Blood pressure profile in school children (6-16 years) of southern India: a prospective observational study

Establishing nomogram of blood pressure for late adolescents in India: Secondary analysis of NFHS-4 data

Background

Hypertension among adolescents is a public health problem, which is going to become more severe given the current obesity epidemic. There is a scarcity of information on the reference range value for blood pressure (BP) cut-off for adolescents.

Aim

We aimed to establish BP distribution in adolescents aged 15-19 years by using the nationally representative National Family Health Survey-4 (NFHS-4) data.

Materials and Methods

We analyzed the data of 15,936 boys and 1,04,132 girls aged 15-19 years in the NFHS-4 survey. We took the mean of systolic and diastolic BPs. Height for age z scores for each individual was calculated using the WHO Anthro plus. The sampling weight was taken as provided by the demographic and health surveys (DHS) website. Nomograms of systolic and diastolic BPs were made by calculating their 50^th, 90^th, and 95^th percentiles for each age (in months), gender, and height percentile for age categories.

Results

Both systolic and diastolic BPs increased with age and height centiles. The BP was higher in boys than girls. The average annual increase in systolic and diastolic BPs was 2.52 and 1.20 mmHg in boys and 0.50 and 0.46 mmHg in girls, respectively, when adjusted for height centiles.

Conclusion

This study provides a BP nomogram that can be generalized to all the Indian population. Research is required for the diagnostic performance of this nomogram for the diagnosis of adolescent hypertension.

Early-onset subclinical cardiovascular damage assessed by non-invasive methods in children with Juvenile Idiopathic Arthritis: analytical cross-sectional study

Chronic inflammation starting early in life and continuing into adulthood may predispose children with Juvenile Idiopathic Arthritis (JIA) to cardiovascular (CV) complications. To compare non-invasive CV risk markers- left ventricular mass index (LVMi), brachial artery flow mediated dilatation (FMD) and carotid artery intima-media thickness (CIMT) between patients with JIA and healthy controls. Measurements of LVMi, CIMT and FMD and lipid profile were compared between 4 and 18 year old 81 patients with JIA and 78 age and sex matched healthy controls. Among 81, 20 had systemic onset, 19 enthesitis related arthritis, 9 polyarticular rheumatoid factor (RF) + ve, 19 polyarticular RF -ve, 11 oligo-articular, and 3 un-differentiated JIA. FMD was significantly lower (p < 0.001), CIMT and LVMi significantly higher in patients (p ≤  0.001). CIMT showed positive correlation with blood pressure (p = 0.001), disease duration (p  ≤  0.001) and negative correlation with high density lipoprotein (HDL) (p ≤  0.001). FMD correlated positively with HDL (p = 0.006) and negatively with disease duration (p ≤  0.001). CIMT (p = 0.017) and FMD (p = 0.04) were significantly worse in active than inactive disease. Children with JIA have worse lipid profile, increased LVMi, CIMT, and reduced brachial artery FMD, suggestive of early cardiovascular dysfunction.

Blood pressure profile for children aged 5 to 6 years and its associated factors - a cross-sectional study in Kuching district, Sarawak

INTRODUCTION

This study aimed to determine the blood pressure profile for preschool children in Kuching Sarawak and its relationship with sociodemographic characteristics, nutritional status and parental hypertension.

METHODS

This was a cross sectional study conducted in a government preschool in Kuching district from January to June 2017. Data were collected using questionnaire as well as anthropometric and blood pressure measurements. Data were entered into and analyzed using SPSS Version 22.

RESULTS

A total of 229 preschool children participated in this study (response rate of 81%). About 9.7% of the respondents were at risk for hypertension. The mean systolic blood pressure was 95.6 mmHg (SD=8.36), and the mean diastolic blood pressure was 59.9 mmHg (SD=6.09). Ten percent of the children were overweight and 7.4% were obese. Binary logistics regression analysis indicated that gender (Male: OR = 3.085, p< 0.05), parent's education level (comparing primary education and below with secondary education: OR = 4.88, p<0.05; comparing primary education and below tertiary education: OR = 7.63, p<0.05) and ethnicity (comparing Malay with Chinese: OR = 0.10, p< 0.01) were significantly associated with being at risk for hypertension.

CONCLUSION

The study showed that 9.7% of the children were at risk for hypertension and that 17.4% had abnormal body weights. Identifying and tackling the factors leading to these issues will help to improve and ensure a better quality of non-communicable disease programs offered in primary health clinics and school health programs.

A Cross-Sectional Study on Correlates of High Blood Pressure among School-Going Children in an Urban Area

CONTEXT

School-going children are documenting the increasing incidence of high blood pressure (BP). Compared to adults, the prevalence of hypertension (HT) is low among children, but high BP among them can lead to HT in their adult life.

AIM

The aim of was to study the risk factors and correlates of high BP among school-going children.

MATERIALS AND METHODS

A cross-sectional study was carried out for 1½ years among 892 randomly selected school children of 6^th-10^th class. Measurements such as height, weight, and BP were recorded and classified as per the standard guidelines for given age and sex.

STATISTICAL ANALYSIS

Correlation and linear regression analysis were done for continuous variables. For dichotomous variables, mean and standard deviation were calculated and t-test was used in this study.

RESULTS

Higher age group, being male, and obesity were found to be significantly associated with elevated systolic BP (SBP) and elevated diastolic BP (DBP). Family history of diabetes and HT was significantly associated with elevated DBP. On linear regression analysis, the studied factors explained 30% variation in SBP and only 12% variation in DBP. Weight and body mass index explained the maximum variation in both SBP and DBP.

CONCLUSION

Overweight or obesity, being male, family history of HT, and increasing age were important risk factors of elevated BP.

Prevalence of Hypertension and its Risk Factors Among School Going Adolescents of Patna, India

INTRODUCTION

Hypertension (HT) has its origin in childhood and adolescent period but it goes undetected due to absence of sign and symptoms, unless specifically looked for during this period. It has been seen that one with raised blood pressure level in this period will also have raised Blood Pressure (BP) level in their adulthood and elderly period.

AIM

The present study was conducted to estimate the prevalence of HT and its risk factor among apparently healthy school going adolescents of Patna district.

MATERIALS AND METHODS

A cross-sectional study among 2913 school going adolescents of eighth to 10^th standard was conducted from April 2014 to August 2015 by adopting a two stage cluster sampling technique. The questions pertaining to risk behavior in relation to cardiovascular diseases from WHO's Global School based Student Health Survey were used for this study.

RESULTS

The mean systolic and diastolic blood pressure of study population was 107.4 mm of Hg (95% C.I. 106.93-107.77) and 67.4 mm of Hg (95% C.I. 67.26-67.54), respectively. Prevalence of pre-HT and HT was 10.9% and 4.6% in school going adolescents while prevalence of overweight/obesity was 1.5%. Both systolic and diastolic blood pressures had positive and significant correlation with age, height and body mass index. The proportion of children who had ever taken tobacco was 5.3%, cigarette smoking 4.3%, alcohol consumption 2.1%, and excess salt intake 22.3%. Only 49.1% children were doing physical activity at least one hour a day in past seven days for maintenance of good health.

CONCLUSION

The present study recommends that regular screening of blood pressure level must be initiated in adolescents so that remedial measure can be initiated as early as possible.