ABSTRACT Background: high blood pressure and obesity in the pediatric age exhibit high levels of prevalence worldwide, including Cuba, which bases its early diagnosis to reduce its effects at these ages and its impact on adulthood. Objective: to develop an educational strategy aimed at improving the teaching work to promote an adequate health culture among schoolchildren. Methods: a cross-sectional descriptive and prospective epidemiological study was developed that included the calculation of obesity and the test of sustained weight in schoolchildren of several primary schools. Theoretical methods were used: analysis-synthesis, induction-deduction and systemic-structural; empirical ones: documentary analysis and surveys to schoolchildren, teachers and family; and the mathematical-statistic for the analyzed values. Results: in the clinical diagnosis a high prevalence of cardiovascular risk factors was found, in figures related to high blood pressure, body overweight, obesity, and cardiovascular hyperactivity; while the educational diagnosis allowed knowing deficiencies in the teaching preparation and in the family of schoolchildren on topics as healthy habits and lifestyles, so an educational strategy was developed and applied to offer a solution to the problem. Conclusions: the strategy allowed teachers to provide the necessary knowledge and means to promote healthy lifestyles, inside the curriculum and out of it where methodological work was strengthened by integrating these issues into the teaching-learning process, which led to the development of a necessary health culture in the students.

RESUMEN Fundamento: la hipertensión arterial y la obesidad en la edad pediátrica exhiben altos niveles de prevalencia a nivel mundial, incluyendo Cuba, lo cual fundamenta su diagnóstico precoz para disminuir sus efectos en estas edades y su impacto en la adultez. Objetivo: elaborar una estrategia educativa encaminada al perfeccionamiento de la labor docente para fomentar una adecuada cultura en salud entre los escolares. Métodos: se desarrolló un estudio epidemiológico descriptivo y prospectivo de carácter transversal, que incluyó el cálculo de la obesidad y otros factores de riesgo, en escolares de varias escuelas primarias. Se emplearon métodos teóricos: análisis-síntesis, inducción-deducción y sistémico-estructural; empíricos: análisis documental y encuestas a escolares, docentes y familiares y los matemático-estadístico para los valores analizados. Resultados: en el diagnóstico clínico se encontró elevada prevalencia de factores de riesgo cardiovascular, en cifras relacionadas con hipertensión arterial, obesidad, sobrepeso, sedentarismo y otros; mientras el diagnóstico educativo permitió conocer carencias en la preparación docente y en la familia de los escolares sobre temas de hábitos y estilos de vida saludable, por lo que se elaboró y aplicó una estrategia pedagógica para ofrecer solución a la problemática. Conclusiones: la estrategia permitió dotar a los docentes de los conocimientos y medios necesarios para promover estilos de vida saludables, desde lo curricular y extracurricular donde se fortaleció el trabajo metodológico integrando estos temas al proceso docente educativo, lo cual propició desarrollar una cultura de salud en los escolares.

ABSTRACT INTRODUCTION Hypertension is one of the most studied risk factors for cardiovascular disease in adults; in children and adolescents, its global prevalence changes with age, from 1%-3% in children to 3.2% in adolescents. In adults, in addition to hypertension, several biochemical markers of cardiovascular risk have been identified. Confirming an association between these and hypertension in childhood and adolescence would allow for more timely diagnosis and monitoring of cardiovascular disease, since the presence of both the markers and hypertension would imply increased risk. OBJECTIVE Confirm an association between biochemical risk markers of cardiovascular disease and hypertension in children aged 8 to 11 years. METHODS A cross-sectional study of 373 children aged 8-11 years was conducted in 3 primary schools in the city of Santa Clara in central Cuba. The variables examined were age, sex, height, blood pressure, cholesterol, triglycerides, lipoproteins and apolipoproteins. The children were classified as normotensive, prehypertensive or hypertensive, based on blood pressure readings and percentiles for age, sex and height. Descriptive statistics were calculated for quantitative variables. A bivariate analysis, tests of independence for qualitative variables and a means comparison for quantitative variables (ANOVA and its nonparametric alternative, the Kruskal Wallis test) were performed. Fisher’s F-test and its associated probability value were employed. RESULTS Some 32.2% of the children were prehypertensive and 5.1% hypertensive. Cholesterol and triglyceride values were significantly higher in hypertensive than in normotensive children (p = 0.028 and p = 0.047, respectively). HDL numbers were higher in normotensive children (p = 0.001), and LDL numbers and the LDL/ HDL ratio were higher in the hypertensive children, with differences between groups (p = 0.001 for both variables). There were differences between the three blood pressure categories for lipoprotein(a) and ApoA (p <0.001 and p = 0.001), for ApoB and for the ApoB/ApoA ratio (p <0.001 for both variables), with lower ApoA values and higher ApoB and ApoB/ApoA values in the hypertensive children. CONCLUSIONS The biochemical risk markers most strongly associated with hypertension in children are ApoB values, LDL, lipoprotein(a), and LDL/HDL and ApoB/ApoA ratios.

