Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis

Background: Despite substantial attention paid to the threat of elevated blood pressure in children and adolescents in high-income countries and the epidemic of hypertension in African adult populations, data on the burden of elevated blood pressure in African children and adolescents have not yet b...

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Main Authors: Dr Jean Jacques Noubiap, MD, Mickael Essouma, MD, Jean Joel Bigna, MD, Ahmadou M Jingi, MD, Leopold N Aminde, MD, Jobert Richie Nansseu, MD
Format: Article
Language:English
Published: Elsevier 2017-08-01
Series:The Lancet Public Health
Online Access:http://www.sciencedirect.com/science/article/pii/S2468266717301238
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spelling doaj-c8f6a4c80ddf447ba033a649f665c7302020-11-25T01:25:43ZengElsevierThe Lancet Public Health2468-26672017-08-0128e375e38610.1016/S2468-2667(17)30123-8Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysisDr Jean Jacques Noubiap, MD0Mickael Essouma, MD1Jean Joel Bigna, MD2Ahmadou M Jingi, MD3Leopold N Aminde, MD4Jobert Richie Nansseu, MD5Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDepartment of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, CameroonDepartment of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, CameroonDepartment of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, CameroonSchool of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, AustraliaDepartment of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, CameroonBackground: Despite substantial attention paid to the threat of elevated blood pressure in children and adolescents in high-income countries and the epidemic of hypertension in African adult populations, data on the burden of elevated blood pressure in African children and adolescents have not yet been synthesised. We did a systematic review and meta-analysis to provide estimates of the prevalence of elevated blood pressure and assess associated factors among children and adolescents in Africa. Methods: We searched Embase, PubMed, African Journals Online, and African Index Medicus to identify articles published from Jan 1, 1996, to Feb 2, 2017, and searched the reference list of retrieved articles. Each study was independently reviewed for methodological quality. We used a random-effects model to estimate the prevalence of elevated blood pressure across studies and heterogeneity (I2) was assessed via the χ2 test on Cochran's Q statistic. This review is registered with PROSPERO, number CRD42015019029. Findings: We included 51 studies in qualitative synthesis and 25 in the meta-analysis reporting data of a pooled sample of 54 196 participants aged 2–19 years. Study quality was high with only four medium-quality studies and no low-quality studies. Prevalence of elevated blood pressure varied widely across studies (range 0·2–24·8%). The pooled prevalence of elevated blood pressure (systolic or diastolic blood pressure ≥95th percentile) was 5·5% (95% CI 4·2–6·9), whereas that of slightly elevated blood pressure (systolic or diastolic blood pressure ≥90th percentile and <95th percentile) was 12·7% (2·1–30·4). The prevalence of elevated blood pressure was largely associated with body-mass index (BMI), with a prevalence of elevated blood pressure six times higher in obese (30·8%, 95% CI 20·1–42·6) versus normal-weight children (5·5%, 3·1–8·4; p<0·0001). Interpretation: This study suggests a high prevalence of elevated blood pressure among children and adolescents in Africa, with overweight and obesity being an important risk factor. Efforts to address this burden of elevated blood pressure in children and adolescents should mainly focus on primary prevention at the community level, by promoting healthy lifestyles and avoiding other cardiovascular risk factors, especially overweight and obesity. This study also stresses the need for more elaborate studies using uniform and reliable diagnostic methods to reliably map the burden of elevated blood pressure in children and adolescents in Africa. Funding: None.http://www.sciencedirect.com/science/article/pii/S2468266717301238
collection DOAJ
language English
format Article
sources DOAJ
author Dr Jean Jacques Noubiap, MD
Mickael Essouma, MD
Jean Joel Bigna, MD
Ahmadou M Jingi, MD
Leopold N Aminde, MD
Jobert Richie Nansseu, MD
spellingShingle Dr Jean Jacques Noubiap, MD
Mickael Essouma, MD
Jean Joel Bigna, MD
Ahmadou M Jingi, MD
Leopold N Aminde, MD
Jobert Richie Nansseu, MD
Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis
The Lancet Public Health
author_facet Dr Jean Jacques Noubiap, MD
Mickael Essouma, MD
Jean Joel Bigna, MD
Ahmadou M Jingi, MD
Leopold N Aminde, MD
Jobert Richie Nansseu, MD
author_sort Dr Jean Jacques Noubiap, MD
title Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis
title_short Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis
title_full Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis
title_fullStr Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis
title_full_unstemmed Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis
title_sort prevalence of elevated blood pressure in children and adolescents in africa: a systematic review and meta-analysis
publisher Elsevier
series The Lancet Public Health
issn 2468-2667
publishDate 2017-08-01
description Background: Despite substantial attention paid to the threat of elevated blood pressure in children and adolescents in high-income countries and the epidemic of hypertension in African adult populations, data on the burden of elevated blood pressure in African children and adolescents have not yet been synthesised. We did a systematic review and meta-analysis to provide estimates of the prevalence of elevated blood pressure and assess associated factors among children and adolescents in Africa. Methods: We searched Embase, PubMed, African Journals Online, and African Index Medicus to identify articles published from Jan 1, 1996, to Feb 2, 2017, and searched the reference list of retrieved articles. Each study was independently reviewed for methodological quality. We used a random-effects model to estimate the prevalence of elevated blood pressure across studies and heterogeneity (I2) was assessed via the χ2 test on Cochran's Q statistic. This review is registered with PROSPERO, number CRD42015019029. Findings: We included 51 studies in qualitative synthesis and 25 in the meta-analysis reporting data of a pooled sample of 54 196 participants aged 2–19 years. Study quality was high with only four medium-quality studies and no low-quality studies. Prevalence of elevated blood pressure varied widely across studies (range 0·2–24·8%). The pooled prevalence of elevated blood pressure (systolic or diastolic blood pressure ≥95th percentile) was 5·5% (95% CI 4·2–6·9), whereas that of slightly elevated blood pressure (systolic or diastolic blood pressure ≥90th percentile and <95th percentile) was 12·7% (2·1–30·4). The prevalence of elevated blood pressure was largely associated with body-mass index (BMI), with a prevalence of elevated blood pressure six times higher in obese (30·8%, 95% CI 20·1–42·6) versus normal-weight children (5·5%, 3·1–8·4; p<0·0001). Interpretation: This study suggests a high prevalence of elevated blood pressure among children and adolescents in Africa, with overweight and obesity being an important risk factor. Efforts to address this burden of elevated blood pressure in children and adolescents should mainly focus on primary prevention at the community level, by promoting healthy lifestyles and avoiding other cardiovascular risk factors, especially overweight and obesity. This study also stresses the need for more elaborate studies using uniform and reliable diagnostic methods to reliably map the burden of elevated blood pressure in children and adolescents in Africa. Funding: None.
url http://www.sciencedirect.com/science/article/pii/S2468266717301238
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