OPEN ACCESS |Re iew
Un a eling he link be ween bi h o de and blood
p essu e: insigh s om a comp ehensi e sys ema ic
e iew and me a-analysis
Danial Habibia, Ami Hossein Koochekianb, Hamid Reza Ma a ebc, Homayoon masoudid,
Hani eh Mi a oos-Mahya ie, Muhammadhosein Mo adi , Mahdi Akba zadeh d, Ma jan Mansou ian b,g, Miguel
Ángel Mañanasc,h, and Roya Kelishadib
aDepa men o Epidemiology and Bios a is ics, School o Public Heal h, Babol Uni e si y o Medical Sciences, Babol, I an; bChild
G ow h and De elopmen Resea ch Cen e , Resea ch Ins i u e o P imo dial P e en ion o Non-Communicable Disease, Is ahan
Uni e si y o Medical Sciences, Is ahan, I an; cBiomedical Enginee ing Resea ch Cen e (CREB), Au oma ic Con ol Depa men
(ESAII), Uni e si a Poli ècnica de Ca alunya-Ba celona Tech (UPC), 08028 Ba celona, Spain; dCellula and Molecula Endoc ine
Resea ch Cen e , Resea ch Ins i u e o Endoc ine Sciences, Shahid Behesh i Uni e si y o Medical Sciences, Teh an, I an; eLung
T ansplan a ion Resea ch Cen e , Na ional Resea ch Ins i u e o Tube culosis and Lung Diseases, Shahid Behesh i Uni e si y o
Medical Sciences, Teh an, I an; Ca diac P ima y P e en ion Resea ch Cen e , Ca dio ascula Diseases Resea ch Ins i u e, Teh an
Uni e si y o Medical Sciences, Teh an, I an; gDepa men o Au oma ic Con ol, Biomedical Enginee ing Resea ch Cen e ,
Uni e si a Poli ècnica de Ca alunya, Ba celonaTech (UPC), Building H, Floo 4, A . Diagonal 647, 08028 Ba celona, Spain; hCIBER de
Bioingenie ía, Bioma e iales y Nanomedicina (CIBER-BBN), 28029 Mad id, Spain
Co esponding au ho s: Ma jan Mansou iann (email: [email p o ec ed];[email p o ec ed]); Hamid Reza
Ma a eb (email: [email p o ec ed])
Abs ac
The objec i e o he p esen sys ema ic e iew was o inco po a e p e ious s udies in es iga ing he associa ion o bi h o de
wi h he isk o sys olic and dias olic blood p essu e (DBP). We employed andom-e ec s and Bayesian me a-analyses, comple-
men ed by subg oup and sensi i i y analyses, including unnel plo s, Begg’s ank co ela ion es , Egge ’s linea eg ession
es , Galb ai h plo s, and lea e-one-ou me a-analysis. O he 13 a icles analyzed, 92% (12 a icles) we e published om 2010
onwa ds. The agg ega e sample comp ised 466853 fi s bo ns and 646786 la e -bo n indi iduals. Geog aphically, he s udies
we e p ima ily conduc ed in Eu ope (54%), ollowed by Asia (23%), and Ame ica (23%). The pooled mean di e ence o sys olic
blood p essu e (SBP) unde a andom-e ec s model was 0.28 mm Hg (95% CI: −7.03 o 7.59), and o DBP was 0.33 mm Hg (95%
CI: −5.38 o 6.04), nei he o which eached s a is ical significance (SBP: Z=0.08, P=0.939; DBP: Z=0.11, P=0.910). Sensi i -
i y analyses suppo ed hese findings. Bayesian me a-analysis p esen ed a 95% c edible in e al o SBP and DBP anging om
−7.25 o 7.84 and −5.60 o 6.27, espec i ely. The in es iga ion ound no subs an ial e idence o a significan di e ence in
SBP and DBP be ween fi s bo ns and la e -bo n indi iduals, challenging he hypo hesis ha bi h o de significan ly impac s
blood p essu e le els. ID egis a ion numbe : 567971.
