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Using blood pressure height index to define hypertension among secondary school adolescents in southwestern Uganda

Journal of Human Hypertension volume 34, pages 76–81 (2020)Cite this article

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Abstract

Hypertension is the number one risk factor for cardiovascular diseases worldwide and yet its diagnosis among adolescents, based on blood pressure percentiles which are age, height, and sex-specific, is complex. Our study intended to determine the suitability of blood pressure height index in defining adolescent hypertension among secondary school adolescents aged 12–17 years in Mbarara municipality, southwestern Uganda. Our study used data of 485 secondary school adolescents of which 173 were boys. Receiver operating characteristic curve analysis was performed to assess the performance of systolic blood pressure height index (SBPHI) and diastolic blood pressure height index (DBPHI) for screening for adolescent prehypertension and hypertension. The optimal systolic/diastolic thresholds for defining prehypertension were 0.70/0.43 mmHg/cm in boys and 0.76/0.43 in girls. The corresponding values for hypertension were 0.78/0.43 and 0.77/0.48 mmHg/cm, respectively. The negative predictive values were much higher (all ≥ 95%) for prehypertension and hypertension, while the positive predictive value was 100% for hypertension in both sexes. In conclusion, Blood pressure height index is simple and accurate for screening for prehypertension and hypertension in adolescents aged 12–17 years hence can be used for early screening of adolescents at high risk of hypertension but not its diagnosis.

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Data availability

The dataset and the Stata 13 do file are available on request from the corresponding author.

References

  1. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control. Circulation. 2016;134:441–50.

    Article  Google Scholar 

  2. WHO. Global health risks: mortality and burden of disease attributable to selected major risks. World Health Organization; 2009.

  3. Danaei G, Finucane MM, Lin JK, Singh GM, Paciorek CJ, Cowan MJ, et al. National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5· 4 million participants. Lancet. 2011;377:568–77.

    Article  Google Scholar 

  4. Pediatrics NHBPEPWGJ. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–76.

    Article  Google Scholar 

  5. Tran CL, Ehrmann BJ, Messer KL, Herreshoff E, Kroeker A, Wickman L, et al. Recent trends in healthcare utilization among children and adolescents with hypertension in the United States. Hypertension. 2012;60:296–302.

    Article  CAS  Google Scholar 

  6. Uwaezuoke S, Okoli C, Ubesie A, Ikefuna A. Primary hypertension among a population of Nigerian secondary school adolescents: Prevalence and correlation with anthropometric indices: a cross‑sectional study. Niger J Clin Pract. 2016;19:649–54.

    Article  CAS  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. 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:e375–86.

    Article  Google Scholar 

  9. Emmanuel EE, Dada SA, Amu EO, Aduayi VA, Atoyebi OA, Marcus O, et al. Hypertension and its correlates among in‑school adolescents in Ekiti State, South‑west, Nigeria. Asian J Med Sci. 2017;8:1–5.

    Article  Google Scholar 

  10. Akbari M, Moosazadeh M, Ghahramani S, Tabrizi R, Kolahdooz F, Asemi Z, et al. High prevalence of hypertension among Iranian children and adolescents: a systematic review and meta-analysis. J Hypertens. 2017;35:1155–63.

    Article  CAS  Google Scholar 

  11. Pirojsakul K, Paksi W, Sirijunpen S, Nuntnarumit PJP. Increased prevalence of hypertensive-level blood pressure using the American Academy of Pediatrics 2017 guidelines: a cross-sectional study in a primary school in Thailand. Paediat Int Child Health. 2019;39:279–84.

    Article  Google Scholar 

  12. Sorof J, Daniels SJH. Obesity hypertension in children: a problem of epidemic proportions. Hypertension. 2002;40:441–7.

    Article  CAS  Google Scholar 

  13. Roulet C, Bovet P, Brauchli T, Simeoni U, Xi B, Santschi V. et al.Secular trends in blood pressure in children: a systematic review.J Clin Hypertens. 2017;19:488–97.

    Article  Google Scholar 

  14. WHO. A global brief on hypertension: silent killer, global public health crisis: World Health Day 2013.

  15. Xi B, Zhang M, Zhang T, Li S, Steffen LM. Simplification of childhood hypertension definition using blood pressure to height ratio among US youths aged 8–17years, NHANES 1999–2012. Int J Cardiol. 2015;180:210–3.

    Article  Google Scholar 

  16. Lu Q, Ma C, Yin F, Liu B, Lou D, Liu X. How to simplify the diagnostic criteria of hypertension in adolescents. J Hum Hypertens. 2011;25:159–63.

