Background: Hypertension and associated factors among adolescents have not been given the deserved attention in health care, more so as hypertensive children end up as hypertensive adults with serious co-morbidities. This is even more expedient among public school students, who in our environment are generally of lower socioeconomic status than those in private schools.
Objective: To determine the BP profiles and association of obesity indicators, socioeconomic level and physical activity with hypertension among public secondary school students.
Methodology: A cross-sectional school-based assessment of blood pressure (BP), body mass index (BMI), weight to height ratio (WHR), waist circumference (WC), physical activity and socioeconomic level among 593 students aged 10 – 17 years in public schools in Nnewi, Southeast Nigeria was carried out.
Results: The mean systolic BP increased with age and was higher for girls than for boys. The prevalence of systolic hypertension and prehypertension were 8.4% and 6.6% respectively, while that of diastolic hypertension and prehypertension were 5.7% and 11.8% respectively. Both systolic and diastolic hypertension occurred in 2.4% of students. Girls had a higher prevalence of hypertension – both systolic and diastolic. There was no significant gender difference in the prevalence of systolic hypertension and prehypertension between early and late adolescents. Early adolescent males were more likely to have diastolic hypertension and prehypertension compared to late adolescent males, while no difference in prevalence was noted among the females. Systolic hypertension was more evident in the lower socioeconomic level, those with minimal physical activity, and those in the obese/overweight categories of BMI, WC, and WHR.
Conclusion: There is a noteworthy prevalence of hypertension among adolescent public secondary school students in Nnewi. This was significantly higher among the female gender, lower socioeconomic level and students with minimal physical activity. Waist circumference in the obese/overweight category very likely predicts hypertension.
National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: A Working Group Report from the National High Blood Pressure Education Program. Pediatrics 1996; 98 (4): 649–658. Available at http://pediatrics.aappublications.org/content/98/4/649.
Souza CB, Dourado CS, Mill JG, Salaroli LB, Molina MCB. Prevalence of hypertension in children from public schools. Int J Cardiovasc Sci. 2017; 30(1): 42–51.
Mladenova S, Andreenko E. The prevalence of high-normal blood pressure and hypertension among 8 to 15-year-old Bulgarian children and adolescents with various nutritional status (Smolyan Region, 2012-2014). Anthropologist 2015; 21(1,2): 51–60.
Bugaje MA, Yakubu AM, Ogala WN. Prevalence of adolescent hypertension in Zaria. Nigerian Journal of Paediatrics 2005; 32 (4): 77–82.
Ezeudu EC, Chukwuka JO, Ebenebe JC, Igwe WC, Egbuonu I. Hypertension and prehypertension among adolescents attending secondary schools in urban area of south-east Nigeria. PanAfrican Medical Journal 2018; 31: 145.
Ba HO, Menta I, Camara Y, Sidibe N, Dao A, Sangare I et al. Prevalence of high blood pressure (HBP) in the population of 5-17 years in Bamako. Heart and Cardiology: Open Access 2016; 2 (1). http://crescopublications.org/pdf/hcoa/HCOA-2-006.pdf. Article Number: HCOA-2-006.
Mbolla BFE, Okoko AR, Babela JRM, Bowassa GE, Gombet TR, Kimbally-Kaky S. Prehypertension and hypertension among school children in Brazzaville, Congo. International Journal of Hypertension 2014, Article ID 803690, 6 pages. http://dx.doi.org/10.1155/2014/803690.
Nichols S, Cadogan F. Blood pressure and its correlates in Tobagonian adolescents. West Indian Medical Journal 2006; 55 (5): 1–8.
Tony L, Areekal B, Nair ATS, Ramachandran R, Philip RR, Rajasi RS, et al. Prevalence of hypertension and pre-hypertension among adolescent school children in Thiruvananthapuram, Kerala, India. Int J Community Med Public Health 2016; 3 (12): 3556–3563.
Falkner B, Gidding SS, Ramirez-Garnica G, Wiltrout SA, West D, Rappaport EB. The relationship of body mass index and blood pressure in primary care pediatric patients. J Pediatr 2006; 148(2): 195–200.
Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ. Overweight, Ethnicity, and the Prevalence of Hypertension in School-Aged Children. Pediatrics 2004; 113 (3): 475–482.
Riley M, Bluhm B. High blood pressure in children and adolescents. American Family Physician 2012; 85 (7): 693–700.
Soylu A, Kavukcu S, Turkmen M, Cabuk N, Duman M. Effect of socioeconomic status on blood pressure in children living in a developed country. Pediatr Int 2000; 42(1): 37–42.
Brummett BH, Babyak MA, Siegler IC, Shanahan M, Harris KM, Elder GH, et al. Systolic blood pressure, socioeconomic status, and behavioral risk factors in a nationally representative US young adult sample. Hypertension 2011; 58: 161–166.
Oyedeji GA. Socio-economic and cultural background of hospitalized children in Ilesha. Nigerian Journal of Paediatrics 1985; 12: 111–117.
U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung, and Blood Institute. The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. NIH Publication No. 05-5267. Originally printed September 1996 (96-3790). Revised May 2005.