Key wo ds: bi h o de , dias olic blood p essu e, sys olic blood p essu e, sys ema ic e iew, me a analysis, Bayesian me a-
analysis
1. In oduc ion
Hype ension is he leading cause o p ema u e mo ali y
wo ldwide, wi h an es ima ed p e alence o 20%–30% among
adul s wi h essen ial hype ension (Mills e al. 2020;Sab i
e al. 2021;Zhou e al. 2021). The p e alence a ies signi -
ican ly ac oss egions, wi h high-income coun ies demon-
s a ing modes declines in hype ension a es while ma ked
inc eases a e obse ed in low- and middle-income coun ies
(Mills e al. 2016;Zhou e al. 2017). In pedia ic popula ions,
hype ension p edominan ly p esen s as seconda y hype -
ension, o en a esul o inadequa e weigh managemen
and me abolic synd ome, while essen ial hype ension p e a-
lence anges om 4.7% o 19.4% (Kliegman e al. 2007;Sab i
e al. 2021).
The las wo decades ha e seen a p onounced ise in he
p e alence o pedia ic hype ension, d i en by a complex in-
e play o physiological and en i onmen al ac o s. Changes
in amily s uc u e, such as he ise in single-child house-
holds, ha e been sugges ed as con ibu ing ac o s o his
end (Zeng e al. 2013;Song e al. 2019). Pedia ic hype en-
sion, defined as blood p essu e exceeding he 95 h pe cen ile
o a child’s heigh o weigh , has been closely linked wi h
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he de elopmen o essen ial hype ension la e in li e and
an inc eased isk o li elong ca dio ascula complica ions
(Rai aka i e al. 2003;Falkne and Daniels 2004;Kliegman
e al. 2007;Sab i e al. 2021). Due o he significan asso-
cia ed isk o a ious ca diome abolic diseases——including
hea ailu e, myoca dial in a c ion, sudden ca diac dea h,
ce eb o ascula acciden s, and ch onic kidney disease——e a l y
de ec ion h ough ou ine blood p essu e sc eening om he
age o h ee is ad oca ed o imp o e managemen and ou -
comes (Kliegman e al. 2007).
In he ongoing explo a ion o un a el he e iologies and
con ibu ing ac o s o hype ension, conside able esea ch
has ocused on en i onmen al de e minan s. Among hese,
he impac o bi h o de on sys olic and dias olic blood
p essu e (DBP) has been in es iga ed; howe e , s udies yield
inconsis en ou comes. While Wells and Lawlo iden ified
a p opensi y o fi s bo ns o de elop hype ension du ing
childhood and ea ly adolescence (Lawlo e al. 2004;Wells e
al. 2011), o he s udies ound no significan associa ion be-
ween bi h o de and blood p essu e le els (Jelenko ic e al.
2013;Howe e al. 2014).
Unde s anding he ole o bi h o de , as a non-modifiable
isk ac o , is c ucial o he p ecise e alua ion o modifiable
isk ac o s, h ough be e ecogni ion and es ima ion o
isk ac o s e ec sizes and subsequen ly, designing a -
ge ed in e en ions as necessa y (Sie o e al. 2010). Despi e
many indi idual s udies add essing his opic, sys ema ic
e iews and me a-analyses syn hesizing he e idence base
a e lacking. This s udy aims o ully e alua e he ela ionship
be ween bi h o de and blood p essu e, o enhance ou
unde s anding o i s significance, s eng h, and quali y.
Fu he mo e, iden i ying isk ac o s o ad e se ca dio as-
cula ou comes could p o ide hin s owa d ea ly p e en i e
s a egies o slow disease p og ession. Thus, ou esea ch
seeks o cla i y he associa ion be ween bi h o de and he
isk o sys olic and dias olic high blood p essu e.
2. Ma e ials and me hods
2.1. Sea ch s a egy and selec ion c i e ia
This sys ema ic e iew and me a-analysis was conduc ed in
acco dance wi h he P e e ed Repo ing I ems o Sys ema ic
Re iews and Me a-Analyses (PRISMA) guidelines (Mohe e al.
