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Prevalence and subtypes of hypertension in normal-weight and obese Indian adolescents: a cross-sectional study. J Hum Hypertens 2022; 36:1003-1010. [PMID: 34526646 DOI: 10.1038/s41371-021-00605-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 07/24/2021] [Accepted: 09/01/2021] [Indexed: 11/08/2022]
Abstract
This cross-sectional study examined the prevalence, stages, subtypes of hypertension, and the associated risk factors in adolescent school children in Western India. We screened 2,644 adolescents, from 10 different private and government schools in urban and rural areas for hypertension, as defined by the 2017 Clinical Practice Guidelines. The association of stages and subtypes with age, gender, body mass index, type of school, and place of residence was analysed. 197 children (7.5%) had hypertension; 170 (6.4%) had stage I, 27 (1%) had stage II and 76 (2.9%) had elevated blood pressure (EBP). The risk of EBP was higher in children > 15 years of age (p = 0.006). Compared with normal-weight children, obese, and overweight children had a higher risk of hypertension [odds ratio (OR) 9 (5.84, 13.88) and 3.77 (2.59, 5.48) respectively], whereas underweight children had a lower risk [OR 0.39 (0.16, 0.98)]. Normal-weight hypertension was seen in 5.2% and was higher in children from government schools (9.4%). Systolic-diastolic hypertension (SDH) was the most common subtype, seen in 136 (5.1%). SDH was more common in girls, in rural children, and in those with stage II hypertension. Isolated diastolic hypertension, seen in 51 (1.9%), was more common in boys, in urban children, and in those with EBP.
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Vasudevan A, Thomas T, Kurpad A, Sachdev HS. Prevalence of and Factors Associated With High Blood Pressure Among Adolescents in India. JAMA Netw Open 2022; 5:e2239282. [PMID: 36315144 PMCID: PMC9623439 DOI: 10.1001/jamanetworkopen.2022.39282] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
IMPORTANCE High blood pressure (BP) in children and adolescents is becoming one of the most common health conditions worldwide and is much more widely prevalent than previously thought. OBJECTIVE To estimate the prevalence of high BP in adolescents in India and identify associated factors. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study is a secondary analysis of data from the Comprehensive National Nutrition Survey (CNNS, 2016-2018), which used a multistage, stratified, probability proportion to size cluster sampling design to enroll a nationally representative sample of households and individuals aged 10 to 19 years across all states and union territories of India. Adolescents with acute or chronic illness, physical deformity, mental illness, or cognitive disability were excluded from the survey. Because BP was measured only in children between 10 and 19 years of age, only data from children within this age group were included for secondary analyses. Data analysis was performed from March 2021 to April 2022. EXPOSURES Anthropometry. MAIN OUTCOMES AND MEASURES On the basis of the 2017 American Academy of Pediatrics guidelines, high BP was defined as stage 1 and 2 hypertension, with BP above the 95th percentile in children younger than 13 years and greater than 130/80 mm Hg in children 13 years or older. The association of age, sex, region, socioeconomic status, body mass index, fasting blood glucose, hemoglobin A1c, and lipid profile with high BP were examined using log binomial regression. RESULTS Among 16 182 eligible children aged 10 to 19 years (mean [SD] age, 14.2 [2.8] years; 7849 [48.5%] female and 8333 [51.5%] male), 11 718 had valid BP data with 3 repeated readings. the prevalence of high BP was 35.1% (95% CI, 31.5%-38.9%) in children aged 10 to 12 years and 25.1% (95% CI, 22.5%-28.0%) in children 13 years or older. Overweight and obesity were associated with a higher risk of high BP in both younger (prevalence ratio, 1.17; 95% CI, 1.04-1.34) and older children (prevalence ratio, 1.33; 95% CI, 1.18-1.49). The prevalence of high BP in younger children with stunting was high at 40.1% (95% CI, 31.9%-48.9%) and was 21.9% (95% CI, 18.2%-26.1%) among older children with stunting. In both age groups, high BP coexisted with other cardiovascular disease risk factors, such that adolescents with high fasting blood glucose, high hemoglobin A1c, high triglyceride, and high low-density lipoprotein cholesterol levels had a higher risk of high BP. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the prevalence of high BP, along with cardiovascular risk factors, was substantial in Indian adolescents. There is a need to screen and identify adolescents who have high BP and initiate interventions to control the burden of hypertension and its consequences in India.
