Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis. Lancet Public Health. 2017;2:e375-e386. [PMID: 29253478 DOI: 10.1016/s2468-2667(17)30123-8]

Death of a parent during childhood and blood pressure in youth: a population-based cohort study of Swedish men

OBJECTIVE

Compelling evidence suggests that childhood adversities are associated with an increased risk of hypertension in middle age and old age. The link between childhood adversities and blood pressure in youth is less clear. In this cohort study, we examined the association between death of a parent during childhood and blood pressure in early adulthood in men.

SETTING

Sweden.

PARTICIPANTS

We studied 48 624 men born in 1949-1951 who participated in the compulsory military conscription in 1969/1970 in Sweden. Information on death of a parent during childhood was obtained from population-based registers. Information on covariates was obtained from the questionnaire and the clinical examination completed at conscription and from population-based registers.

OUTCOME MEASURES

Blood pressure was measured at conscription according to standard procedures.

RESULTS

The multivariable least square means of systolic and diastolic blood pressure did not differ between bereaved (128.25 (127.04-129.46) and 73.86 (72.89-74.84) mm Hg) and non-bereaved study participants (128.02 (126.86-129.18) and 73.99 (73.06-74.93) mm Hg). Results were similar when considering the cause of the parent's death, the gender of the deceased parent or the child's age at loss. Loss of a parent in childhood tended to be associated with an increased hypertension risk (OR and 95% CI: 1.10 (1 to 1.20)); the association was present only in case of natural deaths.

CONCLUSION

We found no strong support for the hypothesis that stress following the loss of a parent during childhood is associated with blood pressure or hypertension in youth in men.

Sustained high blood pressure and 24-h ambulatory blood pressure monitoring in Tanzanian adolescents

Estimates for prevalence of high blood pressure (BP) among adolescents in Africa vary widely and few studies, if any, have documented the results of the recommended stepwise BP screening. In this cross-sectional study in Tanzania, we aimed to estimate prevalence of sustained high BP in 3 public secondary schools using the American Academy of Pediatrics BP screening strategy. On Day 1, one screening automated office BP (AOBP) measurement (Step 1) was followed by two more AOBP measurements (Step 2). Repeat AOBP measurements were obtained after about one month on adolescents with high AOBP measurements on Day 1 (Step 3). Participants with sustained high BP underwent 24-h ambulatory BP monitoring (step 4). Of all 500 enrolled participants, the prevalence of high blood pressure at each step in the process was 36.6% (183), 25.6% (128), 10.2% (51), and 2.6%(13) respectively for Steps 1-4. All except 6 students completed all 4 steps of the BP screening algorithm as indicated. We conclude that diagnosis of hypertension in African adolescents should use multiple AOBP measurements over multiple days followed by 24-h ABPM. Screening for high BP in school settings appears to be feasible and could provide a platform for cardiovascular disease education and health promotion.

Prevalence and Risk Factors of Hypertension in Schoolchildren from Central Thailand: A Cross-Sectional Study

Background:

Hypertension (HTN) among children is a major health issue with mounting prevalence rates. The aim of this research is to assess the prevalence of HTN and its associated risk factors among apparently healthy schoolchildren.

Methods:

We conducted a cross-sectional study of schoolchildren in the academic year 2015 from 38 public primary schools in central Thailand for the prevalence and risk factors of HTN. Apparently healthy children aged 6-12 years were included. Informed consents were obtained before participation. Hypertension was diagnosed as per the new reference cutoff levels recommended by the American Academy of Pediatrics.

Results:

A total of 3,870 children with a median age of 9.5 years were included in the final analysis. The prevalence of obesity, overweight, and thinness among children was 15.7%, 13.6% and 5.2%, respectively. The overall prevalence of hypertension in the study population was 26.2%. HTN was significantly more prevalent in boys than girls (summary odds ratio (OR) 1.16 [95% confidence interval (CI) = 1.01-1.34]). Overweight and obesity were among the associated risk factors of HTN in the enrolled children with (OR 2.44 [95% CI 1.98-3.00]) and (OR 7.99 [95% CI 6.58-9.70]), respectively. Obese children who had central obesity were at greater risk of hypertension (OR 9.16 [95% CI 7.45-11.27]).

Conclusions:

The prevalence of HTN among Thai children is markedly high. Obesity, overweight, and male gender are considerable risk factors of HTN in children. Routine blood pressure measurement and further studies are recommended to investigate the potential risks and to lessen the associated complications.

Cardiometabolic risk factors and early indicators of vascular dysfunction: a cross-sectional cohort study in South African adolescents

OBJECTIVES

Prevalence of child and adolescents' overweight and obesity in low- and middle-income countries has increased dramatically. Simultaneously, the incidence of pre-hypertension/hypertension is also increasing in children, which, in turn, predisposes these children to the risk of cardiovascular disease (CVD) in later life. The present study assessed cardiometabolic risk factors and early indicators of vascular dysfunction in adolescents from a low socio-economic rural area in South Africa.

DESIGN

Cross-sectional cohort study.

SETTING

The study was conducted in public schools in Mthatha, OR Tambo district municipality, Eastern Cape Province, South Africa.

PARTICIPANTS

A total of 244 adolescents (188 females) of African ancestry aged 13-16 years were enrolled.

PRIMARY AND SECONDARY OUTCOME MEASURES

Anthropometric and haemodynamic measures and pulse wave velocity (PWV) were related to overweight/obesity and hypertension. Blood markers of cardiometabolic syndrome were assessed as well as vascular function (via PWV).

RESULTS

One-third (33.0%) of the adolescents exceeded the age and sex-specific body mass index percentiles for overweight (≥85th) or obesity (>95th) with a prevalence of 61.1% pre-hypertensives in this group. Overweight/obesity and hypertension were associated with higher triglycerides (lean:overweight: 0.79<1.01 mmol/L; normotensive:hypertensive: 0.82<0.89 mmol/L). Fasting glucose was higher in hypertensive as compared to normotensive adolescents (4.85>4.69 mmol/L, p<0.05). PWV was elevated in 25.9% of the children and significantly correlated with asymmetric dimethylarginine and systolic blood pressure (p<0.001).

CONCLUSION

Overweight/obesity and hypertension show a high prevalence in rural South African youth. Almost half of the studied adolescents are at risk for developing CVD. The high association between cardiometabolic risk factors and PWV further suggests that hypertension in adolescents may promote the progression of CVD in adulthood. Early detection of those at risk and the implementation of preventive strategies in underprivileged young people is urgently needed to stop the progression of vascular damage and manifestation of CVD in rural African children.

A Nonlinear Relation Between Maternal Red Blood Cell Manganese Concentrations and Child Blood Pressure at Age 6-12 y: A Prospective Birth Cohort Study

BACKGROUND

Although manganese (Mn) is an essential trace element and a common component of most multivitamins on the market, an adverse effect on blood pressure (BP) has been reported in adults. In addition, the longitudinal relation between prenatal Mn status and childhood BP is still unknown.

OBJECTIVE

This study investigated the association between prenatal Mn concentrations and risk of elevated BP at ages 3-12 y.

METHOD

The analyses included 1268 mother-child dyads who were enrolled at birth and followed prospectively at the Boston Medical Center. Maternal RBC Mn concentrations were measured by inductively coupled plasma mass spectrometry, using RBCs collected within 1-3 d after delivery (reflecting late-pregnancy Mn exposure). Child elevated BP was defined as systolic or diastolic BP ≥90th percentile for a given age, sex and height. Multivariate logistic regression models were conducted. Path analysis was applied to mediation estimation.

RESULTS

The median (IQR) maternal RBC Mn concentration was 37.5 (29.2-48.5) μg/L. The rate of child elevated BP at ages 3-12 y was 25%. Both the lowest and highest quartiles of maternal RBC Mn concentrations were associated with higher risk of elevated BP among children aged 6-12 y (OR: 1.52; 95% CI: 1.04, 2.21 and OR: 1.65; 95% CI: 1.13, 2.40, respectively) compared with those in the second and third quartiles. Gestational age and fetal growth mediated the association between low maternal RBC Mn (first quartile) and child elevated BP, explaining 25% of the association, but not for high (fourth quartile) maternal RBC Mn concentrations. No association was found between maternal RBC Mn concentrations and BP among children aged 3-5 y.

CONCLUSION

We found a nonlinear association between maternal RBC Mn concentrations and elevated BP among children aged 6-12 y from a high-risk, predominantly minority population. Our findings warrant further investigation.

Epidemiology of Obesity and Hypertension in School Adolescents Aged 15-17 from the Region of Central Poland-A Cross-Sectional Study

The aim of this cross-sectional study was to assess the prevalence of abnormal weight and anthropometric parameters along with abnormal blood pressure values in adolescents in Poland. Anthropometric measurements were taken in the studied age group and the correlation between these values and blood pressure values and the diagnosis of hypertension was analyzed. The main aim of the study was to characterize the particular age group in the selected population: 690 students aged 15–17 years were examined. Blood pressure and anthropometric values including height, weight, circumferences of the hips, abdomen and arms, as well as skinfolds on the back of the arm, below the scapula and the stomach, were taken. The following indexes were calculated: WHR (waist to hip ratio), WHtR (waist to height ratio), BAI (body adiposity index-hip to height ratio) and BMI (body mass index). Mean SBP (systolic blood pressure) was 112.3 (standard deviation (SD) 12.2) mmHg, and DBP (diastolic blood pressure) was 66.9 (SD 6.9) mmHg. The prevalence of hypertension in the studied group was 5.8% (3.2% boys, 2.6% girls) and prehypertension was present in 4.4% (1.6% boys, 2.8% girls). The prevalence of excess body weight was 23.6%-obesity 11.3% (40 girls, 27 boys) and overweight 12.3% (50 girls, 34 boys). Correlations between BMI and waist, hip and arm circumference, subscapular and abdominal skinfold thickness, WHtR and BAI were r = 0.86, r = 0.84, r = 0.88, r = 0.81, r = 0.75, r = 0.88 and r = 0.81, respectively (p < 0.05). Significant differences (p < 0.05) of SBP and DBP values, depending on weight category, as defined by BMI, were observed. Abnormal blood pressure values occur in one tenth and abnormal body weight in almost a quarter of the studied population. Obese and overweight children have higher SBP and DBP values compared to children with normal body weight.

Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease.

RESULTS

Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Obesity, metabolic syndrome, and primary hypertension

Primary hypertension is the dominant form of arterial hypertension in adolescents. Disturbed body composition with, among other things, increased visceral fat deposition, accelerated biological maturation, metabolic abnormalities typical for metabolic syndrome, and increased adrenergic drive constitutes the intermediary phenotype of primary hypertension. Metabolic syndrome is observed in 15-20% of adolescents with primary hypertension. These features are also typical of obesity-related hypertension. Metabolic abnormalities and metabolic syndrome are closely associated with both the severity of hypertension and the risk of target organ damage. However, even though increased body mass index is the main determinant of blood pressure in the general population, not every hypertensive adolescent is obese and not every obese patient suffers from hypertension or metabolic abnormalities typical for metabolic syndrome. Thus, the concepts of metabolically healthy obesity, normal weight metabolically unhealthy, and metabolically unhealthy obese phenotypes have been developed. The risk of hypertension and hypertensive target organ damage increases with exposure to metabolic risk factors which are determined by disturbed body composition and visceral obesity. Due to the fact that both primary hypertension and obesity-related hypertension present similar pathogenesis, the principles of treatment are the same and are focused not only on lowering blood pressure, but also on normalizing body composition and metabolic abnormalities.

An Overview of Vascular Dysfunction and Determinants: The Case of Children of African Ancestry

The balance between dilatory and constrictive factors is important as it keeps blood vessels in a homeostatic state. However, altered physiological processes as a result of obesity, hypertension, oxidative stress, and other cardiovascular risk factors may lead to vascular damage, causing an imbalance of vasoactive factors. Over time, the sustained imbalance of these vasoactive factors may lead to vascular dysfunction, which can be assessed by non-invasive methods, such as flow-mediated dilation, pulse wave velocity, flow-mediated slowing, retinal vessel analysis, peripheral vascular reactivity, and carotid intima-media thickness assessment. Although there is increasing prevalence of cardiovascular risk factors (obesity and hypertension) in children in sub-Saharan Africa, little is known about how this may affect vascular function. This review focuses on vasoactive factors implicated in vascular (dys)function, highlighting the determinants and consequences of vascular dysfunction. It further describes the non-invasive methods used for vascular (dys)function assessments and, last, describes the impact of cardiovascular risk factors on vascular dysfunction in children of African ancestry.

Prevalence and factors that are associated with elevated blood pressure among primary school children in Mwanza Region, Tanzania

Introduction

hypertension (HTN) among children is reported to be increasing due to sedentary lifestyles. In developed countries the prevalence of paediatric HTN is recorded to be up to 21% while the magnitude of the same is up to 11% in Tanzania. This study aimed to determine the blood pressure profile and factors associated with elevated blood pressure (BP) among children of Mwanza region.

Methods

a cross sectional study involving 742 children aged 6 to 16 years in selected primary schools in Mwanza region was conducted from June to August 2019. Data were collected using self-administered structured questionnaires where parents helped children to fill in. Blood pressure, body weight and height were measured using digital portable sphygmomanometer, self-calibrating digital weighing scale and Shorr measuring board respectively. Data were analyzed using EpiInfo.

Results

this study found mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 109.2 ± 8.1 mmHg and 62.3 ± 7.2 mmHg respectively. Prevalence of elevated BP was 18.1%. Pre-hypertension 9.6%, and hypertension 8.5%. The age specific elevated BP prevalence was significantly higher (OR = 1.9, 95% CI: 1.2 - 2.9, p = 0.008) among children aged ≥10 years (21.4%) than younger ones (15.1%). Prevalence was also higher (OR = 1.5, 95% CI: 1.1 - 2.3, p = 0.048) among girls (20.1%) than boys (16.0%). Elevated BP was found to be associated with obesity (OR = 3.5, 95% CI: 1.6 - 7.7, p = <0.001), overweight (OR = 1.9, 95% CI: 1.1 - 3.3, p = 0.037), eating fried food (OR = 2.2, 95% CI: 1.1 - 4.4, p = 0.023), drinking sugar soft drinks (OR = 2.0, 95% CI: 1.2 - 3.5, p = 0.002) and not eating fruits (OR = 13.4, 1.6, 95% CI: 2.1 - 65.8, p-value 0.006).

Conclusion

findings indicate high prevalence of elevated BP among children of Mwanza region. There was an association between elevated BP and increased age, gender, sedentary lifestyle and obesity. Importance of measuring paediatric blood pressure and health information regarding effects of sedentary life is recommended to Tanzanians. Parents should encourage their children to have active physical activities. Moreover, health workers should implement programmes to modify sedentary lifestyle and prevent children from elevated blood pressure.

Prevalence and impact of diabetes in patients with COVID-19 in China

BACKGROUND

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that has spread rapidly around the world. Previous studies have indicated that COVID-19 patients with diabetes are prone to having poor clinical outcomes.

AIM

To systematically evaluate the prevalence of diabetes among COVID-19 patients in China and its impact on clinical outcomes, including ICU admission, progression to severe cases, or death.

METHODS

We searched studies published in PubMed, Web of Science, and EMBASE from December 1, 2019 to March 31, 2020 to identify relevant observational study that investigated the prevalence of diabetes among COVID-19 patients or its impact on clinical outcomes. We used a random-effects or fixed-effects model to estimate the pooled prevalence of diabetes and risk ratio (RR) and its 95% confidence interval (CI) of diabetes on outcomes. Funnel plots were used to evaluate the publication bias and the heterogeneity was evaluated by I² statistic.

RESULTS

Twenty-three eligible articles including 49564 COVID-19 patients (1573 with and 47991 without diabetes) were finally included. The pooled prevalence of diabetes was 10% (95%CI: 7%-15%) in COVID-19 patients. In the subgroup analyses, the pooled prevalence of diabetes was higher in studies with patients aged > 50 years (13%; 95%CI: 11%-16%) than in studies with patients aged ≤ 50 years (7%; 95%CI: 6%-8%), in severe patients (17%; 95%CI: 14%-20%) than in non-severe patients (6%; 95%CI: 5%-8%), and in dead patients (30%; 95%CI: 13%-46%) than in survivors (8%; 95%CI: 2%-15%) (P < 0.05 for all). Compared with patients without diabetes, the risk of severe cases was higher (RR = 2.13, 95%CI: 1.76-2.56, I² = 49%) in COVID-19 patients with diabetes. The risk of death was also higher in COVID-19 patients with diabetes (RR = 3.16, 95%CI: 2.64-3.78, I² = 34%). However, diabetes was not found to be significantly associated with admission to ICU (RR = 1.16, 95%CI: 0.15-9.11).

CONCLUSION

Nearly one in ten COVID-19 patients have diabetes in China. Diabetes is associated with a higher risk of severe illness and death. The present study suggested that targeted early intervention is needed in COVID-19 patients with diabetes.

Waist-to-height ratio and skipping breakfast are predictive factors for high blood pressure in adolescents

The purpose of this study was to estimate the prevalence of high blood pressure (HBP) in adolescents of the Valencian Autonomous Community (VC) in Spain. Besides, its association with other risk factors related to cardiovascular disease (CVD) or arterial hypertension (AHT) in order to increase our knowledge of public health and to provide advice about healthy diets. We conducted a multicentre, observational, cross-sectional, epidemiological study in a sample of 4402 adolescents from 15 schools during the 2015-2016 school year. The participants were aged between 11 and 18 years, and any individuals already diagnosed with AHT were excluded. In addition to the Physical Activity Questionnaire for Adolescents (PAQ-A), Evaluation of the Mediterranean Diet Quality Index (KIDMED), a lifestyle habits survey, the waist-to-height ratio (WtHR), and body mass index (BMI) were calculated for each participant. Informed Consent was obtained from Parents of the adolescents involved in the current study. The study received approval from the University ethics committee and all procedures were conducted in accordance with the tenets of the Declaration of Helsinki. Chi-squared, Student t-tests, and ANOVA statistical analyses showed that 653 (14.8%) adolescents had previously undiagnosed HBP and that was significantly associated with male sex (p < 0.001), age over 15 years (p < 0.05), and height, weight, waist circumference, WtHR, BMI, and skipping breakfast. Based on the data we obtained in this study, the modifiable factors that influence HBP in adolescents were WtHR, BMI, and skipping breakfast.

Prevalence of hypertension among adolescents (10-19 years) in India: A systematic review and meta-analysis of cross-sectional studies

BACKGROUND

Despite the well-known short-term and long-term ill effects of elevated blood pressure in children and adolescents, pooled data on its burden among Indian adolescents have not yet been synthesized.

