Prevalence of hypertension in relation to anthropometric indices among secondary adolescents in Mbarara, Southwestern Uganda

Prevalence of modifiable risk factors for cardiovascular disease among school-going children and adolescents in Eldoret, Kenya

Introduction

Cardiovascular disease (CVD) prevalence in Kenya is rising. Overweight, pre-hypertension and physical inactivity at younger ages is contributory. These risk factors are inadequately documented among Kenyan children and adolescents, hampering CVD prevention.

Methods

this cross-sectional study randomly sampled 384 participants from Eldoret, Kenya. After ethical considerations, physical activity was assessed. Body mass index (BMI), Waist-Hip-Ratio (WHR) and Waist-Height-Ratio (WHtR) were determined, and blood pressure (BP) was measured.

Results

participants were 14.6±2.7 years, and 62.6% were female. Eight percent had BMI ≥25.0 kg/m2. Of these, 87% were in secondary schools. Using SBP, 27.9% had CVD risk (42.5% and 20% for males and females ≥13 years and 26.5% and 27% for those <13 years, respectively). For DBP, 12.8% had elevated-to-hypertensive BP (13.2% and 8.3% for males and females ≥13 years and 11.8% and 25.4% for those <13 years, respectively). Combining SBP and DBP, 8.1%, mostly males, had elevated-to-hypertensive BP. Using respective WHR cutoffs of 0.90 and 0.85, 31% (boys) and 15.6% (girls) were at CVD risk. For WHtR, 39.6% of boys were >0.463 cut-off (0.493±0.02) against 32.4% for girls >0.469 cut-off (0.517±0.05). Of these, 52.6% (boys) and 69.7% (girls) were in secondary schools. Overall, 45% of participants were sports-inactive and 77.2% did minimal physical activities.

Conclusion

among school-going children and adolescents in Eldoret, Kenya, the prevalence of CVD risk factors was high, especially among boys and in high schools. Large proportions had elevated BP, BMI, WHR and WHtR, and, further, were sedentary, posing a high CVD risk. Lifestyle interventions to mitigate this are urgently needed.

Associations between Neck Circumference, Mid-Upper Arm Circumference, Wrist Circumference, and High Blood Pressure among Lithuanian Children and Adolescents: A Cross-Sectional Study

(1) Background: High blood pressure (HBP) and obesity are significant and growing public health issues worldwide. Our study aimed to evaluate the associations of neck circumference (NC), mid-upper arm circumference (MUAC), and wrist circumference (WrC) with HBP among Lithuanian children and adolescents aged 7-17 years. (2) Methods: In this cross-sectional study, data on BP and anthropometric measurements were analysed in 3688 children and adolescents aged 7-17 years. Multivariate logistic regression analysis was used to estimate the associations between anthropometric indices and HBP. (3) Results: Overall, the prevalence rates of elevated BP and hypertension were 13.7% and 12.9%, respectively. After adjustment for age, BMI, and WC, statistically significant elevated aORs were observed for associations between greater NC, MUAC, WrC, and HBP in boys (aORs: 2.13, 2.46, and 2.48, respectively) and in girls (aORs: 2.01, 2.36, and 2.09, respectively). Moreover, per-unit increase in NC, MUAC, and WrC was also associated with greater odds of HBP in boys (aORs: 1.20, 1.21, and 1.37, respectively) and in girls (aORs: 1.10, 1.10, and 1.21, respectively). The analysed anthropometric indices presented higher area under the curve values for predicting HBP in boys than in girls. (4) Conclusions: This study suggests that higher NC, MUAC, and WrC are associated with increased odds of HBP in Lithuanian children and adolescents.

Prevalence and factors associated with hypertension among adolescents in Sudan: a cross-sectional school-based study

OBJECTIVES

There is an increasing rate of elevated blood pressure, or hypertension, in children and adolescents worldwide, including Sub-Saharan Africa (SSA). Only a few data on adolescent hypertension in SSA, including Sudan, have been published. The aim of the present study was to investigate the prevalence and associated factors of hypertension among adolescent schoolchildren (within the ages of 10 to 19 years) in Sudan.

DESIGN

A cross-sectional school-based study was conducted from June to September 2022.