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Affiliation(s)
- Anil Vasudevan
- Department of Pediatric Nephrology, St Johns Medical College and Hospital, St John’s Medical College, Bengaluru, India
| | - Tinku Thomas
- Department of Biostatistics, St John’s Medical College, Bengaluru, India
| | - Anura Kurpad
- Department of Physiology, St John’s Medical College, Bengaluru, India
| | - Harshpal S. Sachdev
- Paediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
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Prevalence of prehypertension and hypertension and its risk factors in Iranian school children: a population-based study. J Hypertens 2019; 36:1816-1824. [PMID: 29847484 DOI: 10.1097/hjh.0000000000001789] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Because of the incidence of a childhood obesity epidemic and the widespread changes in people's lifestyle, the prevalence of high blood pressure in children is increasing. This study was conducted to determine the prevalence of prehypertension and hypertension and its risk factors in Iranian children. METHODS Using random cluster sampling in urban areas and census in rural areas, a total of 5620 schoolchildren aged 6-12 years living in Shahroud, Northeast of Iran, were studied. The prevalence of hypertension was determined on the basis of the fourth report of the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents by age, sex, and place of residence. The factors influencing blood pressure were studied using multivariate regression. RESULTS The prevalence of prehypertension was 7.44% and the prevalence of hypertension was 6.82%. The relative risk ratio (RRR) of prehypertension was 1.17 for BMI, 1.43 for female sex, and 3.71 for residence in rural areas; in addition, the RRR of hypertension was 1.22 for BMI, 6.64 for residence in rural areas, 1.69 for moderate economic status, and 1.89 for low economic status. CONCLUSION The prevalence of prehypertension and hypertension is significant in children and alarming in rural areas and requires urgent intervention. As factors such as high BMI, female sex, residence in rural areas, and moderate and low economic status are associated with increased risk of prehypertension and hypertension, it is recommended to conduct routine care programs at regular intervals in schools to prevent hypertension and its related complications.
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Fowokan A, Punthakee Z, Waddell C, Rosin M, Morrison KM, Gupta M, Rangarajan S, Teo K, Lear S. Multifactorial correlates of blood pressure in South Asian children in Canada: a cross-sectional study. BMJ Open 2019; 9:e027844. [PMID: 30962241 PMCID: PMC6500289 DOI: 10.1136/bmjopen-2018-027844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE We sought to explore various correlates of blood pressure (BP) and hypertension, and to identify the most important aggregate combination of correlates for BP in South Asian children. DESIGN Cross-sectional study SETTING: Community-based recruitment in two Canadian cities PARTICIPANTS: South Asian children (n=762) provided a range of physiological, lifestyle and social variables. BP was assessed using an automated device. Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and BP were transformed to z-scores using published standards. OUTCOME MEASURES Linear and logistic regression analyses were used to explore associations between the range of variables with BP z-scores and hypertension while stepwise regression was used to identify aggregate factors that provided explanatory capacity for systolic BP (SBP) and diastolic BP (DBP) z-scores. RESULTS A range of variables were associated with BP z-score and hypertension in unadjusted analysis. On adjustment for confounders, the association between age (β=-0.054, 95% CI=-0.078 to 0.029), female sex (β=-0.208, 95% CI=-0.350 to -0.067), height (β=0.022, 95% CI=0.011 to 0.033), weight (β=0.047, 95% CI=0.040 to 0.055), BMI z-score (β=0.292, 95% CI=0.249 to 0.336), WC z-score (β=0.273, 95% CI=0.219 to 0.326), WHtR z-score (β=0.289, 95% CI=0.236 to 0.342), heart rate (β=0.016, 95% CI=0.010 to 0.022), child's perception of body image (β=0.183, 95% CI=0.128 to 0.239) and grip strength (β=0.025, 95% CI=0.007 to 0.043) with SBP z-score remained. In stepwise regression, age, sex, BMI z-score, heart rate and weight accounted for 30% of the variance of SBP z-score, while age, BMI z-score, heart rate and daily fast food intake accounted for 23% of the DBP z-score variance. CONCLUSION Our findings suggest that variables, such as age, sex, height, adiposity and heart rate, provide stronger explanatory capacity to BP variance and hypertension risk than other variables in South Asian children.