OBJECTIVES

We did a systematic review with meta-analysis to calculate the pooled prevalence of hypertension among adolescents (10-19 years) in India.

METHODS

We searched PubMed, Embase, Cochrane library, Google Scholar and IndMed, and included cross-sectional studies reporting data on hypertension prevalence among 10 to19 years old and published in English language from their inception till 1st March 2020. Modified New castle Ottawa scale was used to assess risk of bias based on research design, recruitment strategy, response rate and reliability of outcome determination. A random effects model was used to estimate pooled prevalence, and heterogeneity was assessed using Cochrane's Q statistic test of heterogeneity and I2 statistic. To explore the heterogeneity, we did a meta-regression, and sub-group analyses based on region, study setting and number of blood pressure readings.

RESULTS

Out of 25 studies (pooled sample of 27,682 participants) six studies were of high, eighteen of moderate, and one was of low quality. The prevalence of hypertension across studies ranged from 2% to 20.5%, with a pooled estimate of 7.6% (95% CI: 6.1 to 9.1%), I2 = 96.6% (p-value <0.001). Sub-group analysis restricted only to the western India demonstrated a smaller heterogeneity (I2 = 18.3%). In univariate model of meta-regression, diagnostic criteria was significantly associated with pooled prevalence (-4.33, 95%CI: -7.532, -1.134).

CONCLUSION

The pooled prevalence of hypertension among adolescent in India is 7.6% with substantial heterogeneity between the studies. To tackle the high prevalence of hypertension among adolescents, early detection by screening under school health programme and opportunistic screening at Paediatric OPD should be implemented by Policy makers.

Combined effects of dietary zinc at 3 years of age and obesity at 7 years of age on the serum uric acid levels of Korean children

BACKGROUND/OBJECTIVES

To assess the longitudinal associations of the antioxidant capacity of zinc and body mass index (BMI) with serum uric acid (SUA) in South Korean children.

SUBJECTS/METHODS

Using follow-up data from the Ewha Birth and Growth Cohort, we included subjects who were seen at 3 and 7 years of age (n = 183; 90 boys, 93 girls). Daily zinc intake and BMI were assessed at 3 and 7 years of age. SUA measured at 7 years was used as the outcome variable. Using a general linear model, the effects of dietary zinc intake and BMI on SUA were assessed. We also assessed the combined effect of early dietary zinc intake and BMI on SUA in children.

RESULTS

The dietary zinc intake at 3 years of age was negatively correlated (ρ = −0.18, P = 0.04), whereas the BMI at 7 years of age was positively correlated (r = 0.18, P = 0.01), with the SUA level at 7 years of age. The dietary zinc intake level at 3 years of age and the BMI level at 7 years of age were, together, significantly related to SUA in children at 7 years of age. SUA was lower in group 1 (normal-weight, high-zinc group) than in the other two groups (group 2: normal-weight, low-zinc and overweight, high-zinc group; and group 3: overweight, low-zinc group). Our results demonstrate the combined effect of zinc intake and BMI on SUA. The combined association remained significant in both the crude and adjusted models (P < 0.01).

CONCLUSIONS

SUA was related to combined BMI and dietary zinc intake, and increased zinc intake and normal body weight had a beneficial effect on reducing SUA in children.

Clustering of Cardiometabolic Risk Factors among Children and Adolescents in a Rural Community in Ondo, Southwest Nigeria

BACKGROUND

Clustering of cardiometabolic risk factors is rapidly becoming prevalent among children and adolescents with grave implications for their cardiovascular health. We set out to determine prevalence and pattern of clustering of risk factors and, identify factors (if any) that determine their clustering.

METHODS

A cross-sectional study of children (3-9 years) and adolescents (10-17 years) in a rural, agrarian community. Their blood pressure, body mass index and lipids were measured. Data was analyzed with SPSS 20.

RESULTS

A total of 114 (M : F, 1 : 1.1) subjects were studied. The mean age of children and adolescents were 5.6 ± 2.1 and 12.9 ± 2.2 years respectively. The most prevalent cardiometabolic risk factors were elevated non-high density lipoprotein-cholesterol (HDL-c; 39.5%), low HDL-c (33.3%), prehypertension (12.3%) and overweight (9.6%). The prevalence of hypertension was higher among females (11.9% vs. 1.8%, p = 0.024) and adolescents (13.2% vs. 1.6%, p = 0.037). Serum levels of non-HDL-c was higher among adolescents than children (50.9% vs. 29.5%, p = 0.013). At least one risk factor was present in 68.4% of the subjects. Clustering of two and three risk factors were present in 18.4% and 6.1%. The presence of prehypertension (χ2 23.93, p < .001), hypertension (χ2 12.19, p = 0.002), high serum non-HDL-c (χ2 6.336, p = 0.011) and high serum total cholesterol (TC; χ2 8.810, p < 0.001) were associated with clustering of cardiometabolic risk factors.

CONCLUSION

The burden of cardiometabolic risk factors among children and adolescents is high. Identified determinants of risk factor clustering were prehypertension, hypertension, non-HDL-c and TC.

Retinal Vessel Diameters and Blood Pressure Progression in Children

The prevalence of high childhood blood pressure (BP) is rising globally and has been associated with subclinical vascular impairments in children. Longitudinal data on the association of microvascular alterations with the development of high BP in children are lacking. We aimed to analyze the association of central retinal arteriolar (CRAE) and venular (CRVE) diameters with development of higher BP over 4 years in young school children. In 2014, 391 children aged 6 to 8 years were screened for BP and retinal vessel diameters using standardized protocols. Retinal vessel analysis was performed using a retinal vessel analyzer to determine CRAE and central retinal venular equivalent. In the follow-up of 2018, all parameters were assessed in 262 children using the same standardized protocols. During follow-up, systolic and diastolic BP increased significantly (Δ 3.965±8.25 and 1.733±7.63 mm Hg, respectively), while CRAE decreased by Δ -6.325±8.55 µm without significant changes in central retinal venular equivalent (Δ -0.163±7.94 µm). Children with narrower CRAE at baseline developed higher systolic BP after four years (β [95% CI] 0.78 [0.170-1.398] mm Hg per 10 µm decrease, P=0.012). Children with increased systolic or diastolic BP at baseline developed narrower CRAE (β [95% CI] -0.154 [-0.294 to -0.014] µm per 1mmHg, P=0.031 and β [95% CI] -0.02 [-0.344 to -0.057] µm per 1 mmHg, P=0.006, respectively) at follow-up. Narrowing of retinal arterioles predicted evolution of systolic BP. In turn, higher initial systolic and diastolic BP was associated with subsequent development of microvascular impairments. Our results give good evidence for a bivariate temporal relationship between BP and microvascular health in children.

Longitudinal relationships between changes in body composition and changes in selected metabolic risk factors (abdominal obesity and blood pressure) among South African adolescents

BACKGROUND

Incidence of childhood high blood pressure (BP) is increasing worldwide. This study examined the longitudinal relationship between changes in body composition (i.e. body mass index (BMI), waist circumference (WC) and percentage body fat) and selected metabolic risk factors (abdominal obesity and BP) among adolescents from the Tlokwe municipality in the North West Province of South Africa.

METHOD

One hundred and eight-six adolescents (81 boys and 105 girls) aged 14 to 16 years participated in the study. Body composition was measured following the International Society of the Advancement of Kinanthropometry standard procedures. BMI, abdominal obesity using WC measurement, and resting BP were determined. Analysis of variance (ANOVA) for repeated measures was calculated to determine changes in anthropometric measures and body composition as well as changes in BP. Additionally, Univariate analysis of variance with repeated measures and participants as a random sample was applied. Diastolic BP (DBP) and systolic BP (SBP) were used as dependent variables and sex, age, BMI, WC, and waist-to-height ratio as independent variables.

RESULTS

Significant changes were found for stature, BMI, body mass, WC, SBP, and DBP. BMI for the total group was significant and positively related to abdominal obesity in 2012 (r = 0.55; p < 0.01) and in 2013 (r = 0.77; p < 0.01) and to SBP (r = 0.26; p < 0.05) in 2012 and (r = 0.17; p = 0.43) in 2013. BMI among the boys was significantly and positively related to abdominal obesity in 2012 (r = 0.83; p < 0.01) and 2013 (r = 0.91; p < 0.01). For the girls, BMI was significantly and positively related to abdominal obesity (r = 0.49; p < 0.01) and to SBP (r = 0.32; p = 0.05) in 2012. Boys with a higher WC in 2012 had significantly increased DBP (p < 0.05). Boys measured in 2012 with greater WC and BMI show a significant increase in SBP.

CONCLUSIONS

BMI was positively related to BP and abdominal obesity over time. Relatively high BMI and abdominal obesity significantly increased the likelihood of elevated BP over time, especially in boys. BMI was a predictor of abdominal obesity in boys, while in girls, BMI was a predictor of both abdominal obesity and SBP. In view of the future health implications of both abdominal obesity and elevated BP, urgent strategic interventions programs aimed at increasing physical activity and advocating for well-balanced dietary practices as well as importance of keeping normal blood pressure among South African adolescents are needed.