SETTINGS

Six randomly selected schools in Almatamah, River Nile State, Sudan.

PARTICIPANTS

Adolescent schoolchildren (within the ages of 10 to 19 years).

MAIN OUTCOME MEASURES

Sociodemographic information. Anthropometric and blood pressure measurements were performed in accordance with the standard procedures. An adjusted logistic regression analysis was performed.

RESULTS

Of the 384 enrolled adolescents, 166 (43.2%) and 218 (56.8%) were boys and girls, respectively. The median (IQR) age and body mass index (BMI) were 15.2 years (14.0‒16.4 years) and 18.5 kg/m2 (16.4‒21.5 kg/m2), respectively. Of the 384 adolescents, 240 (62.5%) and 255 (66.4%) had educated mothers and fathers (≥secondary), respectively. 38 adolescents (9.9%) had hypertension (≥95th percentile). The multivariable logistic regression analysis revealed that age, sex and maternal educational level were not associated with hypertension. Paternal educational level according to secondary education attainment (adjusted OR (AOR), 2.72; 95% CI 1.36‒5.46) and increasing BMI (AOR, 1.12; 95% CI 1.02‒1.20) were associated with hypertension.

CONCLUSION

1 in 10 adolescents in northern Sudan was hypertensive. Low paternal educational level and increasing BMI were significantly associated with hypertension. The introduction of interventional nutritional programmes at early ages is needed to ensure that adolescents are healthy in their present and later lives. To sustain such programmes, involving all educational parties at early stage is essential.

Hypertension among adolescents in sub-Saharan Africa: a systematic review

Introduction

Hypertension (HTN) among adolescents is common in high-income countries, and leads to increased premature cardiovascular diseases (CVD). In sub-Saharan Africa (SSA), the prevalence of HTN among adolescents, associated risk factors and CVD complications are not well-described. Such data is needed for planning public health programs to prevent premature CVD in SSA.

Methods

We systematically searched 5 databases (MEDLINE, Embase, Google Scholar, Web of Science, and African Index Medicus) from their establishment to December 2021. Key search terms were: adolescent, arterial hypertension, and names of the 48 countries in SSA. We used Covidence® to manage the search results. The review was registered in the Open Science Framework (OSF) https://osf.io/p5sbt/.

Results

We identified 4,008 articles out of which we screened 3,088 abstracts, and reviewed 583 full-text articles. We finally included 92 articles that were published between 1968 to December 2021. The majority were cross-sectional studies (80%) and conducted in school settings (78%). The risk of bias was low for 59 studies (64.1%), moderate for 29 studies (31.5%), and high for 4 studies (4.3%). Overall, the prevalence of HTN varied widely from 0.18% to 34.0% with a median (IQR) of 5.5% (3.1%, 11.1%). It was relatively higher in studies using automated blood pressure (BP) devices, and in studies defining HTN using thresholds based on percentile BP distribution for one's height, age, and sex. In addition, the prevalence of HTN was significantly higher in studies from Southern Africa region of SSA and positively correlated with the year of publication. Across studies, traditional risk factors such as age, sex, body mass index, and physical inactivity, were commonly found to be associated with HTN. In contrast, non-traditional risk factors related to poverty and tropical diseases were rarely assessed. Only three studies investigated the CVD complications related to HTN in the study population.

Conclusion

The prevalence of HTN among adolescents in SSA is high indicating that this is a major health problem. Data on non-traditional risk factors and complications are scarce. Longitudinal studies are needed to clearly define the rates, causes, and complications of HTN.

Systematic Review Registration

https://osf.io/p5sbt/, identifier (10.17605/OSF.IO/P5SBT).

Detecting and Managing Childhood Onset Hypertension in Africa: A Call to Action

PURPOSE OF REVIEW

To review recent evidence on childhood hypertension across Africa, identifying knowledge gaps, challenges and priorities, and highlight clinical perspectives in managing primary hypertension.