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Affiliation(s)
- Adeleke Fowokan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Zubin Punthakee
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Charlotte Waddell
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Miriam Rosin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Milan Gupta
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Koon Teo
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Scott Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
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Xu RY, Zhou YQ, Zhang XM, Wan YP, Gao X. Body mass index, waist circumference, body fat mass, and risk of developing hypertension in normal-weight children and adolescents. Nutr Metab Cardiovasc Dis 2018; 28:1061-1066. [PMID: 30207269 DOI: 10.1016/j.numecd.2018.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/17/2018] [Accepted: 05/24/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS We prospectively examined the association between three adiposity indices, including body mass index (BMI), waist circumference (WC), and percentage of body fat (PBF), and risk of hypertension in normal-weight Chinese children. METHODS AND RESULTS The current study included 1526 (713 boys and 813 girls) normal-weight Chinese children (age 6-14 years old), who were free of hypertension at baseline (2014). Heights, body weight, WC, and PBF (estimated by bioelectrical impedance analysis) were measured at the baseline. Blood pressure was repeatedly measured in 2014, 2015 and 2016. Hypertension was defined as either high systolic blood pressure and/or high diastolic blood pressure, according to age- and sex-specific 95th percentile for Chinese children. We used Cox proportional hazards model to calculate the association between exposures and hypertension. We identified 88 incident hypertension cases during two years of follow up. High BMI was associated with high risk of developing hypertension after adjusting for potential confounders. The adjusted hazard ratio for hypertension was 2.88 (95% CI: 1.24, 6.69) comparing two extreme BMI quartiles. Each SD increase of BMI (≈1.85 kg/m2) was associated with a 32% higher likelihood to developing hypertension (Hazard ratio = 1.32; 95% CI: 1.003, 1.73). In contrast, we did not find significant associations between WC or PBF and higher hypertension risk (p-trend >0.2 for both). CONCLUSION High BMI, but not WC and PBF, was associated with high risk of hypertension in normal-weight Chinese children.
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Affiliation(s)
- R Y Xu
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, China
| | - Y Q Zhou
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - X M Zhang
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Y P Wan
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, China.
| | - X Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.
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Sinha A, Bagga A. Screening Urinalysis in Detection of Chronic Kidney Disease in Children. Indian J Pediatr 2018; 85:603-604. [PMID: 29790006 DOI: 10.1007/s12098-018-2707-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Genovesi S, Antolini L, Orlando A, Brahmochary S, De Servi A, Capelli S, Giussani M, Nava E, Agostoni C, Gallieni M. Poor early growth and high salt intake in Indian infants. Int J Food Sci Nutr 2016; 68:467-472. [DOI: 10.1080/09637486.2016.1249463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Simonetta Genovesi
- Department of Medicine and Surgery, University of Milano-Bicocca and Nephrology Unit, San Gerardo Hospital, Monza, Italy
- Department of Cardiovascular Neural and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy
| | - Laura Antolini
- Department of Medicine and Surgery, Centre of Biostatistics for Clinical Epidemiology University of Milano-Bicocca, Monza, Italy
| | - Antonina Orlando
- Department of Medicine and Surgery, University of Milano-Bicocca and Nephrology Unit, San Gerardo Hospital, Monza, Italy
| | | | | | | | | | - Elisa Nava
- Department of Medicine and Surgery, University of Milano-Bicocca and Nephrology Unit, San Gerardo Hospital, Monza, Italy
| | - Carlo Agostoni
- Pediatric Clinic, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Gallieni
- Project for People, Milan, Italy
- Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Italy
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Mishra PE, Shastri L, Thomas T, Duggan C, Bosch R, McDonald CM, Kurpad AV, Kuriyan R. Waist-to-Height Ratio as an Indicator of High Blood Pressure in Urban Indian School Children. Indian Pediatr 2016; 52:773-8. [PMID: 26519712 DOI: 10.1007/s13312-015-0715-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine the utility of waist-to-height ratio to identify risk of high blood pressure when compared to body mass index and waist circumference in South Indian urban school children. DESIGN Secondary data analysis from a cross-sectional study. SETTING Urban schools around Bangalore, India. PARTICIPANTS 1913 children (58.1% males) aged 6-16 years with no prior history of chronic illness (PEACH study). METHODS Height, weight, waist circumference and of blood pressure were measured. Children with blood pressure ?90th percentile of age-, sex-, and height-adjusted standards were labelled as having high blood pressure. RESULTS 13.9% had a high waist-to-height ratio, 15.1% were overweight /obese and 21.7% had high waist circumference. High obesity indicators were associated with an increased risk of high blood pressure. The adjusted risk ratios (95% CI) of high systolic blood pressure with waist-to-height ratio, body mass index and waist circumference were 2.48 (1.76, 3.47), 2.59 (1.66, 4.04) and 2.38 (1.74, 3.26), respectively. Similar results were seen with high diastolic blood pressure. CONCLUSION Obesity indicators, especially waist-to-height ratio due to its ease of measurement, can be useful initial screening tools for risk of high blood pressure in urban Indian school children.