Elevated blood pressure and its relationship with bodyweight and anthropometric measurements among 8-11-year-old Indonesian school children

Objective: Increased prevalence of elevated blood pressure in children and adolescents was associated with increased body weight and measures. Also, prevalence of elevated blood pressure varies between countries. This study is to investigate the prevalence of elevated blood pressure in Indonesian children and its relationship with bodyweight and anthropometric measures. Methods: This cross-sectional study involved 1010 elementary students aged 8 - 12 years (479 girls, 531 boys). The anthropometric measures and blood pressure were assessed. Elevated blood pressure (EBP) was determined if at the 90^th percentile or above for gender, age, and height. Independent t-test, Chi-square, Pearson correlation, and multivariate logistic regression were applied. Significance was determined at p<0.05. Results: Overall prevalence of EBP was 28.8% (35.9% in girls, 22.4% in boys). BMI, waist circumference (WC), waist to height ratio (WHtR), and abdominal skinfold had significant correlation with EBP. Elevated BP was higher in overweight and obesity than in normoweight (60.5% vs 39.5%, p=0.00). In girls, the OR of EBP for overweight and obesity were 2.33 (95% CI 1.40-3.87, p=0.03) and 3.44 (95% CI 1.98-5.99, p=0.00) whereas in boys were 4.26 (95% CI 2.20-8.28, p=0.00) and 8.82 (95% CI 5.10-15.38, p=0.00). Conclusions: Prevalence of EBP in Indonesian school children aged 8 - 11 years was higher and more prevalent in overweight/ obesity and in girls. Anthropometric measures were correlated with EBP.

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

Background

Studies investigating the prevalence of hypertension and its correlation with anthropometric indices among adolescents are still scarce compared to those conducted in adults of greater than 40 years. So far, no other study estimating the prevalence and correlates of hypertension among adolescents in Uganda has been found.

Objective

The purpose of this study, therefore, was to asses the prevalence of hypertension and its correlation with anthropometric indices among adolescents in Mbarara Municipality, southwestern Uganda.

Methods

A cross-sectional study was carried out among 616 secondary school adolescents aged 12–19 years in Mbarara Municipality, Uganda. Blood pressure and anthropometric indices were determined by standard methods. In the statistical analysis, linear regression analysis was done to assess the relationship between blood pressure and anthropometric indices.

Results

Overall prevalence of hypertension among adolescents was at 3.1% (n = 19) while prehypertension was 7.1% (n = 44). There was a statistically significant correlation between blood pressure, neck circumference, waist to hip ratio and body mass index at bivariate analysis. In multivariate analysis for anthropometric indices and sex, only neck circumference remained significantly correlated with blood pressure (p < 0.05).

Conclusion

The prevalence of hypertension among adolescents in the study setting was low. An increase in neck circumference results in an increase in blood pressure among adolescents.

Effect of birth weight, exclusive breastfeeding and growth in infancy on fat mass and fat free mass indices in early adolescence: an analysis of the Entebbe Mother and Baby Study (EMaBs) cohort

Background: There is limited data from Africa on the effect of pre- and post-natal growth and infant feeding on later body composition. This study's aim was to investigate the effect of birth weight, exclusive breastfeeding and infant growth on adolescent body composition, using data from a Ugandan birth cohort.

Methods: Data was collected prenatally from pregnant women and prospectively from their resulting live offspring. Data on body composition (fat mass index [FMI] and fat free mass index [FFMI]) was collected from 10- and 11-year olds. Linear regression was used to assess the effect of birth weight, exclusive breastfeeding and infant growth on FMI and FFMI, adjusting for confounders.

Results: 177 adolescents with a median age of 10.1 years were included in analysis, with mean FMI 2.9 kg/m ² (standard deviation (SD) 1.2), mean FFMI 12.8 kg/m ² (SD 1.4) and mean birth weight 3.2 kg (SD 0.5). 90 (50.9%) were male and 110 (63.2%) were exclusively breastfeeding at six weeks of age. Birth weight was associated with FMI in adolescence (regression coefficient β= 0.66 per kg increase in birth weight, 95% confidence interval (CI) (0.04, 1.29), P=0.02), while exclusive breastfeeding (β= -0.43, 95% CI (-1.06, 0.19), P=0.12), growth 0-6 months (β= 0.24 95% CI (-0.43, 0.92), P=0.48) and growth 6-12 months (β= 0.61, 95% CI (-0.23, 1.46), P=0.11) were not associated with FMI among adolescents. Birth weight (β= 0.91, 95% CI (0.17, 1.65), P=0.01) was associated with FFMI in adolescence. Exclusive breastfeeding (β= 0.17, 95% CI (-0.60, 0.94), P=0.62), growth 0-6 months (β= 0.56, 95% CI (-0.20, 1.33), P= 0.10), and growth 6-12 months (β= -0.02, 95% CI (-1.02, 0.99), P=0.97) were not associated with FFMI.

Conclusions: Birth weight predicted body composition parameters in Ugandan early adolescents, however, exclusive breastfeeding at six weeks of age and growth in infancy did not.

Prevalence and Risk Factors of Hypertension Among Children Attending Out Patient Department of a Tertiary Care Hospital in Karachi

Introduction: The childhood obesity epidemic has caused the global prevalence of hypertension (HTN) in children to increase from 2% to 4%. However, there is limited data regarding this issue in Pakistan. Hence this cross-sectional study aims to document the prevalence of HTN and its risk factors among children visiting the out patient department (OPD) of a government hospital in Karachi, which is one of the largest cities in Pakistan. Methods: One thousand children aged between 4 and 12 years who visited the OPD in October 2019 were included. Blood pressures (BPs) for each child were measured manually and recorded. Their guardians were then interviewed to assess the risk factors present in each child. Data collected were analyzed using SPSS (Statistical Package for the Social Sciences). Results: Among all the children, those between 4 and 7 years of age had a higher prevalence of HTN (19.2%; 9.2% stage 1 and 10.0% stage 2) than children aged between 8 and 12 years (14.5%; 8.0% stage 1 and 6.5% stage 2). Obese children between the age of 4 and 7 years (OR = 3.11) were more likely to develop HTN. Moreover, children with a positive family history of HTN were 1.43 times more likely to have HTN and 1.32 times more likely to have pre-HTN. There was no significant association of gender, artificial feeding, low birth weight, and maternal smoking with HTN. Conclusion: The prevalence is particularly higher in children aged between 4 and 7 years (19.2%) and there is a strong association between high BMI (body mass index), family history of HTN, and high-fat diet intake with HTN in children. There was no significant variation of prevalence between both genders.

An Assessment of the Relationship between Anthropometric Parameters and Blood Pressure among Polokwane Private School Children

High blood pressure (HBP) among children and adolescents has been associated with elevated risk of cardiovascular diseases later in life. The aim of this study was to determine the relationship between body composition and blood pressure among Polokwane private school children. Mean body fat % was significantly (P < 0.05) higher in girls (23.74) than the boys (16.77). There was a significant (P < 0.05) association between systolic blood pressure (BP) and waist circumference (WC) unadjusted (OR = 1.125) and adjusted (OR = 1.097) for age and gender. This study included a total of 1665 children and adolescents (846 boys and 819 girls) aged 5 to 15 years old. Anthropometric measurements including weight, height, hip circumference (HC) and waist circumference (WC) were taken according to standard procedures. Descriptive statistics were done to determine the prevalence of hypertension and mean of all the variables. Pearson correlation, linear regression and logistic regression were all done to determine the association between blood pressure (BP) and the anthropometric measurements. All statistical analysis were done using SPSS. There was a significant association between body composition and blood pressure among Polokwane Private School children. Lowering the risk factors of high BP in children and adolescents will lower their risk of cardiovascular diseases in adulthood.

An overview of heart failure in low- and middle-income countries

Heart failure (HF) is a global public health concern with disproportionate socioeconomic, morbidity and mortality burden on low- and middle-income countries (LMICs). This review summarises contemporary data on the demographic and clinical characteristics, aetiologies, treatment, economic burden and outcomes of HF in LMICs. Patients with HF in LMICs are younger than those from high-income countries (HICs) and present at advanced stages of the disease. Hypertension, ischaemic heart disease (IHD), cardiomyopathy (CMO), and rheumatic heart disease (RHD) are the leading causes of HF in LMICs. The contribution of infectious diseases to HF remains prominent in many LMICs. Most health facilities in LMICs lack adequate diagnostic tools for HF, and the use of evidence-based medical and device therapies is suboptimal. Further, HF in LMICs is associated with prolonged hospital stay and high in-hospital and one-year mortality. Finally, HF has profound economic impact on individual patients who, mostly, have no health insurance, and on societies where patients are young, comprising those who have the greatest potential to contribute to economic productivity.

Bedtimes and Blood Pressure: A Prospective Cohort Study of Mexican Adolescents

INTRODUCTION

Hypertension affects up to 5% of children worldwide and predicts later cardiovascular morbidity. Associations of short sleep and hypertension have been frequently reported in adults but less consistently in children. This study aims to examine the role of late bedtimes, a marker of short sleep duration, and potentially misaligned circadian rhythms, on incident elevated blood pressure (BP) in a large cohort of Mexican children.

METHODS

Participants included 2,033 adolescents recruited from public schools in Morelos, Mexico, free from elevated BP (<90th sex, age, and height-standardized percentile). Fourteen months later, all adolescents had a second BP assessment. We abstracted baseline habitual bedtimes from questionnaires to evaluate the association between bedtime and elevated BP incidence (≥90th percentile). Risk ratios and 95% confidence intervals were estimated with discrete-time mixed survival models, adjusting for potential confounders and accounting for clustering by school.