RECENT FINDINGS

Only 15 of the 54 African countries reported on absolute blood pressure (BP) measures, elevated BP, pre- and/or hypertension. The reported hypertension prevalence ranged between 0.0 and 38.9%, while elevated BP and/or pre-hypertnesion ranged from 2.7 to 50.5%. Childhood BP nomograms are lacking across Africa and the rates of hypertension were based on guidelines developed in countries with the lowest to no number of children from African ancestry. The recent studies across Africa also showed little to no detail when reporting BP specific methodology. No recent data informing the use or effectiveness of antihypertensive agents in children and adolesents are available. Childhood hypertension is on the rise, while data from Africa remains vastly under-represented. Collaborative research, resources, and policies need to be strengthened in addressing the growing public health concern of childhood onset hypertension on this continent.

Elevated blood pressure among adolescents in sub-Saharan Africa: a systematic review and meta-analysis

BACKGROUND

More people from sub-Saharan Africa aged between 20 years and 60 years are affected by end-organ damage due to underlying hypertension than people in high-income countries. However, there is a paucity of data on the pattern of elevated blood pressure among adolescents aged 10-19 years in sub-Saharan Africa. We aimed to provide pooled estimates of high blood pressure prevalence and mean levels in adolescents aged 10-19 years across sub-Saharan Africa.

METHODS

In this systematic review and meta-analysis, we searched PubMed, Google Scholar, African Index Medicus, and Embase to identify studies published from Jan 1, 2010, to Dec 31, 2021. To be included, primary studies had to be observational studies of adolescents aged 10-19 years residing in sub-Saharan African countries reporting the pooled prevalence of elevated blood pressure or with enough data to compute these estimates. We excluded studies on non-systemic hypertension, in African people not living in sub-Saharan Africa, with participant selection based on the presence of hypertension, and with adult cohorts in which we could not disaggregate data for adolescents. We independently extracted relevant data from individual studies using a standard data extraction form. We used a random-effects model to estimate the pooled prevalence of elevated blood pressure and mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels overall and on a sex-specific basis. This study is registered with PROSPERO (CRD42022297948).

FINDINGS

We identified 2559 studies, and assessed 81 full-text studies for eligibility, of which 36 studies comprising 37 926 participants aged 10-19 years from ten (20%) of 49 sub-Saharan African countries were eligible. A pooled sample of 29 696 adolescents informed meta-analyses of elevated blood pressure and 27 155 adolescents informed meta-analyses of mean blood pressure. Sex data were available from 26 818 adolescents (14 369 [53·6%] were female and 12 449 [46·4%] were male) for the prevalence of elevated blood pressure and 23 777 adolescents (12 864 [54·1%] were female and 10 913 [45·9%] were male) for mean blood pressure. Study quality was high, with no low-quality studies. The reported prevalence of elevated blood pressure ranged from 4 (0·2%) of 1727 to 1755 (25·1%) of 6980 (pooled prevalence 9·9%, 95% CI 7·3-12·5; I?=99·2%, p_{heterogeneity}<0·0001). Mean SBP was 111 mm Hg (95% CI 108-114) and mean DBP was 68 mm Hg (66-70). 13·4% (95% CI 12·9-13·9; p_{heterogeneity}<0·0001) of male participants had elevated blood pressure compared with 11·9% (11·3-12·4; p_{heterogeneity}<0·0001) of female participants (odds ratio 1·04, 95% CI 0·81-1·34; p_{heterogeneity}<0·0001).

INTERPRETATION

To our knowledge, this systematic review and meta-analysis is the first systematic synthesis of blood pressure data specifically derived from adolescents in sub-Saharan Africa. Although many low-income countries were not represented in our study, our findings suggest that approximately one in ten adolescents have elevated blood pressure across sub-Saharan Africa. Accordingly, there is an urgent need to improve preventive heart-health programmes in the region.

FUNDING

None.

High blood pressure and associated factors among HIV-infected young persons aged 13 to 25 years at selected health facilities in Rwenzori region, western Uganda, September-October 2021

BACKGROUND

High blood pressure (HBP), including hypertension (HTN), is a predictor of cardiovascular events, and is an emerging challenge in young persons. The risk of cardiovascular events may be further amplified among people living with HIV (PLHIV). We determined the prevalence of HBP and associated factors among PLHIV aged 13 to 25 years in Rwenzori region, western Uganda.

