Anthropometric indices, but not birth weight, are associated with high blood pressure risk among Malay adolescents in Kuala Lumpur

Current status of elevated blood pressure and hypertension among adolescents in Asia: a systematic review

Background

Hypertension among adolescents in Asia is an emerging public health concern that is directly associated with early onset cardiovascular risks. As such, it can also lead to further health issues and challenges for health care in the future. As existing studies have predominantly focussed on adult populations, we sought to provide targeted insights into adolescent hypertension across Asia, elucidating the impact of rapid lifestyle and environmental changes on this younger population. Therefore, in this systematic review, we aimed to evaluate the prevalence and trends of elevated blood pressure (BP) and hypertension among adolescents aged 10-19 years across Asia, address gaps in region-specific data, and determine any demographic risk factors.

Methods

Following PRISMA guidelines, we searched PubMed, EMBASE, Science Direct, Web of Science, Google Scholar, and Scopus for cross-sectional studies on adolescent hypertension/elevated BP in Asia published from January 2019 to June 2024, after which we narratively synthesised their findings.

Results

Of the 2634 retrieved studies, 39 met the inclusion criteria, covering over 200 000 adolescents in Asia. The prevalence of hypertension ranges from 0.7% in urban Bangladesh to 24.5% in urban Malaysia, with urban areas generally showing higher rates than rural areas (e.g. India: 8.4% urban vs. 5.7% rural). By region, East Asia has the highest overall prevalence (14.25%), followed by West Asia (14.14%), South Asia (13.77%), Southeast Asia (13.16%), and Central Asia (12.37%). Males had higher prevalence rates (for example, 22.3% in Chinese males vs. 20% in females).

Conclusions

The increasing prevalence of adolescent hypertension in urban Asia is a significant public health concern. Although extensive research has been conducted in East and South Asia, there is a dearth of studies in Western, Southeast, and Central Asia, emphasising a need for future research. Standardised diagnostic criteria and targeted interventions are crucial for addressing regional disparities and reducing long-term cardiovascular risks.

Assessment of the Performance of Obesity Measures in the Screening of Hypertension in a South African Adolescent Population

Obesity is known to be one of the most significant risk factors for essential hypertension in childhood. However, whether obesity cut-offs may predict hypertension screening in adolescents remains controversial. This study investigated the performance of obesity cut-off values for the screening of hypertension in a South African adolescent population. In this cross-sectional study, 1144 adolescents aged between 11 and 17 years were recruited from the Eastern Cape Province of South Africa. Anthropometric and blood pressure (BP) parameters including diastolic blood pressure (DBP), systolic blood pressure (SBP), and heart rate (HR) were measured. Assessment of the sensitivity and specific of obesity cut-off values in predicting hypertension was performed using receiver operating characteristic (ROC) analysis. Obesity was positively associated (p < 0.01) with hypertension. Obese individuals, based on the predicted obesity using BMI percentile cut-off (pBMI85.2%), were more likely to develop hypertension (odds ratio: 2.070; p < 0.001) than their counterparts based on the observed obesity cut-off (pBMI95%) (Odd ratio: 1.748 p = 0.004). The area under the curve (AUC) of BMI percentile and WHtR for screening SBP percentile, and DBP percentile and HR as per ROC analysis, was low (<0.65). Equally, the sensitivity and specificity were low (<0.6) for all BP measures (SBP, DBP, and HR). Furthermore, the cut-off values for blood pressure measures, as established by ROC analysis using anthropometric measures, were far below the recommended cut-off values for hypertension screening. The obesity cut-offs for BMI percentile and WHtR established in this populations showed poor performance in diagnosing hypertension even though they were strong predictors of hypertension.