RESULTS

Participants were 12.5 (SD = 0.6) years old at baseline. At the follow-up visit 10% of adolescents had developed elevated BP. Compared to participants with a habitual weekday bedtime between 9 and 10 pm, those with a weekday bedtime 11 pm or later had a 1.87 times higher risk of developing elevated BP over the follow-up period (95% CI = 1.09, 2.21), after accounting for confounders. Participants with earlier weekday bedtimes also had a higher risk of elevated BP (RR = 1.96; 95% CI = 1.27, 3.01). The associations persisted after accounting for wake time.

CONCLUSION

These data showed a U-shaped association between weekday bedtime and elevated/high BP risk among Mexican adolescents.

Use of Static Cutoffs of Hypertension to Determine High cIMT in Children and Adolescents: An International Collaboration Study

BACKGROUND

Pediatric hypertension is typically defined as blood pressure ≥ sex-, age-, and height-specific 95th percentile (high) cutoffs. Given the number of strata, there are hundreds of cutoffs for defining elevated and high blood pressure that make it cumbersome to use in clinical practice. This study aimed to evaluate the utility of the static cutoffs for pediatric hypertension (120/80 mm Hg for children and 130/80 mm Hg for adolescents) in determining high carotid intimamedia thickness (cIMT) in children and adolescents.

METHODS

Data were from 6 population-based cross-sectional studies in Brazil, China, Greece, Italy, Spain, and the United Kingdom. A total of 4280 children and adolescents, aged 6 to 17 years, were included. High cIMT was defined as cIMT ≥ sex-, age- and cohort-specific 90th percentile cutoffs.

RESULTS

Compared with normal blood pressure, hypertension defined using the percentile-based cutoffs from 2017 American Academy of Pediatrics guideline, and the static cutoffs were associated with similar higher odds for high cIMT (percentile-based cutoffs: odds ratio [OR], 1.46, 95% confidence interval [CI], 1.15-1.86; static cutoffs: OR, 1.65, 95% CI, 1.25-2.17), after adjustment for sex, age, race/ethnicity, body mass index, high-density lipoprotein-cholesterol, triglyceride, and fasting blood glucose. The similar utility of 2 definitions in determining high cIMT was further confirmed by area under the receiver operating characteristic curve and net reclassification improvement methods (P for difference > 0.05).

CONCLUSION

Static cutoffs (120/80 mm Hg for children, 130/80 mm Hg for adolescents) performed similarly compared with percentile-based cutoffs in determining high cIMT, supporting the use of static cutoffs in identifying pediatric hypertension in clinical practice.

Elevated Blood Pressure in Childhood or Adolescence and Cardiovascular Outcomes in Adulthood: A Systematic Review

There remains some uncertainty about the magnitude of the associations between elevated blood pressure (BP) in childhood or adolescence and cardiovascular morbidity and mortality in adulthood. We summarized evidence on the long-term impact of elevated BP in childhood or adolescence on cardiovascular morbidity and mortality in adulthood. PubMed and Embase databases were searched up to August 1, 2019, and retrieved studies were reviewed manually. Our systematic review included all eligible prospective cohort studies on the associations between BP status in childhood or adolescence and intermediate markers or hard outcomes of cardiovascular disease in adults, including high pulse wave velocity, high carotid intima-media thickness, left ventricular hypertrophy, and cardiovascular disease (fatal and nonfatal) and total mortality. A total of 19 articles were finally included, and 12 could be synthesized by meta-analysis. Elevated BP in childhood or adolescence was significantly associated, in adulthood, with high pulse wave velocity (3 articles, N=3725; pooled odds ratio [OR], 1.83 [95% CI, 1.39-2.40]); high carotid intima-media thickness (2 articles, N=4152; OR, 1.60 [95% CI, 1.29-2.00]); and left ventricular hypertrophy (2 articles, N=3019; OR, 1.40 [95% CI, 1.20-1.64]). Additionally, our systematic review also shows evidence of associations of elevated BP in youth with cardiovascular disease and mortality in adulthood. In conclusion, our systematic review and meta-analysis confirms that elevated BP in childhood or adolescence is associated with several intermediate markers and hard outcomes of cardiovascular disease in adulthood. These findings emphasize the importance for children and adolescents to have their BP within normal values.

Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals.

RESULTS

Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Are birthweight and postnatal weight gain in childhood associated with blood pressure in early adolescence? Results from a Ugandan birth cohort

BACKGROUND

In Africa, where low birthweight (LBW), malnutrition and high blood pressure (BP) are prevalent, the relationships between birthweight (BW), weight gain and BP later in life remain uncertain. We examined the effects of early life growth on BP among Ugandan adolescents.

METHODS

Data were collected prenatally from women and their offspring were followed from birth, with BP measured following standard protocols in early adolescence. Weight-for-age Z-scores (WAZ) were computed using World Health Organization references. Linear regression was used to relate BW, and changes in WAZ between birth and 5 years, to adolescents' BP, adjusting for confounders.

RESULTS

Among 2345 live offspring, BP was measured in 1119 (47.7%) adolescents, with mean systolic BP 105.9 mmHg and mean diastolic BP 65.2 mmHg. There was little evidence of association between BW and systolic [regression coefficient β = 0.14, 95% confidence interval (CI) (-1.00, 1.27)] or diastolic [β = 0.43, 95% CI (-0.57, 1.43)] BP. Accelerated weight gain between birth and 5 years was associated with increased BP: systolic β = 1.17, 95% CI (0.69, 1.66) and diastolic β = 1.03, 95% CI (0.59, 1.47). Between birth and 6 months of age, effects of accelerated weight gain on adolescent BP were strongest among the LBW (both premature and small-for-gestational-age) children [BW < 2.5 kg: β = 2.64, 95% CI (0.91, 4.37), BW≥2.5 kg: β = 0.58, 95% CI (0.01, 1.14), interaction P-value =  0.024].

CONCLUSIONS

Findings from this large tropical birth cohort in Uganda suggest that postnatal weight gain rather than BW is important in the developmental programming of BP, with fast-growing LBW children at particular risk. Efforts to control BP should adopt a life course approach.

School-Based Interventions Targeting Nutrition and Physical Activity, and Body Weight Status of African Children: A Systematic Review

Background: Overweight/obesity is an emerging health concern among African children. The aim of this study was to summarise available evidence from school-based interventions that focused on improving nutrition and physical activity knowledge, attitude, and behaviours, and weight status of children aged 6–15 years in the African context. Methods: Multiple databases were searched for studies evaluating school-based interventions of African origin that involved diet alone, physical activity alone, or multicomponent interventions, for at least 12 weeks in duration, reporting changes in either diet, physical activity, or body composition, and published between 1 January 2000 and 31 December 2018. No language restrictions were applied. Relevant data from eligible studies were extracted. Narrative synthesis was used to analyse and describe the data. Results: This systematic review included nine interventions comprising 10 studies. Studies were conducted among 9957 children and adolescents in two African countries, namely South Africa and Tunisia, and were generally of low methodological quality. The sample size at baseline ranged from 28 to 4003 participants. Two interventions reported enrolling children from both urban and rural areas. The majority of the study participants were elementary or primary school children and adolescents in grades 4 to 6. Participants were between the ages of 12.4 and 13.5 years. All but one intervention targeted children of both sexes. Four studies were described as randomised control trials, while five were pre- and post-test quasi-experiments. Except for one study that involved the community as a secondary setting, all were primarily school-based studies. The duration of the interventions ranged from four months to three years. The interventions focused largely on weight-related behaviours, while a few targeted weight status. The results of the effectiveness of these interventions were inconsistent: three of five studies that evaluated weight status (body mass index (BMI), BMI z-score, overweight/obesity prevalence), three of six studies that reported physical activity outcomes (number of sports activities, and physical activity duration ≥ 30 min for at least six days/week), and four of six reporting on nutrition-related outcomes (number meeting fruit and vegetable intake ≥ 5 times/day) found beneficial effects of the interventions. Conclusion: Given the dearth of studies and the inconsistent results, definite conclusions about the overall effectiveness and evidence could not be made. Nonetheless, this study has identified research gaps in the childhood obesity literature in Africa and strengthened the need for further studies, the findings of which would contribute valuable data and inform policy.

A novel indicator, childhood lipid accumulation product, is associated with hypertension in Chinese children and adolescents

Childhood hypertension has become an important public health issue. This study explored a novel indicator, namely, childhood lipid accumulation product (CLAP), which is associated with hypertension among children and adolescents. A total of 683 children and adolescents aged 8-15 years were measured for body weight, height, waist circumference (WC), abdominal skinfold thickness (AST), triacylglycerol (TG), blood pressure, dietary behaviors, and physical activity time. The novel childhood lipid accumulation product (CLAP) was the product of WC, AST, and TG (CLAP = WC (cm) × AST (mm) × TG (mmol/L)). The logarithmic CLAP (LnCLAP), height, weight, WC, WHtR, BMI, AST, and TG were standardized for sex and age using the z-score method (standardized variables: SLnCLAP, Sheight, Sweight, SWC, SWHtR, SBMI, SAST, and STG). The results showed that the overall prevalence of hypertension was 11.6% (13.1% in boys and 9.7% in girls). SLnCLAP ≥ 1, Sweight ≥ 1, SWC ≥ 1, SWHtR ≥ 1, SBMI ≥ 1, SAST ≥ 1, and STG ≥ 1 increased the statistical risk of childhood hypertension (odds ratio values (95% CI) were 3.70 (2.22-6.16), 2.58 (1.50-4.43), 3.08 (1.84-5.15), 2.33 (1.38-3.93), 2.96 (1.72-5.29), 2.38 (1.41-4.70), and 2.40 (1.38-4.19), respectively). The area under the ROC curve (AUC) for CLAP was higher than that for weight, WC, WHtR, BMI, AST, and TG in the prediction of hypertension. In conclusion, this study showed that CLAP is a novel indicator associated with hypertension in children and adolescents and can more effectively predict childhood hypertension than weight, WC, WHtR, BMI, AST, and TG can.

