In this study, we aimed to evaluate the effect of time spent on the Internet and video game playing on ABPM parameters in children and adolescents. We detected that as YIA-SF and IGDS9-SF scores increased, the overall mean systolic blood pressure increased, but it did not reach a statistically significant state. In addition, it was determined that there was a positive and significant relationship between daytime systolic blood pressure and maximum systolic blood pressure and YIA-SF scores. Considering that hypertension may develop in relation to obesity, when the internet addiction of obese and nonobese patients was evaluated separately, it was observed that there was a positive and significant correlation between the daytime maximum systolic blood pressures of nonobese patients and YIA-SF scores. Considering this result, we concluded that internet addiction may have an effect on blood pressure independent of its effects on the development of obesity.
There are studies showing that internet addiction, which can be defined as the inability to control internet use, which is one of the most important problems of our era and causes serious deterioration in mental and social functionality, is increasing rapidly, especially among children and adolescents [22]. Additionally, various studies have shown that internet addiction and increased screen exposure are associated with social and psychological problems such as depression, anxiety, loneliness, obesity, changes in lipid profile, and elevated blood pressure [12, 23]. In the study of Cassidy-Bushrow et al., the authors evaluated the time spent on the internet among 331 healthy children aged 14–17 and detected that as the time spent on the internet increased, the blood pressure of the participants increased, and there was a significant positive correlation between diastolic blood pressure and the time spent on the internet [11].The authors claimed that the increase in diastolic blood pressure could not be explained by the increased BMI, and the underlying mechanism needs to be explained with detailed studies [11].
In addition to internet addiction, there are various studies in the literature evaluating the effects of video games on blood pressure, metabolic parameters and obesity [9, 10, 12, 23]. In a study conducted by Goldfield et al. in 282 overweight and obese adolescents aged between 14–18 years, the effect of screen exposure (such as watching TV, video games, time spent on the computer) on blood pressure and lipid profile was evaluated [24]. Office blood pressure measurements were performed, and the presence of hypertension was determined by evaluating the last two of 3 separate measurements taken 4 minutes apart. Screen exposure was evaluated through questionnaires administered to the participants. As a result, Goldfield et al. detected that video games in particular were associated with blood pressure and lipid parameters independently of other factors [24]. The authors suggest that video games cause an increase in heart rate and an increase in sympathetic activity that may lead to high blood pressure [24]. In the study of Wang et al., which included 21 healthy boys aged between 7 and 10 years, office blood pressure measurements were obtained, and the authors found that playing video games caused an increase in systolic blood pressure of 22.3% and diastolic blood pressure of 5.8%.10
In our study, no difference was found between the normotensive, prehypertensive and hypertensive groups in terms of IGDS9-SF test scores. As the IGDS9-SF test scores increased, the overall mean systolic blood pressure increased but did not reach a statistically significant level (r = 0.025, p = 0.80). No significant relationship was found between diastolic blood pressure parameters and the video game scale scores.
In an interesting study by Siervo et al., authors evaluated the effect of violent video games on blood pressure [9]. The authors suggested that violent video games cause a high cardiac load, which is probably related to the activation of the stress response [9]. They found that diastolic blood pressure increased progressively during violent video games, and they stated that ongoing increases in blood pressure may cause significant cardiac problems. Although the content of video games was not evaluated in our study, in light of the studies mentioned above, we think that video games and their contents should be questioned when evaluating particularly hypertensive adolescents.
As has been demonstrated in many studies to date, a sedentary lifestyle may be associated with obesity and consequently hypertension. Considering this well-known finding, we tried to evaluate the effects of internet addiction and video games on ABPM parameters independent of obesity. A positive and significant correlation was found between the daytime maximum systolic blood pressure of nonobese patients and YIA-SF test scores (r = 0.280; p = 0.019). In light of this result, we propose that internet addiction may be related to hypertension independent of obesity. As mentioned above, Siervo et al demonstrated that video games can increase diastolic blood pressure, especially in nonobese young men [9].In the comprehensive study of Gopinath et al. conducted with 2353 school children with a mean age of 12.7 years, in line with our findings, it was determined that screen exposure was significantly associated with blood pressure, independent of BMI and other factors [8]. As demonstrated in previous studies and as we detected in the present study, we think that the increased blood pressure, particularly increased systolic blood pressure parameters, could be related to excitement and activation of the sympathetic nervous system during internet use and video game playing.
The main limitation of our study was the small number of participants. Further studies with an increased number of patients will help to improve our knowledge on this subject.