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Affiliation(s)
- P E Mishra
- St. Johns Medical College, and; Divisions of #Epidemiology and Biostatistics, and Nutrition, St. Johns Research Institute; Bangalore, India; Division of Gastroenterology, Hepatology and Nutrition, and Boston Childrens Hospital, Boston, MA, USA; Department of Biostatistics, Harvard School of Public Health; Boston, MA, USA. Correspondence to: Dr Rebecca Kuriyan, Division of Nutrition, St. Johns Research Institute, Bangalore 560 034, India.
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Borah PK, Devi U, Biswas D, Kalita HC, Sharma M, Mahanta J. Distribution of blood pressure & correlates of hypertension in school children aged 5-14 years from North East India. Indian J Med Res 2016; 142:293-300. [PMID: 26458345 PMCID: PMC4669864 DOI: 10.4103/0971-5916.166591] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background & objectives: Elevated blood pressure (BP) in the young predicts serious cardiovascular events in the adults. High prevalence of adult hypertension reported from Assam, North East (NE) India may be linked with elevated blood pressure in the childhood. The present study was an attempt to describe the distribution of BP and correlates of hypertension in children aged 5-14 yr. Methods: A total of 10,003 school children from 99 schools of Dibrugarh district, Assam, NE India, were surveyed by stratified random cluster method. Blood pressure, demographic and anthropometric information were recorded. Blood pressure was categorized in to normal, prehypertension, stage I and stage II hypertension. Results: Girls had significantly higher (104.2 ± 12.0 vs. 103.2 ± 11.6 mm Hg, P<0.001) mean systolic blood pressure (SBP) than boys. Both SBP and diastolic blood pressure (DBP) revealed significant correlation with age, height, weight and BMI in overall and in gender specific analysis. Hypertension was found in 7.6 per cent school children (Boys: 7.3%, Girls: 7.8%). In multivariable analysis older age (OR 3.3, 95% CI: 2.82-3.91), children from tea garden community (OR 1.3, 95% CI: 1.08-1.55) and other community (OR 1.4, 95% CI: 1.18-1.73) and overweight (OR 1.5, 95% CI: 1.1-2.1) were independently associated with hypertension. Interpretation & conclusions: Mean blood pressure in the young school children of 5-14 yr was high. A programme comprising screening, early detection and health promotion through school health programmes may help prevent future complications of hypertension.