Using blood pressure height index to define hypertension among secondary school adolescents in southwestern Uganda

Hypertension is the number one risk factor for cardiovascular diseases worldwide and yet its diagnosis among adolescents, based on blood pressure percentiles which are age, height, and sex-specific, is complex. Our study intended to determine the suitability of blood pressure height index in defining adolescent hypertension among secondary school adolescents aged 12-17 years in Mbarara municipality, southwestern Uganda. Our study used data of 485 secondary school adolescents of which 173 were boys. Receiver operating characteristic curve analysis was performed to assess the performance of systolic blood pressure height index (SBPHI) and diastolic blood pressure height index (DBPHI) for screening for adolescent prehypertension and hypertension. The optimal systolic/diastolic thresholds for defining prehypertension were 0.70/0.43 mmHg/cm in boys and 0.76/0.43 in girls. The corresponding values for hypertension were 0.78/0.43 and 0.77/0.48 mmHg/cm, respectively. The negative predictive values were much higher (all ≥ 95%) for prehypertension and hypertension, while the positive predictive value was 100% for hypertension in both sexes. In conclusion, Blood pressure height index is simple and accurate for screening for prehypertension and hypertension in adolescents aged 12-17 years hence can be used for early screening of adolescents at high risk of hypertension but not its diagnosis.

Global Prevalence of Hypertension in Children: A Systematic Review and Meta-analysis

IMPORTANCE

Reliable estimates of the prevalence of childhood hypertension serve as the basis for adequate prevention and treatment. However, the prevalence of childhood hypertension has rarely been synthesized at the global level.

OBJECTIVE

To conduct a systematic review and meta-analysis to assess the prevalence of hypertension in the general pediatric population.

DATA SOURCES

PubMed, MEDLINE, Embase, Global Health, and Global Health Library were searched from inception until June 2018, using search terms related to hypertension (hypertension OR high blood pressure OR elevated blood pressure), children (children OR adolescents), and prevalence (prevalence OR epidemiology).

STUDY SELECTION

Studies that were conducted in the general pediatric population and quantified the prevalence of childhood hypertension were eligible. Included studies had blood pressure measurements from at least 3 separate occasions.

DATA EXTRACTION AND SYNTHESIS

Two authors independently extracted data. Random-effects meta-analysis was used to derive the pooled prevalence. Variations in the prevalence estimates in different subgroups, including age group, sex, setting, device, investigation period, BMI group, World Health Organization region and World Bank region, were examined by subgroup meta-analysis. Meta-regression was used to establish the age-specific prevalence of childhood hypertension and to assess its secular trend.

MAIN OUTCOMES AND MEASURES

Prevalence of childhood hypertension overall and by subgroup.

RESULTS

A total of 47 articles were included in the meta-analysis. The pooled prevalence was 4.00% (95% CI, 3.29%-4.78%) for hypertension, 9.67% (95% CI, 7.26%-12.38%) for prehypertension, 4.00% (95% CI, 2.10%-6.48%) for stage 1 hypertension, and 0.95% (95% CI, 0.48%-1.57%) for stage 2 hypertension in children 19 years and younger. In subgroup meta-analyses, the prevalence of childhood hypertension was higher when measured by aneroid sphygmomanometer (7.23% vs 4.59% by mercury sphygmomanometer vs 2.94% by oscillometric sphygmomanometer) and among overweight and obese children (15.27% and 4.99% vs 1.90% among normal-weight children). A trend of increasing prevalence of childhood hypertension was observed during the past 2 decades, with a relative increasing rate of 75% to 79% from 2000 to 2015. In 2015, the prevalence of hypertension ranged from 4.32% (95% CI, 2.79%-6.63%) among children aged 6 years to 3.28% (95% CI, 2.25%-4.77%) among those aged 19 years and peaked at 7.89% (95% CI, 5.75%-10.75%) among those aged 14 years.

CONCLUSIONS AND RELEVANCE

This study provides a global estimation of childhood hypertension prevalence based on blood pressure measurements in at least 3 separate visits. More high-quality epidemiologic investigations on childhood hypertension are still needed.

Hypertension in Children: Could the Prevalence be on the Increase?

Background

In children particularly in the developing world, there is a tendency to downplay the role of primary hypertension in their health. In adults, a number of factors have clearly been associated with the incidence of hypertension. Knowledge of the prevalence of hypertension and its associated factors among children in our environment is important and could inform the need for lifestyle changes and routine blood pressure (BP) checks in children so as to reduce BP-related health risks.

Aim

The aim of this study is to document the prevalence of hypertension and its risk factors among children in Enugu, Nigeria.

Materials and Methods

Children aged 6-17 years attending the outpatient clinic of a tertiary hospital, were enrolled for the study. Their socioeconomic status (SES), weight, height, BP, and dipstick urinalysis were measured using standardized methods. Adherence to Mediterranean diet was assessed using the Mediterranean Diet Quality Index (KIDMED). The prevalence of hypertension and the influence of these factors on their BP were analyzed.

Results

Forty-six (9%) of the 491 participants had hypertension. Of these 46 hypertensive children, 72% were females while a significantly higher proportion 57% (P = 0.006), were in the age group 13-17 years. While age, gender, and the presence of protein in urine were significantly associated with hypertension in these children; body mass index, diet, family history of hypertension, and SES were not.

Conclusion

The prevalence of hypertension in children in this environment is high and appears to be increasing. There is need for routine BP and urinalysis check for all children in our clinics and wards.

Anthropometric and Biochemical Predictors for Hypertension in a Cross-Sectional Study in Zanzibar, Tanzania

Background: Aim of this study was to describe the proportion of hypertension among Zanzibari of different age-groups and to detect possible correlates of this non-communicable disease.

Methods: In 2013 a cross-sectional survey was conducted in Unguja Island, Zanzibar. A total of 235 randomly selected households, including 1,229 (2 to 95 years) eligible study participants, were examined. Association between objectively assessed obesity markers, salt intake and hypertension were investigated. Estimates of 24 h sodium and potassium excretion from a single morning spot urine specimen were calculated and used as surrogate for salt intake. The association between overweight/obesity and hypertension in different age-groups was assessed in multilevel logistic regression models. Further associations between salt intake and hypertension were analyzed.

Results: Measures of systolic and diastolic blood pressure as well as proportion of overweight/obesity and hypertension both increased with age. Overweight and obesity were significantly associated with hypertension in adults. Moreover, thinness seems to be associated with hypertension as well. We observed a significantly reduced chance of hypertension for higher urinary sodium-to-potassium compared to a lower ratio in children.

Conclusion: Overweight/obesity and hypertension were highly prevalent (>47% of adults >40 years are overweight or obese and >69% are hypertensive in the same age group) in our sample. Weight status was confirmed as a correlate of high blood pressure in our sample from Zanzibar, Tanzania. To early and effectively prevent related severe cardiovascular outcomes, screening strategies but also monitoring strategies are required for this population.

Impact of the 2017 American Academy of Pediatrics Guideline on Hypertension Prevalence Compared With the Fourth Report in an International Cohort

In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk.

Prevalence of major cardiovascular disease risk factors among a group of sub-Saharan African young adults: a population-based cross-sectional study in Yaoundé, Cameroon

OBJECTIVE

To determine the prevalence estimates of some major risk factors for cardiovascular disease (CVD) in a young adult-aged population living in Yaoundé, Cameroon.

DESIGN

A cross-sectional study held from May to July 2017.

SETTING

PARTICIPANTS: Students aged 18-35 years, with no known history of CVD, found at the campus during recruitment and who voluntarily agreed to be included in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Data were collected on personal and family history as well as lifestyle and nutritional habits; anthropometric parameters and blood pressure were also measured. Prevalence rates were calculated with their respective 95% CI.

RESULTS

Overall, 931 participants (53.8% males) were included, with a median age of 23 years (IQR 21-25). The prevalence estimates for some major CVD risk factors were: 3.1% (95% CI 2.0 to 4.2) for family history of heart attack, 6.3% (95% CI 4.7 to 7.9) for family history of stroke, 26.7% (95% CI 23.9 to 29.5) for hazardous alcohol consumption, 0.9% (95% 0.3 to 1.5) for current tobacco smoking, 27.6% (95% CI 24.7 to 30.5) for secondhand smoking, 88.9% (95% CI 86.9 to 90.9) for physical inactivity, 99.0% (95% CI 98.4 to 99.6) for inadequate fruits and/or vegetables consumption, 39.8% (95% CI 36.7 to 42.9) for self-reported anxiety, 49.2% (95% CI 46.0 to 52.4) for self-reported depression, 22.1% (95% CI 19.4 to 24.8) for overweight, 3.9% (95% CI 2.7 to 5.1) for obesity, 14.4% (95% CI 12.1 to 16.7) for abdominal obesity, 14.5% (95% CI 12.2 to 16.8) for excess body fat mass, 30.0% (95% CI 27.1 to 32.9) for suspected prehypertension and 2.8% (95% CI 1.7 to 3.9) for suspected hypertension.