METHODS

We conducted a cross-sectional study among PLHIV aged 13 to 25 years at nine health facilities in Kabarole and Kasese districts during September 16 to October 15, 2021. We reviewed medical records to obtain clinical and demographic data. At a single clinic visit, we measured and classified BP as normal (< 120/ < 80 mmHg), elevated (120/ < 80 to 129/ < 80), stage 1 HTN (130/80 to 139/89), and stage 2 HTN (≥ 140/90). We categorized participants as having HBP if they had elevated BP or HTN. We performed multivariable analysis using modified Poisson regression to identify factors associated with HBP.

RESULTS

Of the 1,045 PLHIV, most (68%) were female and the mean age was 20 (3.8) years. The prevalence of HBP was 49% (n = 515; 95% confidence interval [CI], 46%-52%), the prevalence of elevated BP was 22% (n = 229; 95% CI, 26%-31%), and the prevalence of HTN was 27% (n = 286; 95% CI, 25%-30%), including 220 (21%) with stage 1 HTN and 66 (6%) with stage 2 HTN. Older age (adjusted prevalence ratio [aPR], 1.21; 95% CI, 1.01-1.44 for age group of 18-25 years vs. 13-17 years), history of tobacco smoking (aPR, 1.41; 95% CI, 1.08-1.83), and higher resting heart rate (aPR, 1.15; 95% CI, 1.01-1.32 for > 76 beats/min vs. ≤ 76 beats/min) were associated with HBP.

CONCLUSIONS

Nearly half of the PLHIV evaluated had HBP, and one-quarter had HTN. These findings highlight a previously unknown high burden of HBP in this setting's young populations. HBP was associated with older age, elevated resting heart rate, and ever smoking; all of which are known traditional risk factors for HBP in HIV-negative persons. To prevent future cardiovascular disease epidemics among PLHIV, there is a need to integrate HBP/HIV management.

Hypertension in Children and Young Adults

Primary hypertension (PH) is most common during adolescence with increasing prevalence globally, alongside the epidemic of obesity. Unlike in adults, there are no data on children with uncontrolled hypertension and their future risk of hard cardiovascular and cerebrovascular outcomes. However, hypertension in childhood is linked to hypertensive-mediated organ damage (HMOD) which is often reversible if treated appropriately. Despite differing guidelines regarding the threshold for defining hypertension, there is consensus that early recognition and prompt management with lifestyle modification escalating to antihypertensive medication is required to ameliorate adverse outcomes. Unfortunately, many unknowns remain regarding pathophysiology and optimum treatment of childhood hypertension.

Paediatric Hypertension in Africa: A Systematic Review and Meta-Analysis

BACKGROUND

The burden of cardiovascular disease (CVD) and hypertension is rapidly increasing in low- and middle-income countries. This is evident not only in adults, but also in children. Recent estimates of prevalence in children are lacking, particularly in Africa. As such, we conducted a systematic review and meta-analysis to provide updated estimates of paediatric hypertension in Africa.

METHODS

We searched PubMed and EBSCO to identify articles published from January 2017 to November 2020. Studies were assessed for quality. We combined results for meta-analyses using a random effects model (Freeman-Tukey arcsine transformation). Heterogeneity was quantified using the I² statistic.

FINDINGS

In the narrative synthesis of 53 studies, publication bias was low for 28, moderate for 24, and high for one study. Hypertension prevalence ranged substantially (0·2%-38·9%). Meta-analysis included 41 studies resulting in data on 52918 participants aged 3 to 19 years from ten countries. The pooled prevalence for hypertension (systolic/diastolic BP≥95th percentile) was 7·45% (95%CI 5·30-9·92, I²=98.96%), elevated blood pressure (BP, systolic/diastolic BP≥90th percentile and <95th percentile) 11·38% (95%CI 7·94-15·33, I²=98.97%) and combined hypertension/elevated BP 21·74% (95%CI 15·5-28·69, I²=99.48%). Participants categorized as overweight/with obesity had a higher prevalence of hypertension (18·5% [95%CI 10·2-28·5]) than those categorized as underweight/normal (1·0% [95%CI 0·1-2·6], 4·8% [95%CI 2·9-7·1], p<0·001). There were significant differences in hypertension prevalence when comparing BP measurement methods and classification guidelines.

