Prevalence of elevated blood pressure and its relationship with fat mass, body mass index and waist circumference among a group of Moroccan overweight adolescents

Pre-hypertension and Hypertension Among University Students in Bahrain: A Study of Prevalence and Associated Risk Factors

BACKGROUND/OBJECTIVES

In the last 20 years, hypertension has become more common among younger age groups. Based on a global meta-analysis, the combined prevalence of hypertension and prehypertension were 4.0% and 9.7%, respectively. This study aimed to evaluate the prevalence of prehypertension and hypertension among university students and their associated risk factors.

METHODS

Four hundred and eleven students aged between 18 and 25 (196 males and 215 females) were randomly selected to participate from the College of Medicine and Medical Sciences (CMMS) and the College of Business Administration, Bahrain. The data was collected through a structured questionnaire, which gathered information about lifestyle habits. Trained students measured the participant's blood pressure and body mass index (BMI) according to standardized settings. All risk factors were studied according to the study field and their gender.

RESULTS

 The mean age of the participants was 16.4±0.9 years. Of the total participants, 61.3% (n= 252) were normotensive, 30.7% (n= 126) were pre-hypertensive, and 8% (n= 33) were hypertensive. The prevalence of hypertension and pre-hypertension was higher in male students, 13.8% (n=27) and 44.9% (n= 88), compared to female students, 2.8% (n=6) and 17.7% (n=38), respectively. The results of the univariate analysis showed an association of hypertension with the field of study, gender, age, BMI, exercise frequency, frequency of eating junk food, and family history of hypertension (p < 0.05). Multivariate logistic regression analysis found a significant association between hypertension and pre-hypertension with gender, the field of study, and BMI.

CONCLUSIONS

The findings of the study revealed that hypertension and pre-hypertension are common among university students in Bahrain. The risk factors for these conditions include studying medicine, being male, and being obese.

The Increase in Childhood Obesity and Its Association with Hypertension during Pandemics

There has been a major ongoing health impact of the COVID-19 pandemic on children's lives, including lifestyle and overall health. Enforcement of prevention measures, such as school closures and social distancing, has significantly affected children's daily routines and activities. This perspective manuscript aims to explore the rise in childhood obesity and its association with hypertension during pandemics. The COVID-19 pandemic has led to significant disruptions in children's routines, including reduced physical activity, increased sedentary behavior, and changes in dietary patterns. These factors, coupled with the psychological impact of the pandemic, have contributed to an alarming increase in childhood obesity rates. This paper has highlighted the concerning increase in childhood obesity and hypertension during pandemics. The disruptions caused by the COVID-19 pandemic, including reduced physical activity, increased sedentary behaviors, and changes in dietary patterns, have contributed to the rise in these health conditions. It is crucial to recognize the long-term consequences of childhood obesity and hypertension and the urgent need for a comprehensive approach to address them.

Systematic review and meta-analysis: Prevalence of hypertension among adolescents in the Arab countries

PROBLEM

Hypertension (HTN) is one of the non-communicable diseases which prevalence is rising in both developed and developing countries. There is a scarcity of data on the prevalence of HTN in Arab countries. This review outlines what is currently known about prevalence and risk factors of HTN in adolescence in Arab world.

ELIGIBILITY CRITERIA

A systematic review and meta-analysis were conducted using PubMed, Cochrane Library, Scopus, CINAHL, Science Direct, and Google Scholar databases from 2011 to 2021.

SAMPLE

Fourteen studies from 9 Arab countries met inclusion criteria. Studies included a total of 777 adolescents with HTN and 2147 adolescents with pre-HTN.

RESULTS

The overall prevalence of HTN among adolescents in the Arab World was estimated at 12.6% (95CI 0.083-0.176), while pre-HTN was 13.9% (95CI 0.084-0205). Overweight and obesity resemble the higher risk of developing hypertension. Family history, high consumption of salt, smoking and low physical activity also increase the risk of HTN. The development of adolescent HTN can be predicted through anthropometric measurements such as Body Mass Index (BMI), wrist circumferences, and high waist circumference.