CONCLUSION

The prevalence of some major CVD risk factors is high among young adults living in Yaoundé, Cameroon. Therefore, specific actions should be undertaken in this population to mitigate the upcoming burden of CVD. Accordingly, younger-aged adult populations should be encouraged and accompanied to practice physical activity, eat healthily, and stop or avoid smoking and/or hazardous alcohol consumption.

Prevalence of overweight and obesity among African primary school learners: a systematic review and meta-analysis

INTRODUCTION

The increasing trend in the global prevalence of childhood overweight and obesity presents a major public health challenge. This study reports the results of a systematic review and meta-analysis to estimate the prevalence of overweight and obesity among primary school learners residing in Africa according to the different body mass index criteria and population level characteristics.

METHODS

A search of multiple databases was conducted to identify relevant research articles published between January 1980 and February 2017. Random effects models were used to pool prevalence data within and across population level characteristics after variance stabilization through arcsine transformation (PROSPERO registration number CRD42016035248).

RESULTS

Data from 45 studies across 15 African countries, and comprising 92,379 and 89,468 participants for overweight and obesity estimates were included. Estimated overweight and obesity prevalence differed significantly across criteria: 10.5% [95% confidence interval, CI: 7.1-14.3] and 6.1% [3.4-9.7] by World Health Organization; 9.5% [6.5-13.0] and 4.0% [2.5-5.9] by International Obesity Task Force; and 11.5% [9.6-13.4] and 6.9% [5.0-9.0] by Centre for Diseases Control, respectively (p = 0.0027 for overweight; p < 0.0001 for obesity). Estimates were mostly higher in urban, and private schools, but generally similar by gender, major geographic regions, publication year and sample size. Substantial heterogeneity in the estimates across and within criteria were not always explained by major study characteristics.

CONCLUSION

Overweight and obesity are prevalent among African primary school learners, particularly those attending urban, and private schools. The results from this meta-analysis could be helpful in making informed decisions on childhood obesity prevention efforts in African countries.

A genome-wide association and replication study of blood pressure in Ugandan early adolescents

BACKGROUND

Genetic association studies of blood pressure (BP) have mostly been conducted in non-African populations. Using the Entebbe Mother and Baby Study (EMaBS), we aimed to identify genetic variants associated with BP among Ugandan adolescents.

METHODS

Systolic and diastolic BP were measured among 10- and 11-year olds. Whole-genome genotype data were generated using Illumina omni 2.5M arrays and untyped variants were imputed. Genome-wide association study (GWAS) was conducted using linear mixed model regression to account for population structure. Linear regression analysis was used to assess whether variants previously associated with BP (p < 5.0 × 10-8 ) in published BP GWASs were replicated in our study.

RESULTS

Of the 14 million variants analyzed among 815 adolescents, none reached genome-wide significance (p < 5.0×10-8 ) for association with systolic or diastolic BP. The most strongly associated variants were rs181430167 (p = 6.8 × 10-7 ) for systolic BP and rs12991132 (p = 4.0 × 10-7 ) for diastolic BP. Thirty-three (17 single nucleotide polymorphisms (SNPs) for systolic BP, 15 SNPs for diastolic BP and one SNP for both) of 330 variants previously identified as associated with BP were replicated in this study, but none remained significant after accounting for multiple testing.

CONCLUSION

Variants showing suggestive associations are worthy of future investigation. Replication results suggest that variants influencing adolescent BP may overlap somewhat with those already established in previous studies, largely based on adults in Western settings.

Assessing the global risk of cardiovascular disease among a group of university students: population-based cross-sectional study in Yaoundé, Cameroon

OBJECTIVE

To describe the global cardiovascular disease (CVD) risk distribution in a young adult-aged population living in Yaoundé, Cameroon and depict factors likely influencing this risk distribution.

DESIGN

A cross-sectional study between May and July 2017.

SETTING

The University of Yaoundé I, Cameroon.

PARTICIPANTS

Any university student aged 18 years and above, with no known history of CVD, found at the campus during recruitment and who voluntarily agreed to be included in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

The global risk of CVD was measured with the non-laboratory-based INTERHEART Modifiable Risk Score.

RESULTS

A total of 949 participants (54% males) were recruited; the median age was 23 (IQR 21-26) years. The CVD risk varied between 2 and 21, with a median of 9 (IQR 7-12); 51.2% of students had a low risk of CVD, 43.7% had a moderate risk and 5.1% presented a high risk of CVD. The number of years since first registration at the university (β=0.08), history of sudden death among biological parents (β=1.28), history of hypertension among brothers/sisters (β=1.33), history of HIV infection (β=4.34), the Alcohol Use Disorder Identification Test-Consumption score (β=0.13), regular exposure to firewood smoke (β=1.29), eating foods/drinks with too much sugar ≥1 time/day (β=0.96), eating foods/snacks with too much oil ≥3 times/week (β=1.20) and eating dairy products≥1 time/day (β=0.61) were the independent factors likely influencing participants' global risk of CVD.

CONCLUSION

Almost 50% of participants had moderate or high risk of CVD. Specific interventions targeting major CVD risk factors should be put in place among young adults to prevent or reduce this upcoming overburdened picture of CVD.

Breastfeeding, HIV exposure, childhood obesity, and prehypertension: A South African cohort study

BACKGROUND

Evidence on the association between breastfeeding and later childhood obesity and blood pressure (BP) is inconsistent, especially in HIV-prevalent areas where, until recently, HIV-infected women were discouraged from breastfeeding, but obesity is increasingly prevalent.

METHODS AND FINDINGS

The Siyakhula cohort (2012-2014), a population-based prospective cohort study, collected data over 3 visits on HIV-negative children ages 7 to 11 years in rural South Africa. We used weight (body mass index [BMI]), fat, and BP as outcome variables and incorporated early life (including mother's age at delivery and HIV status) and current life factors (including maternal education and current BMI). Our primary exposure was breastfeeding duration. We dichotomized 3 outcome measures using pre-established thresholds for clinical interpretability: (1) overfat: ≥85th percentile of body fat; (2) overweight: >1 SD BMI z score; and (3) prehypertension: ≥90th percentile for systolic BP (SBP) or diastolic BP (DBP). We modelled each outcome using multivariable logistic regression, including stopping breastfeeding, then early life, and finally current life factors. Of 1,536 children (mean age = 9.3 years; 872 girls; 664 boys), 7% were overfat, 13.2% overweight, and 9.1% prehypertensive. Over half (60%) of the mothers reported continued breastfeeding for 12+ months. In multivariable analyses, continued breastfeeding between 6 and 11 months was associated with approximately halved odds of both being overfat (adjusted odds ratio [aOR] = 0.43, 95% confidence interval [CI] 0.21-0.91, P = 0.027) and overweight (aOR = 0.46, CI 0.26-0.82, P = 0.0083), but the association with prehypertension did not reach statistical significance (aOR = 0.72, CI 0.38-1.37, P = 0.32). Children with a mother who was currently obese were 5 times more likely (aOR = 5.02, CI 2.47-10.20, P < 0.001) to be overfat and over 4 times more likely to be overweight (aOR = 4.33, CI 2.65-7.09, P < 0.001) than children with normal weight mothers. Differences between HIV-exposed and unexposed children on any of the outcomes were minimal and not significant. The main study limitation was that duration of breastfeeding was based on maternal recall.

CONCLUSIONS

To our knowledge, this is the first study examining and quantifying the association between breastfeeding and childhood obesity in an African setting with high HIV prevalence. We observed that breastfeeding was independently associated with reduced childhood obesity for both HIV-exposed and unexposed children, suggesting that promoting optimal nutrition throughout the life course, starting with continued breastfeeding, may be critical to tackling the growing obesity epidemic. In the era of widespread effective antiretroviral treatment for HIV-infected women for life, these data further support the recommendation of breastfeeding for all women.

Barriers and Enablers That Influence Overweight/Obesity/Obesogenic Behavior in Adolescents From Lower-Middle Income Countries: A Systematic Review

BACKGROUND

Overweight/obesity during adolescence in lower-middle income countries has become a public health problem with consequences in adulthood. Inadequate dietary habits, poor diet quality, sedentary behavior, and parental obesity have been reported.

OBJECTIVE

To describe management of obesity-like food habits and behavior of adolescents from lower-middle income countries with respect to what keeps them using this diet (barriers) and what helps them avoid it (enablers).

METHODS

Systematic review of the literature related to obesity and food intake of adolescents conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).

RESULTS

We classified 11 eligible studies describing the barriers to and enablers of the management of obesity-like food intake and obesity lifestyle. The dual burdens of malnutrition and increased urbanization have been observed. There is preference for processed food, dietary habits, and obesity-like food intake and sedentary behavior. Barriers to managing body weight gain included mostly consumption of fast-food and snack food, less vegetable and fruit intake, skipping meals, and sedentary behavior. Enablers of managing body weight gain included changes in nutritional habits, perception of the consumption of healthy food, physical activity, and engagement in programs to change lifestyle.

CONCLUSION

The globalization of the fast food industry has provided an obesogenic environmental stimulus for adolescents in lower-middle income countries.