2009). The s udy p o ocol was no p e egis e ed. We included
all ele an esea ch published up o Decembe 2023. Two
esea che s (DH and AHK) independen ly pe o med a com-
p ehensi e li e a u e sea ch ac oss PubMed, MEDLINE, Em-
base, Scopus, and Web o Science, employing a mix o sea ch
e ms ela ed o hype ension (e.g., “hype ension”, “high
blood p essu e”, “ele a ed blood p essu e”) and “bi h o de ”,
p io i izing MeSH e ms. Addi ionally, e e ence lis s om
iden ified a icles we e e iewed o cap u e u he s udies.
The e we e no es ic ions on language o publica ion da e.
Inclusion c i e ia manda ed ha s udies epo on hype -
ension o i s pheno ypes (e.g., sys olic, dias olic, isola ed
sys olic, isola ed dias olic, o sys olic-dias olic hype ension)
wi h clea defini ions and me hods o measu ing blood p es-
su e. Only esea ch wi h blood p essu e measu emen s aken
on a leas h ee sepa a e occasions we e conside ed o min-
imize o e es ima ion. Duplica e s udies we e assessed, e-
aining hose wi h ei he he mos comp ehensi e esul s
o he la ges sample size. Ti les and abs ac s we e ini ially
sc eened by DH and AHK, ollowed by ull- ex e iews o se-
lec ed a icles. Disc epancies we e esol ed h ough discus-
sion.
2.2. Da a ex ac ion and quali y assessmen
Da a ex ac ion was independen ly conduc ed by DH and
AHK, ga he ing in o ma ion on he i le, au ho s, publica-
ion yea , yea o s udy (wi h impu ed da es whe e necessa y),
loca ion, s udy design, and sample size. The S eng hening
he Repo ing o Obse a ional S udies in Epidemiology s a e-
men was u ilized o quali y assessmen (INITIATIVE 2007).
2.3. S a is ical analysis
Key cha ac e is ics o he included s udies we e summa-
ized in a desc ip i e able. Quan i a i e syn hesis was pe -
o med using STATA V.17 and he me a package in R 4.3.1,
conside ing s udies wi h compa able and homogenous da a.
He e ogenei y was assessed using he Q es , I2s a is ic, and
au-squa ed s a is ic, wi h a andom-e ec s model applied
due o expec ed s udy di e ences (Bo ens ein 2023). This ap-
p oach, ecommended o i s conse a i e na u e, was pa -
icula ly sui ed o analyses d awing solely om published
li e a u e.
We also execu ed a Bayesian app oach o con inuous ou -
come ia bayesme a package in R4.3.1 so wa e due o small
numbe o s udies (Reis e al. 2023). Fo his pu pose, bayesian
me hod applied by hal -cauchy p io (scale 10 o he he -
e ogenei y), and le us assume a no mal p io o cen e ed
a ound a mean o 0, wi h a s anda d de ia ion o 50 o he
sco e di e ences in bayesme a package (Rö e 2020).
2.4. Subg oup me a-analysis
Fo s udy design, s udy loca ion, and s udy popula ion, we
conduc ed subg oup me a-analyses o de e mine he po en-
ial sou ces o he e ogenei y (Richa dson e al. 2019). Fo his
pu pose, he e should be a leas h ee s udies in each sub-
g oup.
2.5. Sensi i i y analysis
The po en ial publica ion bias was e alua ed wi h a Fun-
nel plo , Begg’s ank es , and Egge ’s eg ession es , wi h
p< 0.05 being ep esen ed as s a is ically significan (Lin
and Chu 2018). Galb ai h plo was used o de ec he po en-
ial ou lie s, which lie a he away om he shaded egions
(Anzu es-Cab e a and Higgins 2010). Mo eo e , a lea e-one-
ou me a-analysis was pe o med o assess he influence o
each s udy on he o e all e ec -size es ima e and o speci y
influen ial s udies (Hysong 2009).
3. Resul
3.1. S udy selec ion and cha ac e is ics
Ou comp ehensi e li e a u e sea ch yielded 134 eco ds.