CONCLUSION

The prevalence of HTN among adolescents in the Arab world was significant, ranging from 4 to 26%. The heterogeneity between studies was high.

IMPLICATION

Local governments and policymakers must consider strengthening regulations to address environmental risk factors and improve public awareness about risk factors to HTN. A combined use of nurse- and patient targeted educational interventions could also help in reducing the burden of HTN in this population.

Epidemiology of Cardiovascular Diseases in Morocco: A Systematic Review

OBJECTIVE

To provide a systematic review of studies on cardiovascular diseases (CVD) and their risk factors in the Moroccan population.

METHODS

A systematic analysis was performed based on PRISMA guidelines by retrieving data bases (Medline, Embase, and other) using technical keywords in addition to manual research on official websites. Published studies in the English or French language, conducted in Morocco or concerning the Moroccan population within the last two decades, were identified.

RESULTS

This is the first systematic review of CVD in Morocco. Data from 159 studies were retrieved and analyzed. Most studies were written in the English language (75.89%) and published between 2010 and 2019 (85.47%). The mortality rate caused by CVD in Morocco has reached 38%, with ischemic heart disease and stroke as the main events causing death (31.0% and 22.5% respectively). The risk factors present in the population studied were headed by tobacco smoking (45-50%), followed by physical inactivity (21.1%), elevated rate of hypertension (25.3%), and depression (5.47%). Impacted by a high rate of illiteracy and poverty and an unprepared health care system in Morocco, these numbers are expected to increase over the next decade.

CONCLUSIONS

Based on these alarming incidences, investment in scientific research and epidemiological studies should be increased to determine the needs of the local population. The available evidence shows that the risk of cardiovascular disease and the associated mortality is very high in Morocco and will rise in the next years prospectively, which calls for urgent multi-sectorial approaches and treatment strategies.

Relevance of body mass index and bioelectrical impedance analysis vs. deuterium dilution technique to assess excess of fat among young adults

Our study aimed to assess the nutritional status by using body composition among young Tunisian adults through three measurement methods: body mass index (BMI), bioelectrical impedance analysis (BIA) and deuterium oxide dilution technique (²H₂O) and to determine the accuracy of BMI and BIA in order to evaluate the overweight and obesity among young adults in Tunisia. Our study involved 144 young adults. Anthropometric parameters were measured. The fat mass percentage (%FM) was determined by ²H₂O and BIA techniques. The analysis of deuterium enrichment was performed using a Fourier transform infrared spectrophotometer (FTIR). According to BMI, 26.4% of subjects were overweight and 5.5% were obese. The mean of %FM estimated by BIA was significantly higher than that determined by ²H₂O (29.7 ± 7.7 vs. 26.3 ± 10.6, p < .0001). Consequently, the prevalence of overweight and obesity assessed by BIA was significantly higher than by ²H₂O (51.4% vs. 34%, p < .0001). Using BMI, the prevalence of overweight and obesity was similar to that estimated by ²H₂O (31.9% vs. 34%, p = 0.544). Compared to ²H₂O, BIA overestimates the prevalence of overweight and obesity in young adults. On the other hand, the BMI showed an interesting correlation with the %FM determined by ²H₂O.

Association between ATP2B1 and CACNB2 polymorphisms and high blood pressure in a population of Lithuanian children and adolescents: a cross-sectional study

OBJECTIVES

Recently, genome-wide associated studies have identified several genetic loci that are associated with elevated blood pressure and could play a critical role in intracellular calcium homeostasis. The aim of this study was to assess the associations of ATP2B1 rs2681472 and CACNB2 rs12258967 gene polymorphisms with high blood pressure (HBP) among Lithuanian children and adolescents aged 12-15 years.

STUDY DESIGN AND PARTICIPANTS

This was a cross-sectional study of a randomly selected sample of 646 12-15-year-old adolescents who participated in the survey 'The Prevalence and Risk Factors of HBP in 12-15 Year-Old Lithuanian Children and Adolescents (from November 2010 to April 2012)'. Anthropometric parameters and BP were measured. The participants with HBP were screened on two separate occasions. Subjects were genotyped ATP2B1 rs2681472 and CACNB2 rs12258967 gene polymorphisms using real-time PCR method.