Excess risk of preterm birth with periconceptional iron supplementation in a malaria endemic area: analysis of secondary data on birth outcomes in a double blind randomized controlled safety trial in Burkina Faso

BACKGROUND

Iron supplementation before a first pregnancy may improve the future health of mother and baby by reducing maternal anaemia. Iron supplementation could, however, increase malaria infections, notably in primigravidae who are most susceptible. The pathogenicity of other iron-utilizing pathogens could also increase, causing inflammation leading to increased risk of adverse birth outcomes. This paper reports pre-specified secondary birth outcomes from a safety trial in Burkina Faso in an area of high malaria endemicity. Primary outcomes from that trial had investigated effects of long-term weekly iron supplementation on malaria and genital tract infections in non-pregnant and pregnant women.

METHODS

A double-blind, randomized controlled trial. Nulliparous, mainly adolescent women, were individually randomized periconceptionally to receive weekly either 60 mg elemental iron and 2.8 mg folic acid, or 2.8 mg folic acid alone, continuing up to the first antenatal visit for those becoming pregnant. Secondary outcomes were ultrasound-dated gestational age, fetal growth, placental malaria, chorioamnionitis and iron biomarkers. Seasonal effects were assessed. Analysis was by intention to treat.

RESULTS

478 pregnancies occurred to 1959 women: 258/980 women assigned iron and folic acid and 220/979 women assigned folic acid alone. Malaria prevalence at the first antenatal visit was 53% (iron) and 55% (controls). Mean birthweight was 111 g lower in the iron group (95% CI 9:213 g, P = 0.033). Mean gestational ages were 264 days (iron) and 269 days (controls) (P = 0.012), with 27.5% under 37 weeks compared to 13.9% in controls (adjRR = 2.22; 95% CI 1.39-3.61) P < 0.001). One-third of babies were growth restricted, but incidence did not differ by trial arm. Half of placentae had evidence of past malaria infection. C-reactive protein > 5 mg/l was more common prior to births < 37 weeks (adjRR = 2.06, 95% CI 1.04-4.10, P = 0.034). Preterm birth incidence during the rainy season was ~ 50% in the iron arm and < 20% in controls (P = 0.001). Chorioamnionitis prevalence peaked in the dry season (P = 0.046), with no difference by trial arm (P = 0.14).

CONCLUSION

Long-term weekly iron supplementation given to nulliparous women in a malaria endemic area was associated with higher risk of preterm birth in their first pregnancy. Trial Registration NCT01210040. Registered with Clinicaltrials.gov on 27th September 2010.

Prevalence of high blood pressure and associated factors among adolescents and young people in Tanzania and Uganda

We conducted a cross-sectional study among school/college students in Tanzania and Uganda to determine the prevalence of high blood pressure (BP) and associated factors. Participants were classified to have high BP if they had pre-hypertension or hypertension. Interviews were done using the WHO STEPS instrument. Using data from both countries (n = 1596), the overall prevalence of high BP was 40% (95% CI: 37-42). The prevalence of pre-hypertension was 29% (95% CI: 26-31) and that of hypertension was 11% (95% CI: 10-13). High BP was independently associated with obesity (aOR = 6.7, 95% CI: 2.2-20.0), male sex (aOR = 3.2, 95% CI: 2.4-4.4), and among males aged above 20 years (aOR = 5.5, 95% CI: 2.9-10.5). Consumption of fruits/vegetables was associated with decreased odds for high BP (aOR = 0.7, 95% CI: 0.50-0.98). The increasing burden of pre-hypertension across age groups could explain the early onset of hypertension and cardiovascular diseases (CVDs) among young African adults. There is a need for longitudinal studies to explore the drivers of pre-hypertension in East African adolescents.

Diagnostic Effect of the Single BP Cut-Offs for Identifying Elevated BP and Hypertension in Adolescents Aged 13-17 Years

In contrast to the percentile-based definitions of elevated blood pressure (BP) and hypertension for children and adolescents of all ages in the 2004 fourth report, the 2017 American Academy of Pediatrics (AAP) BP guideline recommends a change to single BP cut-offs for clinical diagnosis (120/< 80-129/< 80 mmHg for elevated BP and ≥ 130/80 mmHg for hypertension) in adolescents aged 13 years and older, and it also recommends researchers using the percentile-based definitions for more precise BP classification. The aim of our study was to assess the diagnostic effect of the single BP cut-offs for identifying adolescent abnormal BP as compared to the 2017 AAP percentile table by sex, age, and height. Data were from 8287 adolescents aged 13-17 years in NHANES 1999-2016 and 1659 adolescents aged 13-17 years in NHANES III (1988-1994). Compared to the 2017 AAP percentile table, the single BP thresholds performed well for identifying elevated BP in adolescents in NHANES 1999-2016/NHANES III, with high values of area under the curve 0.93/0.95, sensitivity 86.7%/89.9%, specificity 100%/100%, positive predictive value (PPV) 100%/100%, negative predictive value (NPV) 98.2%/98.8%, and kappa coefficient 0.92/0.94. The results were similar for identifying hypertension in the two datasets, with especially high PPV 100%/100% and NPV 99.2%/99.2%. However, the sensitivity values of the simple method for identifying hypertension were not satisfactory among girls, younger adolescents, and Hispanic adolescents in both datasets. In conclusion, the single BP cut-offs in general performed similarly well for identifying abnormal BP as compared to 2017 AAP percentile table, but not well in some subgroups.

Hypertension among adolescents in Nigeria: a retrospective study of adolescent university freshmen

PURPOSE

The burden of hypertension is rising both globally and in Africa specifically. We determined the prevalence of hypertension and the risk factors for clinical hypertension in a population of new university intakes over a 4-year period.

METHODS

We analyzed retrospectively, the records of 6980 older adolescents (15-19 years). We used population-specific metrics to categorize blood pressure (BP) based on the 2017 Clinical Practice Guidelines by the American Academy of Pediatrics.

RESULTS

The overall prevalence of high BP in our study was 25.1% [95% confidence interval (CI) 24.1-26.2] for elevated BP, 19.8% (95% CI 18.9-20.8) for stage 1 hypertension, and 5.5% (95% CI 5.0-6.1) for stage 2 hypertension. The prevalence of stage 2 hypertension was 8.7% (7.5-9.5) among the male participants and 3.2% (95% CI 2.7-3.2) among the female participants (p < 0.001). The multivariate analyses demonstrated an increased risk of high levels of BP (p < 0.001) with age (1.21: 95% CI 1.16-1.26), waist-to-height ratio (WHtR) (1.05: 95% CI 1.04-1.05), z-score for body mass index (BMI) (1.47: 95% CI 1.41-1.54), and hemoglobin concentration (1.10: 95% CI 1.09-1.12). It demonstrated a reduced risk of high levels of BP (p < 0.001) being female (0.35: 95% CI 0.32-0.39).

CONCLUSIONS

Hypertension, its risk factors and the risk of cardiovascular diseases in later life are prevalent in our Nigerian adolescent population. There is, therefore, a need for the development, evaluation and implementation of context-appropriate strategies and interventions to mitigate the risk of hypertension among adolescents, and cardiovascular diseases later in life.

Effect of birth weight, exclusive breastfeeding and growth in infancy on fat mass and fat free mass indices in early adolescence: an analysis of the Entebbe Mother and Baby Study (EMaBs) cohort

Background: There is limited data from Africa on the effect of pre- and post-natal growth and infant feeding on later body composition. This study's aim was to investigate the effect of birth weight, exclusive breastfeeding and infant growth on adolescent body composition, using data from a Ugandan birth cohort. Methods: Data was collected prenatally from pregnant women and prospectively from their resulting live offspring. Data on body composition (fat mass index [FMI] and fat free mass index [FFMI]) was collected from 10- and 11-year olds. Linear regression was used to assess the effect of birth weight, exclusive breastfeeding and infant growth on FMI and FFMI, adjusting for confounders. Results: 177 adolescents with a median age of 10.1 years were included in analysis, with mean FMI 2.9 kg/m2 (standard deviation (SD) 1.2), mean FFMI 12.8 kg/m2 (SD 1.4) and mean birth weight 3.2 kg (SD 0.5). 90 (50.9%) were male and 110 (63.2%) were exclusively breastfeeding at six weeks of age. Birth weight was associated with FMI in adolescence (regression coefficient β= 0.66 per kg increase in birth weight, 95% confidence interval (CI) (0.04, 1.29), P=0.02), while exclusive breastfeeding (β= -0.43, 95% CI (-1.06, 0.19), P=0.12), growth 0-6 months (β= 0.24 95% CI (-0.43, 0.92), P=0.48) and growth 6-12 months (β= 0.61, 95% CI (-0.23, 1.46), P=0.11) were not associated with FMI among adolescents. Birth weight (β= 0.91, 95% CI (0.17, 1.65), P=0.01) was associated with FFMI in adolescence. Exclusive breastfeeding (β= 0.17, 95% CI (-0.60, 0.94), P=0.62), growth 0-6 months (β= 0.56, 95% CI (-0.20, 1.33), P= 0.10), and growth 6-12 months (β= -0.02, 95% CI (-1.02, 0.99), P=0.97) were not associated with FFMI. Conclusions: Birth weight predicted body composition parameters in Ugandan early adolescents, however, exclusive breastfeeding at six weeks of age and growth in infancy did not.