.44 (1.52-3.92) and 1.04 (1.03-1.06), respectively. No statistical association between total bilirubin and high blood pressure was observed (p > 0.05).

Conclusion:

Total bilirubin could be weakly correlated with both systolic and diastolic blood pressure, as correlations varied with age and gender in children and adolescents; in turn, the increased levels of red blood cell and hemoglobin are proposed to be positively associated with the prevalence of high blood pressure.

KEYWORDS
Bilirubin; Erythrocyte; Hemoglobin; Blood pressure

Variables	Group	Normotensive	Pre-HBP	HBP	χ² /F	p
		(n = 3154)	(n = 298)	(n = 314)
Age (years)		10.68 ± 2.87	10.17 ± 2.90^a	10.26 ± 2.92^b	5.41	<0.01
Gender	Boys	1625 (51.52%)	144 (48.32%)	160 (50.96%)	1.13	0.57
Gender	Girls	1529 (48.48%)	154 (51.68%)	154 (49.04%)
Height (cm)		146.09 ± 16.52	145.56 ± 17.48	146.63 ± 16.86	0.32	0.73
Weight (kg)		40.46 ± 15.20	45.16 ± 16.14^a	44.96 ± 17.36^b	13.09	<0.01
BMI (kg/m²)		18.24 ± 3.64	19.10 ± 3.87^a	20.09 ± 4.55^b	39.78	<0.01
TBIL (µmol/L)		11.55 ± 4.67	11.54 ± 5.32	11.72 ± 4.89	0.08	0.91
LgRBC		12.65 ± 0.03	12.66 ± 0.03^a	12.67 ± 0.03^b	38.92	<0.01
HGB (g/L)		131.64 ± 9.81	133.56 ± 9.37^a	135.84 ± 10.08^b	29.06	<0.01
HDL-C (mmol/L)		1.27 ± 0.28	1.24 ± 0.28	1.23 ± 0.29^b	4.32	0.01
LDL-C (mmol/L)		2.06 ± 0.60	2.14 ± 0.60^a	2.13 ± 0.66^b	3.88	0.02
TC (mmol/L)		3.90 ± 0.68	4.00 ± 0.68^a	4.01 ± 0.72^b	6.13	<0.01
TG (mmol/L)		1.25 ± 0.69	1.36 ± 0.91^a	1.44 ± 0.86^b	11.44	<0.01
SBP (mmHg)		111.59 ± 10.63	124.23 ± 9.80	130.27 ± 12.25	577.54	<0.01
DBP (mmHg)		62.70 ± 6.34	71.34 ± 5.93	75.82 ± 6.74	800.31	<0.01

Stratification	Variables	Normotensive	Pre-HBP	HBP	p	p _trend
Total population	TBIL (µmol/L)	11.55 ± 4.67	11.54 ± 5.32	11.72 ± 4.89	0.98^a a Adjusted for age, HDL, LDL, TC, TG, RBC, and HGB.	0.99^a a Adjusted for age, HDL, LDL, TC, TG, RBC, and HGB.
	LgRBC	12.65 ± 0.03	12.66 ± 0.03	12.67 ± 0.03	<0.01^b b Adjusted for age, HDL, LDL, TC, TG, and HGB.	<0.01^b b Adjusted for age, HDL, LDL, TC, TG, and HGB.
	HGB (g/L)	131.64 ± 9.81	133.56 ± 9.37	135.84 ± 10.08	<0.01^c c Adjusted for age, HDL, LDL, TC, TG, and RBC.	<0.01^c c Adjusted for age, HDL, LDL, TC, TG, and RBC.
Boys	TBIL (µmol/L)	11.39 ± 4.21	10.93 ± 4.50	11.17 ± 4.26	0.65^a a Adjusted for age, HDL, LDL, TC, TG, RBC, and HGB.	0.39^a a Adjusted for age, HDL, LDL, TC, TG, RBC, and HGB.
	LgRBC	12.66 ± 0.03	12.67 ± 0.03	12.68 ± 0.03	0.04^b b Adjusted for age, HDL, LDL, TC, TG, and HGB.	<0.01^b b Adjusted for age, HDL, LDL, TC, TG, and HGB.
	HGB (g/L)	133.95 ± 10.82	135.81 ± 10.68	138.74 ± 11.09	<0.01^c c Adjusted for age, HDL, LDL, TC, TG, and RBC.	<0.01^c c Adjusted for age, HDL, LDL, TC, TG, and RBC.
Girls	TBIL (µmol/L)	11.23 ± 3.82	11.55 ± 4.14	11.61 ± 4.00	0.48^a a Adjusted for age, HDL, LDL, TC, TG, RBC, and HGB.	0.37^a a Adjusted for age, HDL, LDL, TC, TG, RBC, and HGB.
	LgRBC	12.64 ± 0.03	12.65 ± 0.03	12.66 ± 0.03	<0.01^b b Adjusted for age, HDL, LDL, TC, TG, and HGB.	<0.01^b b Adjusted for age, HDL, LDL, TC, TG, and HGB.
	HGB (g/L)	129.18 ± 7.91	131.43 ± 7.36	132.89 ± 7.96	<0.01^c c Adjusted for age, HDL, LDL, TC, TG, and RBC.	<0.01^c c Adjusted for age, HDL, LDL, TC, TG, and RBC.