RESULTS

The prevalence of HBP was 36.7%, significantly higher for boys than for girls. In the multivariate analysis, after adjustment for body mass index and waist circumference, boys with CACNB2 CG genotype, CACNB2 GG genotype and CACNB2 CG +GG genotype had higher odds of having HBP in codominant (adjusted OR (aOR)=1.92; 95% CI 1.16 to 3.18, p=0.011; and aOR=2.64; 95% CI 1.19 to 5.90, p=0.018) and in dominant (aOR=2.05; 95% CI 1.27 to 3.30, p=0.003) inheritance models. Girls carrying CACNB2 CG genotype and CACNB2 CG +GG genotype had increased odds of HBP in codominant (aOR=1.82; 95% CI 1.02 to 3.24, p=0.044) and in dominant (aOR=1.89; 95% CI 1.09 to 3.28, p=0.023) inheritance models. Furthermore, significant associations were found in additive models separately for boys (aOR=1.72; 95% CI 1.20 to 2.46, p=0.003) and girls (aOR=1.52; 95% CI 1.05 to 2.20, p=0.027). No significant association was found between ATP2B1 gene polymorphism and the odds of HBP.

CONCLUSIONS

Our results indicate that CACNB2 gene polymorphism was significantly associated with higher odds of HBP in Lithuanian adolescents aged 12-15 years.

Prevalence of hypertension and prehypertension among children and adolescents in a semi-urban area of Uyo Metropolis, Nigeria

Introduction

In the past, Hypertension in childhood was not considered a problem but in the last few decades, it has gradually become a source of concern especially as children are known to maintain their blood pressures into adulthood. Therefore, hypertensive children are at risk of developing cardiovascular complications earlier in adulthood. In our own environment, the prevalence of hypertension in children is undocumented, hence the purpose of this study.

Methods

Two hundred children aged between 3-17 years were recruited into this study from two public schools-one primary, one secondary in a semi urban community in Uyo metropolis. The blood pressure of respondents was measured in accordance with the technique described by the 4^th Task Force on Blood Pressure Control in Children. The height and weight of all eligible subjects was measured using a stadiometer and a calibrated scale respectively. Body Mass Index (BMI) was assessed for each subject and World Health Organization (WHO) charts of BMI for age and sex were used as reference standards. Waist circumference was measured according to the technique described in the National Health and Nutrition Examination Survey.

Results

The prevalence of hypertension and prehypertension was found to be 3.5% and 2.5% respectively in this study. Only age (OR = 1.74, p = 0.005, 95%CI = 1.186-2.566), BMI (OR = 1.54, p = <0.001, 95% CI = 1.249-1.913) and waist circumference (OR = 1.16, p = 0.002, 95%CI = 1.056-1.271) were found to significantly predict the development of high blood pressure.

Conclusion

The prevalence of hypertension and prehypertension in this study was found to be low. Hypertension/prehypertension was more likely to develop with increasing age, BMI and waist circumference.

Renin-angiotensin system gene polymorphisms and high blood pressure in Lithuanian children and adolescents

Background

Epidemiological studies have demonstrated the influence of environmental factors on HBP in the population of Lithuanian children, although the role of genetic factors in hypertension has not yet been studied. The aim of this study was to assess the distribution of AGTR1, AGT, and ACE genotypes in the Lithuanian child population and to determine whether these genotypes have an impact on HBP in childhood.

Methods

This cross-sectional study enrolled 709 participants aged 12–15 years. The subjects were genotyped for AGT (M235 T, rs699), AGTR1 (A1166C, rs5186), and ACE (rs4340) gene polymorphisms using real-time and conventional polymerase chain reactions. Blood pressure and anthropometric parameters were measured.