INTERPRETATION

Compared to a previous systematic review conducted in 2017, this study suggests a continued increase in prevalence of paediatric hypertension in Africa, and highlights the potential role of increasing overweight/obesity.

FUNDING

This research was funded in part by the Wellcome Trust [Grant number:214082/Z/18/Z]. LJW and SAN are supported by the DSI-NRF Centre of Human Development at the University of the Witwatersrand.

The utility of resting pulse rate in defining high blood pressure among adolescents in Mbarara municipality, Uganda

High resting pulse rate (RPR) is associated with adverse cardiovascular events and could be used as a marker of cardiovascular health. We determined the correlation between RPR and blood pressure (BP); and its accuracy in defining high blood pressure among adolescents attending secondary schools in Mbarara municipality, south-western Uganda. We conducted a cross-sectional study among secondary school adolescents aged 12-19 years in Mbarara municipality, Uganda. We captured demographic characteristics using a structured questionnaire; and measured anthropometric indices and BP. We performed a linear regression analysis to determine the relationship between RPR and blood pressure and plotted receiver operating characteristics curves (ROC) to assess the accuracy of RPR in defining high BP. We enrolled 616 adolescents with a mean age of 15.6 ± 2.0 years and 65.6% (404/616) were female. The RPR was significantly correlated with diastolic blood pressure (DBP) in both boys (Beta = 0.22 [95% CI: 0.10; 0.36]), p < 0.001 and girls (Beta = 0.51 [95% CI: 0.43; 0.60]), p < 0.001. RPR was significantly correlated with systolic blood pressure (SBP) only in the girls (Beta = 0.23 [95% CI: 0.15; 0.30]), p < 0.001. The optimal threshold for RPR in defining prehypertension was RPR ≥ 76 bpm with an area under the curve (AUC) of 0.653 [95% CI: 0.583-0.722], the sensitivity of 0.737 and specificity of 0.577. In defining hypertension, the optimal threshold was RPR ≥ 79 bpm at a sensitivity of 0.737 and specificity of 0.719, with an AUC of 0.728 [95% CI: 0.624-0.831]. Resting pulse rate was positively correlated with BP and was more accurate in defining hypertension compared to prehypertension in the study.

Neck and Wrist Circumferences as Indicators of Metabolic Alterations in the Pediatric Population: A Scoping Review

Neck circumference (NC) and wrist circumference (WrC) have been proposed as practical and inexpensive tools with the capacity to indicate metabolic alterations to some extent. Nevertheless, their application in the pediatric population is relatively recent. Thus, the aim of this scoping review was to review and analyze the reported evidence regarding the correlation of NC and WrC with metabolic alterations in the pediatric stage. The literature search was performed in January 2021 in seven indexes and databases. A total of 26 articles published between 2011 and 2020 were included. Most significant results were grouped into three categories: serum lipid profile, glucose homeostasis, and blood pressure. The parameter that showed the most significant results regardless of the anthropometric indicator analyzed for association was blood pressure. In contrast, total cholesterol and LDL-cholesterol showed non-significant associations along with conflicting results. We conclude that the use of NC and WrC, in addition to other well-established indicators, could facilitate the identification of metabolic alterations, specifically in plasma insulin and blood pressure. In fact, further studies are required to address the potential use of NC and WrC as predictors of early metabolic alterations, especially in countries with a fast-growing prevalence in obesity.

Relationship of anthropometric indices with rate pressure product, pulse pressure and mean arterial pressure among secondary adolescents of 12-17 years

OBJECTIVES

To determine the correlation between anthropometric indices and the selected hemodynamic parameters among secondary adolescents aged 12-17 years.

RESULTS

Our findings showed weak positive correlation between generally body surface area, neck circumference and conicity index with the hemodynamic parameters (systolic blood pressure, diastolic blood pressure, resting pulse rate, mean arterial pressure, rate pressure product and pulse pressure). However, the ponderosity index, body mass index and waist hip ratio showed negative weak correlations with the hemodynamic parameters. There was a significant difference in pulse pressure among the BMI categories. All parameters showed significant (p < 0.05) differences across the categories of neck circumference and waist hip ratio. Generally, in multivariate regression analysis, anthropometric indices showed significant prediction of the hemodynamic parameters.