Revelas A, Tahmazidis O. Defining hypertension in children. South African Family Practice 2012; 54(2): 100–105.
World Health Organization. Waist Circumference and Waist-Hip Ratio. Report of a WHO Expert Consultation. Geneva, 8-11 December 2008. World Health Organization 2011.
Chen X, Wang Y. Tracking of blood pressure from childhood to adulthood. A systematic review and meta-regression analysis. Circulation 2008; 117(25): 3171–3180. Available at: http://circ.ahajournals.org.18559702.
Moselakgomo VK, Toriola AL, Shaw BS, Goon DT, Akinyemi O. Body mass index, overweight, and blood pressure among adolescent school children in Limpopo provice, South Africa. Rev Paul Pediatr 2012; 30 (4): 562 – 569.
Sayeemuddin M, Sharma D, Pandita A, Sultana T, Shastri S. Blood pressure profile in school children (6-16 years) of Southern India: a prospective observational study. Frontiers in Pediatrics 2015; 3(24): 1-6.
Okpokowuruk FS, Akpan MU, Ikpeme EE. Prevalence of hypertension and prehypertension among children and adolescents in a semi-urban area of Uyo Metropolis, Nigeria. Pan African Medical Journal 2017; 28: 303–312.
Noubiap JJ, Essouma M, Bigna JJ, Jingi AM, Aminde LN, Nansseu JR. Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis. Lancet Public Health 2017; 2: e375–386.
Bell CS, Samuel JP, Samuels JA. Prevalence of hypertension in children: Applying the new American Academy of Pediatrics Clinical Practice Guideline. Hypertension 2019; 73: 148–152.
Bhimma R, Naicker E, Gounden V, Nandlal L, Connolly C, Hariparshad S. Prevalence of primary hypertension and risk factors in Grade XII learners in KwaZulu-Natal, South Africa. International Journal of Hypertension. Hindawi. Volume 2018. Article ID 3848591, 9 pages. https://doi.org/10.1155/2018/3848591.
Physical exercise in the management of hypertension: a consensus statement by the World Hypertension League. J Hypertens 1991; 9 (3): 283–287.
Morales MC, Coplan NL, Zabetakis P, Gleim GW. Hypertension: the acute and chronic response to exercise. Am Heart J 1991; 122 (1Pt1): 264–266. Available at https://doi.org/10.1016/0002-8703(91)90797-L.
Leary SD, Ness AR, Smith GD, Mattocks C, Deere K, Blair SN, et al. physical activity and blood pressure in childhood: Findings from a population-based study. Hypertension 2008; 51: 92–98.
Knowles G, Pallan M, Thomas GN, Ekelund U, Cheng KK, Barrett T, et al. Physical activity and blood pressure in primary school children: A longitudinal study. Hypertension 2013; 61: 70–75.
Durrani AM, Fatima W. Effect of physical activity on blood pressure distribution among children. Advances in Public Health. Hindawi Publishing Corporation. Volume 2015, Article ID 379314, 4 pages. http://dx.doi.org/10.1155/2015/379314.
Wilson DK, Kliewer W, Plybon L. Sica DA. Socioeconomic status and blood pressure reactivity in healthy black adolescents. Hypertension 2000; 35 (part 2): 496–500.
Kaczmarek M, Stawinska-Witoszynska B, Krzyzaniak A, Krzywinska-Wiewiorowska M, Siwinska A. Who is at higher risk of hypertension? Socioeconomic status differences in blood pressure among Polish adolescents: a population-based ADOPOLNOR study. Eur J Paediatr 2015; 174: 1461–1473.
Chaix, B, Bean K, Leal C, Thomas F, Harvard S, Evans D, et al. Individual/neighborhood social factors and blood pressure in the RECORD Cohort Study: which risk factors explain the associations? Hypertension 2010; 55: 769–775.
Isezuo KO, Jiya NM, Audu LI, Ibitoye PK, Sani UM, Yusuf T, et al. Blood pressure pattern and relationship with body mass index among apparently healthy secondary school students in Sokoto metropolis, Nigeria. South African Journal of Child Health 2018; 12 (3): 105–110.
Noronha JAF, Ramos ALC, Ramos AT, Cardoso MAA, de Carvalho DF, Medeiros CCM. High blood pressure in overweight children and adolescents. Journal of Human Growth and Development 2012; 22(2): 196–201.
Mishra PE, Shastri L, Thomas T, Duggan C, Bosch R, McDonald CM, et al. Waist-to-height ratio as an indicator of high blood pressure in urban Indian school children. Indian Pediatrics 2015; 52: 773–778.
Chen TL, Choy CS, Chan WY, Chen CH, Liao CC. Waist-to-height ratio and elevated blood pressure among
children in Taiwan. Indian Pediatrics 2012; 49: 463–466.
Motswagole BS, Kruger HS, Faber M, van Rooyen JM, de Ridder JH. The sensitivity of waist-to-height ratio in identifying children with high blood pressure. Cardiovascular Journal of Africa 2011; 22 (4): 208–211.
This work is licensed under a Creative Commons Attribution 4.0 International License.