Introduction: Increased P wave dispersion are identified as a predictor of atrial fibrillation. There are associations between hypertension, P wave dispersion, constitutional and echocardiographic variables. These relationships have been scarcely studied in pediatrics. Objective: The aim of this study was to determine the relationship between P wave dispersion, blood pressure, echocardiographic and constitutional variables, and determine the most influential variables on P wave dispersion increases in pediatrics. Method: In the frame of the PROCDEC II project, children from 8 to 11 years old, without known heart conditions were studied. Arterial blood pressure was measured in all the children; a 12-lead surface electrocardiogram and an echocardiogram were done as well. Results: Left ventricular mass index mean values for normotensive (25.91 ± 5.96 g/m2.7) and hypertensive (30.34 ± 8.48 g/m2.7) showed significant differences P = .000. When we add prehypertensive and hypertensive there are 50.38% with normal left ventricular mass index and P wave dispersion was increased versus 13.36% of normotensive. Multiple regression demonstrated that the mean blood pressure, duration of A wave of mitral inflow, weight and height have a value of r = 0.88 as related to P wave dispersion. Conclusions: P wave dispersion is increased in pre- and hypertensive children compared to normotensive. There are pre- and hypertensive patients with normal left ventricular mass index and increased P wave dispersion. Mean arterial pressure, duration of the A wave of mitral inflow, weight and height are the variables with the highest influence on increased P wave dispersion.

Introducción: La dispersión de onda P incrementada se señala como predictor de fibrilación auricular, existiendo asociación entre hipertensión arterial, dispersión de onda P y variables ecocardiográficas y constitucionales. Estas relaciones han sido poco estudiadas en pediatría. Objetivo: Determinar la relación de la dispersión de la onda P con presión arterial, variables ecocardiográficas y constitucionales, y determinar las variables más influyentes en los incrementos de la dispersión de la onda P en pediatría. Método: Se estudiaron en el marco del proyecto PROCDEC II niños de 8 a 11 años. Se midió presión arterial, se realizó electrocardiograma de superficie y ecocardiograma. Resultados: Los valores de media del índice de masa ventricular izquierda para normotensos (25.91 ± 5.96 g/m2.7) e hipertensos (30.34 ± 8.48 g/m2.7) mostraron diferencias significativas (p = 0.000). Un 50.38% de prehipertensos más hipertensos presentan índice de masa ventricular normal y dispersión de la onda P incrementada versus normotensos (13.36%). La presión arterial media, la duración de la onda A, el peso y la talla presentan un valor de r = 0.88 al relacionarlo de forma múltiple con la dispersión de la onda P. Conclusiones: El índice de masa ventricular y la dispersión de la onda P demuestran ser mayores en pacientes prehipertensos e hipertensos que en normotensos. Se encontraron pacientes prehipertensos e hipertensos con índice de masa ventricular normal y dispersión de la onda P incrementada. Las variables que demostraron mayor influencia en los aumentos de la dispersión de la onda P fueron la presión arterial media, la duración de la onda A del flujo mitral, el peso y la talla.

Background: the electrocardiogram is a simple cardiac evaluation method. Even more, it is the simplest complementary tool in cardiology and its interpretation is always of clinical interest. Objective: to describe the normal criteria for electrocardiographic voltages in a Cuban pediatric population. Methods: a descriptive study was conducted. The sample included 376 students in third, fourth and fifth grade from two elementary schools in the Municipality of Santa Clara, Villa Clara. All patients underwent 12-derivation surface, two-dimensional and M-mode echocardiographies. Left ventricular mass index was calculated according to the 95th percentile. Electrocardiogram voltages were measured and the 98th percentile was selected for each of these values, so that voltage criteria in a pediatric population would emerge. Results: size, size 2,7and age did not differ significantly according to sex; the 95th percentile of left ventricular mass index was 48.0 g / m 2, 7. Significant differences for average voltages were only found in SV1 and SV2. Conclusions: it is necessary to establish cutoff points for left ventricular mass index and voltage criteria for left ventricular hypertrophy in different populations, so that biases are eliminated in future samples selection.

