Blood pressure levels among children in rural Uganda: results from 1913 children in a general population survey

Abstract

Despite increasing levels of adult hypertension in sub-Saharan Africa (SSA), there is limited information on elevated blood pressure among children in SSA. We described the distribution of blood pressure among children in rural Uganda and estimated hypertension prevalence. We conducted a cross-sectional study in south-western Uganda, collecting demographic, anthropometric and blood pressure measurements from children aged 6-12 years. Children with elevated blood pressure (systolic and/or diastolic blood pressure greater or equal to the 95th percentile for age, height and sex) were invited for two further assessments 6-18 months later.We described blood pressure distribution at first assessment, assessed associations with demographic and anthropometric characteristics and estimated prevalence of hypertension as defined by having elevated blood pressure on three separate occasions months apart. Blood pressure (BP) was measured in 1913 children (50% male, 3% overweight or obese, 22% stunted) at the first assessment. Mean (SD) systolic and diastolic BP at first assessment was 113.4mmHg (±10.8) and 69.5mmHg (±8.3), respectively, and 44.2% had elevated BP. Older age, higher BMI, and being female were associated with higher BP, and stunted height was associated with lower BP. An estimated 7.8% [95% CI:(6.6 -9.1)], (males: 6.8%, females: 9.0%), had elevated BP on three separate occasions, and were considered hypertensive. High blood pressure levels among adults in SSA may be set early in life. In this study, obesity (a common lifestyle modifiable risk factor in other settings) was largely irrelevant. More research is needed to understand the main drivers for elevated blood pressure in SSA further.

Detecting and Managing Childhood Onset Hypertension in Africa: A Call to Action

“…A high statistical significance was found between BMI and pre-HTN and HTN Gewa et al [ 39 ] Kenya 390 10–12 Overweight (BMI-for-age percentiles) children with EBP was 1.85-fold greater and the proportion of children with HTN was 1.83-fold greater compared with normal weight children. Similar patterns of significant associations were seen among obese children, those with central obesity and those with high total skinfold values Kansiime et al [ 40 ] Uganda 1913 6–12 Higher BMI associated with higher BP. Obesity was largely irrelevant in this study Physical activity Jourbet et al [ 41 ] South Africa 1009 8–13 39% physically inactive (self-reported) Hypertensive children were more likely to be overweight/obese, but only if they did not meet physical activity recommendations Fossou et al [ 42 ] Ivory Coast 1251 5–15 8.1% of overweight/obese (10.3% (BMI z-score > + 1SD WHO)) children do not play sport (self-reported) BMI influenced SBP and DBP in both sexes.…”

“…These factors have been reported in children and adolescents between the ages of 1–19 years, with the majority of the studies done in Western and Southern African regions. Among the BP associated risk factors, the majority of the findings showed an adverse association between overweight/obesity and pre-hypertension and/or hypertension [ 27 ••, 28 ••, 29 – 40 ]. The prevalence of overweight/obesity ranged from 2.2 to 33.0% with the highest prevalence being reported in South Africa.…”

Elevated blood pressure among children born to women with obstructed labour in Eastern Uganda: a cohort study

“…A study conducted among high school children in Uganda found that 11% of the 688 children had elevated blood pressure [ 5 ]. Another study in rural Uganda among 1913 children found 44.2% had elevated blood pressure [ 6 ].…”