Results

The prevalence of HBP was 38.6% and was more frequently detected in boys than in girls (47.9% vs. 29.5%; p < 0.001). No significant differences in the frequencies of the AGT or AGTR1 genotypes or alleles between boys and girls were observed, except for ACE genotypes. The mean SBP value was higher in HBP subjects with ACE ID genotype compared to those with ACE II homozygotes (p = 0.04). No significant differences in BP between different AGT and AGTR1 genotype groups were found. Boys who carried the ACE ID + DD genotypes had higher odds of having HBP than carriers of the ACE II genotype did (controlling for the body mass index (BMI): OR_MH = 1.83; 95% CI, 1.11–3.02, p = 0.024; and controlling for waist circumference (WC): OR_MH = 1.76; 95% CI, 1.07–2.92, p = 0.035). These associations were not significant among girls. The same trend was observed in the multivariate analysis – after adjustment for BMI and WC, only boys with ACE ID genotype and ACE ID + DD genotypes had statistically significantly increased odds of HBP (aOR = 2.05; 95% CI, 1.19–3.53 (p = 0.01) and aOR = 1.82; 95% CI, 1.09–3.04 (p = 0.022), respectively).

Conclusions

The evaluated polymorphisms of the AGT and AGTR1 genes did not contribute to the presence of HBP in the present study and may be seen as predisposing factors, while ACE ID genotypes were associated with significantly increased odds for the development of HBP in the Lithuanian child and adolescent population - especially in boys.

Blood pressure effects of adiposity in non-overweight children aged 6-17 years

BACKGROUND

Obesity is a well-established risk factor of elevated blood pressure; however, the relationships between normal weight status and the risk of hypertension and pre-hypertension are not clear.

AIM

The aim of this study is to describe the blood pressure effects of adiposity in non-overweight children.

METHODS AND RESULTS

In total, 588 097 non-overweight children aged 6-17 years were included from the National Surveys on Students' Constitution and Health. A non-linear relationship was found between age- and gender-standardised body mass index (BMI) z-score and pre-hypertension and hypertension, respectively. The odds ratios and 95% confidence intervals [ORs (95% CIs)] of pre-hypertension were 0.61 (0.59-0.63), 0.67 (0.65-0.68), 0.83 (0.83-0.84), 1.00 (reference), 1.13 (1.12-1.14), 1.18 (1.16-1.20) and 1.20 (1.18-1.22) for BMI z-scores of -1.2, -1.0, -0.5, 0 (reference), 0.5, 0.7 and 0.8, respectively. The ORs (95% CIs) of hypertension were 0.56 (0.54-0.58), 0.62 (0.61-0.64), 0.81 (0.80-0.82), 1.00 (reference), 1.17 (1.16-1.18), 1.23 (1.22-1.5) and 1.27 (1.24-1.29) for BMI z-scores of -1.2, -1.0, -0.5, 0 (reference), 0.5, 0.7 and 0.8, respectively. The above-mentioned associations were consistent in sub-group analysis by age, gender and height.

CONCLUSIONS

Non-linear relationships of BMI z-scores with pre-hypertension and hypertension were found in non-overweight children. Interventions to control blood pressure are also important in non-overweight children.

Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis

BACKGROUND

Despite substantial attention paid to the threat of elevated blood pressure in children and adolescents in high-income countries and the epidemic of hypertension in African adult populations, data on the burden of elevated blood pressure in African children and adolescents have not yet been synthesised. We did a systematic review and meta-analysis to provide estimates of the prevalence of elevated blood pressure and assess associated factors among children and adolescents in Africa.

METHODS

We searched Embase, PubMed, African Journals Online, and African Index Medicus to identify articles published from Jan 1, 1996, to Feb 2, 2017, and searched the reference list of retrieved articles. Each study was independently reviewed for methodological quality. We used a random-effects model to estimate the prevalence of elevated blood pressure across studies and heterogeneity (I²) was assessed via the χ² test on Cochran's Q statistic. This review is registered with PROSPERO, number CRD42015019029.