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Affiliation(s)
- Prasanta Kr Borah
- Regional Medical Research Centre (ICMR), Assam Medical College & Hospital, Dibrugarh, India
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Nkeh-Chungag BN, Sekokotla AM, Sewani-Rusike C, Namugowa A, Iputo JE. Prevalence of Hypertension and Pre-hypertension in 13-17 Year Old Adolescents Living in Mthatha - South Africa: a Cross-Sectional Study. Cent Eur J Public Health 2015; 23:59-64. [DOI: 10.21101/cejph.a3922] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gallieni M, Ene-Iordache B, Aiello A, Tucci B, Sala V, Brahmochary Mandal SK, Doneda A, Stella A, Carminati S, Perico N, Genovesi S. Hypertension and kidney function in an adult population of West Bengal, India: role of body weight, waist circumference, proteinuria and rural area living. Nephrology (Carlton) 2014; 18:798-807. [PMID: 23889782 DOI: 10.1111/nep.12142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2013] [Indexed: 11/30/2022]
Abstract
AIM Hypertension (HTN) and chronic kidney disease (CKD) are important emerging problems in low-income countries, with an increasing number of patients dying from their consequences. METHODS A project for investigating these issues was carried out in West Bengal, India, in 2536 adult subjects. Body mass index (BMI) was classified using traditional and new cut-offs identified by the World Health Organization for Asian populations. HTN was classified according to the Joint National Committee 7 and CKD according to presence of estimated glomerular filtration rate (eGFR) of less than 60 mL/min per 1.73 m(2) . RESULTS Normal BMI (Asian reference) was found in 41.5% of subjects, while 33.4% were underweight, 19.3% overweight and 5.8% obese. Prevalence of stage 1 and 2 HTN was 39.4%. Proteinuria (urine dipstick >1+) was present in 7.7% of the sample. In a subsample of 1526 subjects, eGFR of less than 60 mL/min per 1.73 m(2) was found in 4.2%. At multivariate analysis, factors associated with HTN were weight classes (P<0.001), presence of proteinuria (P<0.001) and family history of HTN (P=0.028), while living in rural areas was associated with lower risk for HTN (P=0.003). eGFR was inversely related to BMI (P=0.03), the presence of proteinuria (P<0.001) and HTN (P<0.003), and directly related to living in rural areas (P=0.003). CONCLUSION High prevalence of HTN was found in subjects with very limited access to health care in West Bengal. HTN was more common in overweight individuals, but also affected normal weight and underweight subjects in a significant part of the tested population. Preventive medicine should be a strong priority in this setting.
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Affiliation(s)
- Maurizio Gallieni
- Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Graduate School of Nephrology, University of Milan, Milan, Italy; Project for People, Milan, Italy
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Prehypertension and Hypertension among Schoolchildren in Brazzaville, Congo. Int J Hypertens 2014; 2014:803690. [PMID: 24963398 PMCID: PMC4054926 DOI: 10.1155/2014/803690] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 05/06/2014] [Indexed: 11/18/2022] Open
Abstract
Background. To determine the prevalence and associated factors of prehypertension (pre-HT) and hypertension (HT) in schoolchildren at Brazzaville (Congo). Methods. This cross-sectional study was conducted from March to May 2011 in five representative urban schools in Brazzaville. American Pediatric Society's definition of pre-HT and HT was used. The measurement of blood pressure was obtained using auscultator method. Univariable and multivariable analyses were performed to establish associations between blood pressure levels and sociobiographical factors. Results. 603 children were included. The mean age was 11.8 ± 3.6 years (range 5-18 years). The prevalence of pre-HT was 20.7% (n = 125). Factors associated with pre-HT were secondary school (P = 0.02), private schools (P < 0.004), migrants (P = 0.03), the obese (P = 0.004), high socioeconomic level (P < 0.01), and overweight (P = 0.02). In logistic regression, the independent determinants of pre-HT were secondary school (P = 0.0001), migration (P = 0.04), obesity (P = 0.004), and overweight (P = 0.01). The prevalence of HT was 10.1% (n = 61) during the first screening and 3.3% (n = 20) in second screening. The independent determinants of HT were obesity (P = 0.0001) and overweight (P = 0.0001). Conclusion. Pre-HT and HT are emerging as a mass problem in Congolese schoolchildren with urban migration and overweight/obesity to be controlled and prevented.
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Hypertension in Developing Countries. Can J Cardiol 2014; 30:527-33. [DOI: 10.1016/j.cjca.2014.02.020] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 02/28/2014] [Accepted: 02/28/2014] [Indexed: 11/23/2022] Open
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Gallieni M, Aiello A, Tucci B, Sala V, Brahmochary Mandal SK, Doneda A, Genovesi S. The burden of hypertension and kidney disease in Northeast India: the Institute for Indian Mother and Child noncommunicable diseases project. ScientificWorldJournal 2014; 2014:320869. [PMID: 24616621 PMCID: PMC3927758 DOI: 10.1155/2014/320869] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 10/27/2013] [Indexed: 11/17/2022] Open
Abstract
Chronic noncommunicable diseases (NCDs) such as hypertension, atherosclerosis, acute myocardial infarction, stroke, diabetes, obesity, and chronic kidney disease are the major cause of death not only in high income, but also in medium and low income countries. Hypertension and diabetes, the most common causes of chronic kidney disease, are particularly common in southeast Asian Countries. Because early intervention can markedly slow the progression of these two killer diseases, assessment of their presence through screening and intervention program is a priority. We summarize here results of the screening activities and the perspectives of a noncommunicable diseases project started in West Bengal, India, in collaboration with the Institute for Indian Mother and Child (IIMC), a nongovernmental voluntary organization committed to promoting child and maternal health. We started investigating hypertension and chronic kidney disease with screen in school-age children and in adults >30 years old. We found a remarkable prevalence of hypertension, even in underweight subjects, in both children and adult populations. A glomerular filtration rate <60 mL/min was found in 4.1% of adult subjects significantly higher than that of 0.8% to 1.4% reported 10 years ago. Increased awareness and intervention projects to identify NCDs and block their progression are necessary in all countries.