Fundamento: el electrocardiograma constituye un método sencillo de evaluación cardiaca. Es la herramienta complementaria más simple en cardiología; interpretarlo siempre será de interés clínico. Objetivo: describir los criterios normales para los voltajes electrocardiográficos en una población pediátrica cubana. Métodos: estudio descriptivo que incluyó 376 escolares que cursaban el tercero, cuarto y quinto grados, de dos escuelas primarias del Municipio de Santa Clara, Villa Clara. A todos se les realizó electrocardiograma de superficie de doce derivaciones y ecocardiograma bidimensional y modo M; se calculó el índice de masa ventricular izquierda, teniendo en cuenta el 95 percentil. Se midieron los voltajes del electrocardiograma y se seleccionó el 98 percentil para cada uno de esos valores, para así conocer los criterios de voltaje de una población pediátrica. Resultados: la talla, talla2.7 y la edad no presentaron diferencias significativas según el sexo; el 95 percentil del índice de masa ventricular izquierda fue de 48,0 g/m 2,7. Solo existieron diferencias significativas para las medias de los voltajes de SV1 y SV2. Conclusiones: existe necesidad de establecer puntos de corte para el índice de masa ventricular izquierda y para los criterios de voltajes de hipertrofia ventricular izquierda en diferentes poblaciones, para así no cometer sesgos en las selecciones de muestras en estudios futuros.

The electrocardiogram is a complementary test with high specificity but low sensitivity. In the case of patients with arterial hypertension it is of great importance in the diagnosis, prognosis and monitoring during treatment. The prevalence of left ventricular hypertrophy observed through electrocardiogram in hypertensive patients has been reported in up to 9% of them. Different indexes have been described to approach the diagnosis of left ventricular hypertrophy, including the Sokolow and Cornell indexes. Atrial and ventricular arrhythmias are both considered as comorbidity in arterial hypertension. The mechanisms involved are varied and include left ventricular hypertrophy and myocardial ischemia. In patients suffering from hypertension, premature atrial complexes are frequently found and there is an increasing risk of atrial fibrillation, mainly in patients over 65 years old. The predisposition of patients with hypertension to episodes of paroxysmal atrial fibrillation can be determined through manual measurement of P wave?s maximum, minimum and dispersion. The highest values of P wave dispersion in the reading of a 12-lead surface electrocardiogram are more related to events of paroxysmal atrial fibrillation. Irrigation increases in patients with P wave maximum values up to 134 ms and P wave dispersion values up to 46 ms.

El electrocardiograma es una exploración complementaria con alta especificidad, pero con baja sensibilidad. En el caso del paciente con hipertensión arterial es de gran importancia en el diagnóstico, pronóstico y para el seguimiento durante el tratamiento. La prevalencia de hipertrofia ventricular izquierda observada por electrocardiograma en el paciente hipertenso, se ha reportado, hasta en un 9 %. Se han descrito diferentes índices para la aproximación al diagnóstico de la hipertrofia ventricular izquierda, entre ellos el índice de Sokolow y el de Cornell. Las arritmias auriculares y ventriculares, ambas, están consideradas comorbilidad de la hipertensión arterial. Los mecanismos implicados son varios e incluyen la hipertrofia ventricular izquierda y la isquemia miocárdica. En el paciente que padece de hipertensión arterial es frecuente encontrar complejos auriculares prematuros y está incrementado el riesgo de padecer fibrilación auricular, fundamentalmente en pacientes mayores de 65 años, la predisposición de los pacientes con hipertensión arterial a presentar episodios de fibrilación auricular paroxística puede ser determinada por la medición manual de la onda P con su duración máxima, mínima y la dispersión de ella. Los mayores valores de dispersión de la onda P en la lectura de un electrocardiograma de superficie de 12 derivaciones se ven más relacionados con los eventos de fibrilación auricular paroxística. El riego se ve incrementado en aquellos pacientes con valores de onda P máxima de hasta 134 ms y dispersión de la onda P de hasta 46 ms.