    Article  CAS  Google Scholar 

  17. Galescu O, George M, Basetty S, Predescu I, Mongia A, Ten S, et al. Blood pressure over height ratios: simple and accurate method of detecting elevated blood pressure in children. Int J Pediatrics. 2012;2012:253497.

    Article  Google Scholar 

  18. Ejike CE. Blood pressure to height ratios as simple, sensitive and specific diagnostic tools for adolescent (pre) hypertension in Nigeria. Ital J Pediatr. 2011;37:30.

    Article  Google Scholar 

  19. Ahmed A, Ali SW, Massodi S, Bhat MAJIP. Blood pressure-to-height ratio as a screening tool for hypertension in children. Indian Pediatr. 2016;53:137–9.

    Article  Google Scholar 

  20. Kelishadi R, Bahreynian M, Heshmat R, Motlagh ME, Djalalinia S, Naji F, et al. Accuracy of blood pressure-to-height ratio to define elevated blood pressure in children and adolescents: the CASPIAN-IV study. Pediatr Cardiol. 2016;37:378–85.

    Article  Google Scholar 

  21. Sekgala M, Monyeki K, Mogale M, Ramoshaba NJJohh. Performance of blood pressure to height ratio as a screening tool for elevated blood pressure in rural children: Ellisras Longitudinal Study. J Hum Hypertens. 2017;31:591.

    Article  CAS  Google Scholar 

  22. Yin X, Liu Q, Bovet P, Ma C, Xi BJJohh. Performance of blood pressure-to-height ratio as a screening tool for elevated blood pressure in pediatric population: a systematic meta-analysis. J Hum Hypertens. 2016;30:697.

    Article  CAS  Google Scholar 

  23. Guo X, Zheng L, Li Y, Zhang X, Yu S, Sun YJP, et al. Blood pressure to height ratio: a novel method for detecting hypertension in paediatric age groups. Paediatr Child Health. 2013;18:65–9.

    Article  Google Scholar 

  24. Xi B, Zhang M, Zhang T, Liang Y, Li S, Steffen LMJP. Hypertension screen using blood press height ratio. 2014;134:e106–11.

    Google Scholar 

  25. Bourgeois B, Watts K, Thomas DM, Carmichael O, Hu FB, Heo M, et al. Associations between height and blood pressure in the United States population. Medicine. 2017;96:e9233.

    Article  Google Scholar 

  26. Korhonen PE, Kautiainen H, Eriksson JGJJoh. The shorter the person, the higher the blood pressure: a birth cohort study. J Hypertens. 2017;35:1170–7.

    Article  CAS  Google Scholar 

  27. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005;111:697–716.

    Article  Google Scholar 

  28. O'brien E, Waeber B, Parati G, Staessen J, Myers MGJBBMJ. Blood pressure measuring devices: recommendations of the European Society of Hypertension. Br Med J. 2001;322:531.

    Article  CAS  Google Scholar 

  29. Hansen ML, Gunn PW, Kaelber DCJJ. Underdiagnosis of hypertension in children and adolescents. JAMA. 2007;298:874–9.

    Article  CAS  Google Scholar 

  30. Lu Q, Ma C, Yin F, Liu B, Lou D, Liu XJJohh. How to simplify the diagnostic criteria of hypertension in adolescents. J Hum Hypertens. 2011;25:159.

    Article  CAS  Google Scholar 

  31. Dong B, Wang Z, Wang HJ, Ma J. Improving hypertension screening in childhood using modified blood pressure to height ratio. J Clin Hypertens. 2016;18:557–64.

    Article  Google Scholar 

  32. Xi B, Zhang M, Zhang T, Liang Y, Li S, Steffen LM. Hypertension screening using blood pressure to height ratio. Pediatrics. 2014;134:e106–11.

    Article  Google Scholar 

Download references

Acknowledgements

The research used the data obtained from the general study titled “Prevalence of hypertension and diagnostic accuracy of resting pulse rate in relation to anthropometric indices among adolescents” as was approved by the Mbarara University of Science and Technology research ethics committee (IRB No.18/03–18). Therefore, the participants in this study and data collectors are highly appreciated.

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Authors and Affiliations

  1. Department of Physiology, St. Augustine International University, P.O Box 88, Kampala, Uganda

    Godfrey Katamba & Agnes Namaganda

  2. Department of Physiology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda

    David Collins Agaba, Richard Migisha & Rosemary Namayanja

  3. Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda

    Eleanor Turyakira

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  1. Godfrey Katamba
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  2. David Collins Agaba
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Correspondence to Godfrey Katamba.

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Katamba, G., Collins Agaba, D., Migisha, R. et al. Using blood pressure height index to define hypertension among secondary school adolescents in southwestern Uganda. J Hum Hypertens 34, 76–81 (2020). https://doi.org/10.1038/s41371-019-0292-x

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