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Affiliation(s)
- Maurizio Gallieni
- Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Graduate School of Nephrology, University of Milan, Via Pio II, 3-20153 Milano, Italy
| | - Angela Aiello
- Dialysis Unit, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Benedetta Tucci
- Nephrology and Dialysis Unit, San Gerardo Hospital, Graduate School of Nephrology, University of Milano Bicocca, 20090 Monza, Italy
| | - Valeria Sala
- Nephrology and Dialysis Unit, San Gerardo Hospital, Graduate School of Nephrology, University of Milano Bicocca, 20090 Monza, Italy
| | | | | | - Simonetta Genovesi
- Nephrology and Dialysis Unit, San Gerardo Hospital, Graduate School of Nephrology, University of Milano Bicocca, 20090 Monza, Italy
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Raj M, Krishnakumar R. Hypertension in children and adolescents: epidemiology and pathogenesis. Indian J Pediatr 2013; 80 Suppl 1:S71-6. [PMID: 22941155 DOI: 10.1007/s12098-012-0851-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 06/29/2012] [Indexed: 12/14/2022]
Abstract
High blood pressure is one among the leading contributors to burden of disease globally. Approximately 54 % of stroke and 47 % of ischemic heart disease events worldwide were attributable to high blood pressure in the year 2001. There is deficiency of data on the long-term outcome of hypertension in children. In spite of this, there is sufficient evidence to suspect that the health risks of hypertension in pediatric patients are substantial. Hypertension in childhood is known to result in hypertension in young adulthood. The epidemiology of hypertension in children is well represented from various studies conducted across continents. Factors like methodological issues in measurement, socio demographic differences, adiposity levels and ethnicity appear to influence the distribution of blood pressure as well as prevalence of hypertension in children. The etio-pathogenesis of essential (primary) hypertension is multi-factorial in origin. Obesity, insulin resistance, activation of sympathetic nervous system, alterations in sodium homeostasis, renin-angiotensin system changes, changes in vascular smooth muscle structure and reactivity, high serum uric acid levels, genetic factors and fetal programming have been reported to contribute to this disorder. The causes of secondary hypertension vary with age. Renal disorders and coarctation of the aorta are the most common causes of hypertension in children up to age 6 y. In older children, renal parenchymal disease remains the most frequent cause of increased blood pressure. Other causes of hypertension in children are relatively rare and include systemic arteritis and certain tumours, endocrine dysfunction, and neurologic disorders.
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Affiliation(s)
- Manu Raj
- Division of Pediatric Cardiology, Amrita Institutes of Medical Sciences and Research Centre, Kochi, Kerala, India.