In e - a e eliabili y o de e mining s udy ele ance was
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Fig. 1. P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-analyses (PRISMA) diag am o li e a u e sea ch and s udy
selec ion.
assessed using Cohen’s kappa s a is ic. The le el o ag ee-
men be ween e iewe s was subs an ial, wi h a kappa alue
o 0.86. A e igo ous sc eening and applica ion o eligibil-
i y c i e ia, 13 a icles we e selec ed o inclusion (Fig. 1),
which p o ided da a on sys olic and dias olic blood p essu e
(Whincup e al. 1989;Sie o e al. 2010;Wells e al. 2011;
Ayya oo e al. 2013;Jelenko ic e al. 2013;Albe e al. 2014;
Howe e al. 2014;Schee s Ande sson e al. 2015;Kwok e al.
2016;Kelishadi e al. 2018;Au pibul e al. 2021;Pihlman e al.
2021;Pan ke e al. 2023). These s udies, p edominan ly pub-
lished om 2010 onwa ds, encompassed a combined sample
size o 466853 o fi s bo ns and 646 786 o la e -bo ns. Geo-
g aphically, he s udies we e dis ibu ed ac oss Eu ope (54%),
Asia (23%), and Ame ica (23%). All included s udies achie ed
a quali y sco e o 6 o highe , indica ing obus esea ch
me hodologies (Supplemen a y Table S1).
3.2. Changes in sys olic and dias olic blood
p essu e
The ange o sample sizes a ied significan ly ac oss s ud-
ies, wi h Albe e al. (Pihlman e al. 2021) epo ing he small-
es coho and Jelenko ic e al. (2013) he la ges . He e o-
genei y es s e ealed subs an ial a iabili y o bo h sys olic
blood p essu e (SBP) (Q=66.42, P< 0.001; I2=96.34, 95%
CI: 92.19, 99.24) and DBP (Q=234.13, P< 0.001; I2=95.53,
95% CI: 90.65, 99.14). The pooled mean di e ence o SBP, cal-
cula ed using a andom-e ec s model, was 0.28 mm Hg (95%
CI: −7.03 o 7.59), wi h no s a is ical significance (Z=0.08,
P=0.939). Simila ly, he pooled mean di e ence o DBP was
0.33 mm Hg (95% CI: −5.38 o 6.04), also lacking s a is ical
significance (Z=0.11, P=0.910), sugges ing no subs an ial
e idence o di e ence in SBP and DBP be ween fi s bo ns and
la e -bo ns (Fig. 2).
The Bayesian me a-analysis (Fig. 3) u he suppo ed hese
findings, displaying a 95% in e al o SBP and DBP ha
anged om −7.25 o 7.84 and −5.60 o 6.27, espec i ely,
indica ing conside able unce ain y a ound he e ec sizes
(Supplemen a y Figs. S13 and S14). The plo displays indi id-
ual s udy es ima es and hei 95% confidence in e als. The
e ec sizes a y widely among s udies, wi h some s udies e-
po ing high posi i e es ima es while o he s show nega i e
es ima es. No ably, se e al s udies ha e wide confidence in-
e als indica ing a lack o p ecision due o small sample sizes
o subs an ial a iabili y wi hin he da a. The sh inkage es-
ima es, indica ed by diamonds, ep esen a Bayesian adjus -
men ha sh inks indi idual s udy es ima es owa d he o e -
all mean.
The mean e ec size is ep esen ed by he diamond a he
bo om o he plo . Impo an ly, he in e al includes ze o, in-
dica ing ha he o e all e ec is no s a is ically significan .
The wide c edible in e al eflec s he unce ain y and a i-
abili y ac oss s udies, making i challenging o d aw a defini-
i e conclusion abou he ue e ec . The p edic ion in e al
p o ides an es ima e o whe e he e ec size o a u u e s udy
migh lie.