FINDINGS

We included 51 studies in qualitative synthesis and 25 in the meta-analysis reporting data of a pooled sample of 54 196 participants aged 2-19 years. Study quality was high with only four medium-quality studies and no low-quality studies. Prevalence of elevated blood pressure varied widely across studies (range 0·2-24·8%). The pooled prevalence of elevated blood pressure (systolic or diastolic blood pressure ≥95th percentile) was 5·5% (95% CI 4·2-6·9), whereas that of slightly elevated blood pressure (systolic or diastolic blood pressure ≥90th percentile and <95th percentile) was 12·7% (2·1-30·4). The prevalence of elevated blood pressure was largely associated with body-mass index (BMI), with a prevalence of elevated blood pressure six times higher in obese (30·8%, 95% CI 20·1-42·6) versus normal-weight children (5·5%, 3·1-8·4; p<0·0001).

INTERPRETATION

This study suggests a high prevalence of elevated blood pressure among children and adolescents in Africa, with overweight and obesity being an important risk factor. Efforts to address this burden of elevated blood pressure in children and adolescents should mainly focus on primary prevention at the community level, by promoting healthy lifestyles and avoiding other cardiovascular risk factors, especially overweight and obesity. This study also stresses the need for more elaborate studies using uniform and reliable diagnostic methods to reliably map the burden of elevated blood pressure in children and adolescents in Africa.

FUNDING

None.

Comparison of body mass index with abdominal obesity for identifying elevated blood pressure in children and adolescents: The SNEC study

Body mass index (BMI) and waist circumference (WC) are two common ways to measure obesity. There is a debate, however, about which of these two measures are more closely associated with elevated blood pressure (BP). The aim of this study is to investigate the prevalence of obesity and whether BMI and WC is better associated with elevated BP in children and adolescents. A representative sample of 8613 Chinese youth aged 7-17 years from seven cities in Northeastern China was selected and measurements of height, weight, WC, BP were taken from 2012 to 2013. The average age of the children was 11.3±2.3years. The prevalence of overweight/obese and abdominal obesity in the subjects was 35% and 44.8%, respectively. We found that both BMI and WC were significantly associated with elevated BP. An increase of 1kgm^-2 in BMI was associated with a 1.10 (1.08-1.12, 95% CI) increased risk of an elevated BP diagnosis in boys, and a 1.14 (1.11-1.16, 95% CI) increased risk in girls. Meanwhile, a 1cm increase in WC correlated with a 1.03 (1.02-1.04, 95% CI) and a 1.05 (1.04-1.06, 95% CI) increased risk of higher BP in boys and girls, respectively. Compared to the normal-weight youth, subjects with elevated BMI (BMI>85th) had higher risk of elevated BP (OR: 2.42, 95% CI: 2.13-2.75) than that of in elevated WC participants (OR: 2.00, 95% CI: 1.77-2.27). Therefore, BMI may associate better with elevated BP than WC in Chinese youth in our Seven Northeastern Cities study.

Development of hypertension in overweight adolescents: a review

The upward trend in adolescent hypertension is widely attributed to the adolescent obesity epidemic. Secular trends in adolescent prehypertension and hypertension have risen in congruence with increasing trends in the prevalence of overweight and obesity. The correlation between body mass index and blood pressure in adolescence is moderate to strong in most studies and strongest in those classified as overweight or obese. The mechanisms relating to the development of hypertension in overweight adolescents are unclear; however, a number of nonmodifiable and modifiable factors have been implicated. Importantly, certain clinical and biochemical markers in overweight adolescents are indicative of high risk for hypertension, including family history of hypertension and hyperinsulinemia. These characteristics may prove useful in stratifying overweight adolescents as high or low risk of comorbid hypertension. The treatment of overweight and obesity related hypertension in this population focuses on two key modalities: lifestyle change and pharmacotherapy. These approaches focus almost exclusively on weight reduction; however, a number of emerging strategies target hypertension more specifically. Among adolescents with overt hypertension there are also several factors that indicate higher risk of concurrent subclinical disease, persistent adult hypertension, and adult cardiovascular disease. This group may benefit substantially from more aggressive pharmacological treatments. Limitations in the literature relate to the paucity of studies reporting specific effects for the adolescent age group of overweight and obese individuals. Nonetheless, intervention for adiposity-related hypertension in adolescence may partially mitigate some of the cardiovascular risk in adulthood.