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The increased prevalence of left ventricular hypertrophy and concentric remodeling in UK Indian Asians compared with European Whites. J Hum Hypertens 2012. [DOI: 10.1038/jhh.2012.50] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Nutritional status and its relationship with blood pressure among children and adolescents in South China. Eur J Pediatr 2012; 171:1073-9. [PMID: 22311167 DOI: 10.1007/s00431-012-1684-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 01/24/2012] [Indexed: 10/14/2022]
Abstract
The present study measures the nutritional status and the blood pressure to assess their relationship in a group of children and adolescents in the Hainan province, China. A total of 5,456 students aged 7 to 18 years were recruited from 10 public schools in Hainan province of South China during the period March 2009 to December 2009. Height, weight, systolic blood pressure, and diastolic blood pressure were measured by health-care professionals. Body mass index (BMI) was calculated and used to define thinness, overweight, and obesity according to the existing standards. Prevalence of thinness, overweight, obesity, pre-hypertension, and hypertension was computed, and logistical regression model was used to examine the association of BMI with elevated blood pressure. A high prevalence of thinness was observed in male and female children and adolescents (34.0% and 34.3%, respectively). The percentage of overweight and obesity was 2.7% and 1.3%, respectively. Pre-hypertension and hypertension were detected in 3.9% and 3.3% children and adolescents, respectively. Multivariate logistical regression analysis showed that obesity was positively associated with both pre-hypertension and hypertension, with adjusted odds ratio of 1.44 (95% confidence interval (CI) = 1.08-1.92, P = 0.014) and 2.00 (95%CI = 1.53-2.60, P < 0.001) compared to normal weight students. Overweight was also associated with pre-hypertension and hypertension. However, no significant association between thinness and pre-hypertension and hypertension was found. In conclusion, this study showed that thinness, especially mild thinness, was a major public health problem among children and adolescents in Hainan province of South China. Overweight and obesity were strongly associated with pre-hypertension and hypertension among studied students.
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Prasad DS, Kabir Z, Dash AK, Das BC. Childhood cardiovascular risk factors in South Asians: A cause of concern for adult cardiovascular disease epidemic. Ann Pediatr Cardiol 2011; 4:166-71. [PMID: 21976880 PMCID: PMC3180978 DOI: 10.4103/0974-2069.84663] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Cardiovascular risk factors in children are increasing at an alarming rate in the western world. However, there is limited information regarding these in the South Asian children. This review attempts at summarizing such evidence. South Asians are remarkable for the earlier onset of adult cardiovascular disease (CVD) by almost a decade compared to the Caucasians. We identified published literature, mainly on PubMed, Embase and Cochrane library using specific search terms such as lipid abnormalities, high blood pressure, hyperglycemia, tobacco use, obesity, physical inactivity, and unhealthy dietary practices. Atherosclerotic CVD processes begin early in childhood and are influenced over the life course by genetic and potentially modifiable risk factors and environmental exposure. 80% of adult CVD burden will fall on the developing nations by 2020. The concept of primordial prevention is fast emerging as a necessary prevention tool to curb adult CVD epidemic. Established guidelines and proven preventive strategies on cardiovascular health exist; however, are always implemented half-heartedly. Composite screening and prediction tools for adults can be adapted and validated in children tailored to South Asian population. South Asian children could be at a greater risk of developing cardiovascular risk factors at an earlier stage, thus, timely interventions are imperative.
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Affiliation(s)
| | - Zubair Kabir
- Epidemiologist, Research Institute for a Tobacco Free Society, The Digital Depot, Thomas Street, Dublin, Ireland, India
| | - Ashok Kumar Dash
- Department of Pathology, M.K.C.G. Medical College, Berhampur, Orissa, India
| | - Bhagabati Charan Das
- Department of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneshwar, Orissa, India
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Tocci G, Volpe M. Olmesartan medoxomil for the treatment of hypertension in children and adolescents. Vasc Health Risk Manag 2011; 7:177-81. [PMID: 21490943 PMCID: PMC3072741 DOI: 10.2147/vhrm.s11672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Indexed: 11/23/2022] Open
Abstract
Prevalence of hypertension in children and adolescents has progressively and continuously increased over recent decades. Thus, early and effective control of high blood pressure may be considered an effective therapeutic approach, in order to reduce the burden of hypertension-related cardiovascular disease in future. In the past, due to the absence of prospective, long-term, randomized, controlled clinical trials performed in young hypertensive patients, lifestyle changes have been long seen as the only strategy to reduce high blood pressure levels. More recently, clinical data on the efficacy and safety of five major classes of antihypertensive drugs (including angiotensin converting enzyme inhibitors, angiotensin receptor blockers [ARBs], beta-blockers, calcium-antagonists, and diuretics) have become available. In particular, these trials demonstrated dose-dependent blood pressure reductions and a good tolerability profile of several ARBs in hypertensive children and adolescents. An overview is provided of the clinical benefits of early detection and prompt intervention of high blood pressure levels, with a closer analysis of recent clinical trials, performed with olmesartan medoxomil in young subjects with hypertension.
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Affiliation(s)
- Giuliano Tocci
- Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
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