3.3. Subg oup analysis
Subg oup analyses we e pe o med o explo e po en ial
sou ces o he e ogenei y based on s udy design, loca ion,
and popula ion. These analyses e ealed no significan di e -
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Fig. 2. Fo es plo o mean di e ence (fi s o de ——la e o de ) o sys olic blood p essu e (A) and dias olic blood p essu e (B).
ences in SBP and DBP ac oss di e en age g oups (child en,
child en +you h, you h) and geog aphic egions (Ame ica,
Asia, Eu ope), as well as be ween c oss-sec ional and coho
s udies. The e ec sizes emained non-significan ac oss hese
subg oups (Supplemen a y Figs. S1–S6).
3.4. Sensi i i y analysis
The Galb ai h plo did no iden i y any po en ial ou lie s
o SBP and DBP (Supplemen a y Figs. S7 and S8). Lea e-one-
ou analyses o SBP and DBP u he confi med he s abili y
o ou findings, wi h no single s udy unduly influencing he
o e all e ec size es ima es (Supplemen a y Figs. S9 and S10).
Publica ion bias es s o SBP (Begg’s es : P=0.304, Egge ’s
es : P=0.864) and DBP (Begg’s es : P=0.09, Egge ’s es :
P=0.854) indica ed no significan bias in he published li e -
a u e (Supplemen a y Figs. S11 and S12).
4. Discussion
We conduc ed ou analysis using da a om hese 13 s ud-
ies ca ied ou in Eu ope, Asia, and he Ame icas in ol ing a
o al o 1113 639 pa icipan s, o which he popula ions we e
1078834 you h, 15 915 om pedia ic popula ions and 18 890
pa icipan s om combined you h and pedia ic popula ions.
We ound ha he mean SBP and DBP mean di e ences be-
ween fi s -bo n and la e -bo n indi iduals we e 0.28 mm Hg
(95% CI: −7.03, 7.59) and 0.33 mm Hg (95% CI: −5.38, 6.04), e-
spec i ely. These mean di e ences did no ep esen a s a is i-
cally significan e ec . Simila ly, analyses by pa ien popula-
ions, geog aphical loca ions, and s udy ypes showed no s a-
is ically significan di e ences in blood p essu e abou bi h
o de .
To ou knowledge, his s udy ep esen s he fi s sys em-
a ic e iew and me a-analysis examining he associa ion be-
ween bi h o de and bo h sys olic and dias olic blood p es-
su e. Gi en he global ise in hype ension and obesi y among
young popula ions (Helen e al. 2013), unde s anding hese
associa ions is c ucial o iden i ying ea ly-li e isk ac o s o
ca dio ascula diseases, majo causes o mo ali y in indus i-
alized na ions (Gaziano 2007).
The ela ionship be ween bi h o de and ca diome abolic
isk ac o s has been a subjec o ex ensi e in es iga ion
in ecen yea s. Nume ous me a-analyses and sys ema ic e-
iews suppo he no ion ha bi h o de significan ly in-
fluences isk ac o s such as obesi y, dyslipidemia, diabe es
( ypes 1 and 2), ca dio ascula disease, and insulin esis ance.
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Fig. 3. The o es plo showed he hi een p o ided es ima es wi h hei 95% confidence in e als along wi h he syn hesis
es ima e ( he diamond a he bo om, cen e ed a he pos e io median and spanning he 95% in e al), and a p edic i e
in e al ( he ba a he bo om, spanning he 95% p edic ion in e al). The es ima ed mean sco e o sys olic blood p essu e
and dias olic blood p essu e was anging om −7.25 o 7.84, and −5.60 o 6.27, espec i ely.
P io me a-analyses ha e iden ified a no able co ela ion be-
ween lowe bi h o de and an inc eased isk o obesi y, and
sugges ed a p o ec i e e ec o highe bi h o de agains
childhood-onse ype 1 diabe es, especially in child en unde
5 yea s o age (Melle e al. 2018). Schooling CM e al.’s find-
ings u he indica e ha bi h o de may influence de elop-
men al pa e ns wi h las ing heal h implica ions (Melle e
al. 2018).