Stratification	Variables	Pre-HBP		HBP
		OR (95% CI)	aOR (95% CI)	OR (95% CI)	aOR (95% CI)
Total population	TBIL (µmol/L)	1.00 (0.97-1.03)	1.00 (0.90-1.04)^a a Adjusted for age, gender, HDL, LDL, TC, TG, RBC, and HGB.	1.00 (0.98-1.03)	1.00 (0.97-1.03)^a a Adjusted for age, gender, HDL, LDL, TC, TG, RBC, and HGB.
	LgRBC	1.98 (1.41-2.78)	1.45 (0.89-2.38)^b b Adjusted for age, gender, HDL, LDL, TC, TG, and HGB.	3.74 (2.71-5.14)	2.44 (1.52-3.92)^b b Adjusted for age, gender, HDL, LDL, TC, TG, and HGB.
	HGB (g/L)	1.02 (1.01-1.03)	1.03 (1.01-1.05)^c c Adjusted for age, gender, HDL, LDL, TC, TG, and RBC.	1.04 (1.03-1.05)	1.04 (1.03-1.06)^c c Adjusted for age, gender, HDL, LDL, TC, TG, and RBC.
Boys	TBIL (µmol/L)	0.99 (0.95-1.02)	0.99 (0.94-1.04)^d d Adjusted for age, HDL, LDL, TC, TG, RBC, and HGB.	0.99 (0.95-1.02)	0.98 (0.93-1.03)^d d Adjusted for age, HDL, LDL, TC, TG, RBC, and HGB.
	LgRBC	1.79 (1.10-2.90)	1.03 (0.46-2.29)^e e Adjusted for age, HDL, LDL, TC, TG, and HGB.	4.42 (2.82-6.94)	2.59 (1.29-5.21)^e e Adjusted for age, HDL, LDL, TC, TG, and HGB.
	HGB (g/L)	1.02 (1.00-1.03)	1.06 (1.03-1.09)^f f Adjusted for age, HDL, LDL, TC, TG, and RBC.	1.04 (1.03-1.06)	1.06 (1.03-1.09)^f f Adjusted for age, HDL, LDL, TC, TG, and RBC.
Girls	TBIL (µmol/L)	1.02 (0.98-1.05)	1.02 (0.98-1.07)^d d Adjusted for age, HDL, LDL, TC, TG, RBC, and HGB.	1.03 (1.00-1.07)	1.02 (0.98-1.07)^d d Adjusted for age, HDL, LDL, TC, TG, RBC, and HGB.
	LgRBC	2.98 (1.76-5.04)	2.02 (1.07-3.81)^e e Adjusted for age, HDL, LDL, TC, TG, and HGB.	4.36 (2.62-7.27)	2.46 (1.28-4.74)^e e Adjusted for age, HDL, LDL, TC, TG, and HGB.
	HGB	1.04 (1.02-1.06)	1.03 (1.00-1.05)^f f Adjusted for age, HDL, LDL, TC, TG, and RBC.	1.06 (1.04-1.08)	1.05 (1.02-1.04)^f f Adjusted for age, HDL, LDL, TC, TG, and RBC.

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[1] * Corresponding author.E-mail:sc@njmu.edu.cn (C. Shen).