Association between obesity and high blood pressure among Lithuanian adolescents: a cross-sectional study

BACKGROUND

Most epidemiological studies have shown that the prevalence of high blood pressure (BP) has significantly increased among children and adolescents in various countries of the world. The aim of this study was to examine the associations between overweight, obesity, abdominal obesity and prehypertension and hypertension among Lithuanian adolescents aged 12-15 years.

METHODS

The subjects with increased BP (≥90th percentile) were screened on two separate occasions. Data on the body mass index (BMI), waist circumference (WC), and BP were analysed in 7,457 adolescents aged 12-15 years. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) for the associations were estimated using multivariate logistic regression models.

RESULTS

After two screenings, the study participants were categorised as prehypertensive (12.8%), hypertensive (22.2%), and normotensive (65%). The overall prevalence of overweight, obesity, and abdominal obesity (if WC was in the ≥75th percentile) were 12.1%, 2.4%, and 9%, respectively. After adjusting for age and sex, significant associations were found between overweight and obesity and high BP, namely, prehypertension (overweight: aOR = 2.62; 95% CI 2.13-3.23; obesity: aOR = 4.81; 95% CI 3.08-7.52) and hypertension (overweight: aOR = 3.56; 95% CI 3.02-4.19; obesity: aOR = 6.64; 95% CI 4.65-9.49). Prehypertension was found to be significantly associated with WC in the 75th- < 90th percentiles (aOR = 3.16; 95% CI 2.43-4.10) and WC in the ≥90th percentile (aOR = 4.08; 95% CI 2.35-7.10). For hypertension, significant associations were detected with WC in the 75th- < 90th percentiles (aOR = 3.92; 95% CI 3.18-4.82) and WC in the ≥90th percentile (aOR = 7.41; 95% CI 4.97-11.05).

CONCLUSIONS

Overweight, obesity, and abdominal obesity were associated with prehypertension and hypertension.

Factors affecting blood pressure profile in pre and postmenopausal women with obstructive sleep apnea hypopnea syndrome

PURPOSE

Obstructive sleep apnea hypopnea syndrome (OSAHS) is an independent risk factor for development of hypertension. Epidemiological surveys have found that risk of cardiovascular diseases increased in postmenopausal women. However, it is not well known about the profiles of hypertension of women with OSAHS in their different reproductive stages. This study aimed to investigate the difference of blood pressure profile between pre and postmenopausal women with OSAHS.

METHODS

Women who were tested by polysomnography (PSG) (n = 207) in Ruijin Hospital were recruited in the study. The subjects were divided into two groups of premenopausal women (24 with and 30 without OSAHS), and two groups of postmenopausal women (116 with and 37 without OSAHS). Among the groups, the differences of demographic and PSG variables were compared. The factors influencing blood pressure were further studied.

RESULTS

The prevalence of hypertension (56.9 %) in postmenopausal OSAHS patients was higher than the other three groups. Among OSAHS patients, both average systolic blood pressure (SBP) and diastolic blood pressure (DBP) of postmenopausal women were higher than those of premenopausal ones [(129.9 ± 16.16 mmHg vs. 123.7 ± 18.89), (84.96 ± 9.88 mmHg vs. 78.81 ± 10.34), P = 0.05, P < 0.01, respectively], with the elevation of DBP being more pronounced. For premenopausal women, body mass index (BMI) was the only factor affecting blood pressure (p < 0.05); in postmenopausal women, BMI was a factor affecting SBP, while BMI and apnea hypopnea index (AHI) affecting DBP (P < 0.05).

CONCLUSION

Blood pressure profile of postmenopausal women with OSAHS was affected by both BMI and AHI. But those of premenopausal ones were predominantly related to BMI.