Con a y o expec a ions and exis ing hypo heses, ou find-
ings do no suppo a significan impac o bi h o de on sys-
olic and dias olic blood p essu e. This aligns wi h he wo k
o Jona han C. K. Wells e al. (Gaziano 2007), which, despi e
ini ial obse a ions o highe sys olic blood p essu e in fi s -
bo ns among adolescen s, ound no s a is ically significan
associa ion a e adjus ing o ele an ma e nal and child
ac o s. Con e sely, s udies by (Ayya oo e al. 2013)ando h-
e s ha e epo ed associa ions be ween bi h o de and in-
c eased blood p essu e, sugges ing a po en ial isk o hype -
ension and ca dio ascula diseases la e in li e.
Lau a D. Howe and colleagues’ explo a ion o bi h o -
de and ca diome abolic isk ac o s e ealed weak and in-
consis en associa ions, u he complica ing he na a i e.
Thei esea ch specula es on he influence o p ena al and
pos na al en i onmen al di e ences be ween fi s -bo n and
la e -bo n child en, which could a ec ca dio ascula and
me abolic sys em de elopmen , hus influencing blood p es-
su e and body composi ion in la e li e (Howe e al. 2014).
Fi s -bo n child en’s exposu e o a es ic ed nu ien sup-
ply du ing in au e ine g ow h due o he s uc u al p ope -
ies o he u e ine spi al a e ies is hypo hesized o con ibu e
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o lowe bi h weigh s and, consequen ly, a highe isk o
hype ension (Valdés-Ramos e al. 2002;Ayya oo e al. 2013;
Kwok e al. 2016;Pan ke e al. 2023). This phenomenon, cou-
pled wi h impai ed glucose me abolism and educed insulin
sensi i i y known as he h i y pheno ype hypo hesis, unde -
sco es he complex in e play o physiological and en i on-
men al ac o s in he de elopmen o hype ension (Sie o e
al. 2010;Pihlman e al. 2021).
The associa ion be ween bi h o de and a ious ca -
diome abolic isk ac o s has been a poin o con o e sy. Di -
e ences ha e been epo ed in ou comes like weigh , obesi y,
and hype ension be ween fi s -bo n opposed o la e -bo n
o sp ing. Hype ension is a well-es ablished ca diome abolic
isk ac o , es ablishing ha essen ial hype ension accoun s
o nea ly 95% o adul popula ions (Ca e e o and Opa il
2000). The e o e, a be e unde s anding o he ac o s con-
ibu ing o he de elopmen o hype ension o influencing
blood p essu e is undamen al in enhancing he e ec i eness
o p e en ion and ea men s a egies. Among hese ac o s,
he ole o bi h o de as a non-modifiable isk ac o has
been an issue o g ea in e es (Ghandi e al. 2018). A be e
unde s anding o how bi h o de con ibu es o blood p es-
su e could go a long way in un a eling he angled h eads be-
ween modifiable isk ac o s and hype ension, sha pening
ou capaci y o p e en and manage his ampan condi ion
and enabling us o p o ide mo e indi idualized ecommen-
da ions in clinical se ings.
Fo clinicians, hese findings p o ide eassu ance ha
bi h o de should no be conside ed a significan isk ac o
o hype ension o blood p essu e abno mali ies. O he
es ablished isk ac o s, such as age, obesi y, physical ac-
i i y, smoking, die , and gene ic p edisposi ions, should
emain he p ima y ocus in assessing and managing blood
p essu e. Clinicians can be confiden ha while bi h o de
migh influence o he de elopmen al aspec s (e.g., academic
achie emen , pe sonali y), i does no play a majo ole in
de e mining blood p essu e le els. This allows o mo e a -
ge ed in e en ions ocusing on modifiable li es yle ac o s,
a he han unnecessa y conce n abou bi h o de in ca -
dio ascula heal h assessmen s. The clinical akeaway om
his s udy is ha bi h o de does no appea o influence
sys olic o dias olic blood p essu e in a clinically significan
manne . Clinicians should no conside bi h o de as an
impo an ac o when assessing a pa ien ’s isk o high
blood p essu e o ca dio ascula disease. Ins ead, emphasis
should emain on well-es ablished isk ac o s ha ha e a
clea and subs an ial impac on blood p essu e egula ion.
Se e al limi a ions need o be add essed when in e p e ing
his s udy’s esul s. Fi s , we could no measu e amily size o
age gaps be ween siblings, which migh impac he ela ion-
ship be ween bi h o de and ca diome abolic isk ac o s.
Secondly, pa en ing s yles and child en’s use o echnology
ha e changed conside ably o e he pas wo decades, and
hese changes may al e he dynamics be ween pa en s and
child en and he po en ial impac o bi h o de on hose dy-
namics. These ac o s may no be su icien ly cap u ed in he
p esen s udy. Ano he impo an ac o known o con ibu e
o he ca diome abolic isk p ofile is p ema u i y. Un o u-
na ely, none o he s udies included had da a a ailable on he
p ema u i y s a us o pa icipan s. Sex is a well-known de e -
minan o ca diome abolic isk p ofile; un o una ely, none
o he s udies epo ed esul s by gende . The e o e, his im-
po an a iable could no be included in ou analysis.
Al hough obse a ional s udies gene ally p o ide less con-
incing e idence han andomized con olled ials, we e al-
ua ed he me hodological quali y o he s udies included in
his me a-analysis. Howe e , he ac ha ou s udy is based
on hi een published s udies limi s i s ex e nal alidi y and
gene alizabili y. In addi ion, i was no s a ed whe he he in-
cluded s udies dis inguished be ween essen ial (p ima y) and
seconda y hype ension: his may a ec he accu acy o he
in e p e a ion o ou comes.
Conside ing he gaps wi hin he cu en li e a u e, u u e
s udies should ocus on a comp ehensi e e alua ion o he
di e ences be ween he ca diome abolic p ofiles associa ed
wi h fi s -bo n and la e -bo n child en h ough adolescence
o adul hood. Such s udies should include ac o s such as age
gap, sex, unde lying diseases, physical ac i i y, nu i ional
habi s, and psychia ic p ofiles. In his way, mo e defini i e
esul s can be ob ained be e o unde s and modifiable and
non-modifiable isk ac o s o ca diome abolic heal h, en-
abling mo e accu a e ecommenda ions ega ding clinical
p ac ice.
5. Conclusion
In conclusion, ou findings did no iden i y con incing e -
idence o di e in SBP and DBP o he fi s and la e o -
de . Mo eo e , hese esul s did no di e among con inen s,
s udy ypes, and ange o ages. These findings emained con-
sis en using di e en sensi i i y analyses.
Acknowledgmen
We wan o acknowledge he esea ch ha made summa y
da a a ailable.
A icle in o ma ion
Edi o (s)
Vance L T udeau, Jian Liu
His o y da es
Recei ed:18July2024
Accep ed: 14 Janua y 2025
Ve sion o eco d online: 27 Ma ch 2025
Copy igh
©2025 The Au ho (s). This wo k is licensed unde a C ea i e
Commons A ibu ion 4.0 In e na ional License (CC BY 4.0),
which pe mi s un es ic ed use, dis ibu ion, and ep oduc-
ion in any medium, p o ided he o iginal au ho (s) and
sou ce a e c edi ed.
Da a a ailabili y
None.
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Au ho in o ma ion
Au ho ORCIDs
MahdiAkba zadehh ps://o cid.o g/0000-0002-8048-744X
Ma janMansou ianh ps://o cid.o g/0000-0002-7217-0282
Au ho no es
Ma jan Mansou ian and Hamid Reza Ma a eb con ibu ed
equally o his wo k.
Au ho con ibu ions
Concep ualiza ion: MM
Da a cu a ion: HRM, MM
Fo mal analysis: DH, MA
In es iga ion: AHK, MM
Me hodology: DH, MM
P ojec adminis a ion: HRM, RK
Resou ces: AHK
So wa e: DH, HRM, MA, MM
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Supplemen a y ma e ial
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