Blood pressure and associated factors in a North African adolescent population. a national cross-sectional study in Tunisia

BMC Public Health

Bernard Maire²  Noureddine Achour³  Francis Delpeuch²  Sabrina Eymard-Duvernay²  Habiba Ben Romdhane³  Pierre Traissac²  Jalila El Ati¹  Hajer Aounallah-Skhiri⁴ 

[1] National Institute of Nutrition and Food Technology (INNTA), 11 rue Jebel Lakhdar, Tunis, Tunisia;IRD (Institut de Recherche pour le Developpement), UMR 204 NUTRIPASS, IRD-UM2-UM1, 911 av. Agropolis, 34394 Montpellier, France;National Institute of Public Health (INSP), 5-7 rue El-Khartoum, Tunis, Tunisie;Doctoral School 393, Université Pierre et Marie Curie, Paris, France

关键词: Risk factors;    Prevalence;    Tunisia;    Blood pressure;    Adolescent;   

Others  :  1163877
DOI  :  10.1186/1471-2458-12-98

 received in 2011-08-02, accepted in 2012-02-03,  发布年份 2012

【 摘 要 】

Background

In southern and eastern Mediterranean countries, changes in lifestyle and the increasing prevalence of excess weight in childhood are risk factors for high blood pressure (BP) during adolescence and adulthood. The aim of this study was to evaluate the BP status of Tunisian adolescents and to identify associated factors.

Methods

A cross-sectional study in 2005, based on a national, stratified, random cluster sample of 1294 boys and 1576 girls aged 15-19 surveyed in home visits. The socio-economic and behavioral characteristics of the adolescents were recorded. Overweight/obesity were assessed by Body Mass Index (BMI) from measured height and weight (WHO, 2007), abdominal obesity by waist circumference (WC). BP was measured twice during the same visit. Elevated BP was systolic (SBP) or diastolic blood pressure (DBP) ≥ 90th of the international reference or ≥ 120/80 mm Hg for 15-17 y., and SBP/DBP ≥ 120/80 mm Hg for 18-19 y.; hypertension was SBP/DBP ≥ 95th for 15-17 y. and ≥ 140/90 mm Hg for 18-19 y. Adjusted associations were assessed by logistic regression.

Results

The prevalence of elevated BP was 35.1%[32.9-37.4]: higher among boys (46.1% vs. 33.3%; P < 0.0001); 4.7%[3.8-5.9] of adolescents had hypertension. Associations adjusted for all covariates showed independent relationships with BMI and WC: - obesity vs. no excess weight increased elevated BP (boys OR = 2.1[1.0-4.2], girls OR = 2.3[1.3-3.9]) and hypertension (boys OR = 3.5[1.4-8.9], girls OR = 5.4[2.2-13.4]), - abdominal obesity (WC) was also associated with elevated BP in both genders (for boys: 2nd vs. 1st tertile OR = 1.7[1.3-2.3], 3rd vs.1st tertile OR = 2.8[1.9-4.2]; for girls: 2nd vs. 1st tertile OR = 1.6[1.2-2.1], 3rd vs.1st tertile OR = 2.1[1.5-3.0]) but only among boys for hypertension. Associations with other covariates were weaker: for boys, hypertension increased somewhat with sedentary lifestyle, while elevated BP was slightly more prevalent among urban girls and those not attending school.

Conclusion

Within the limits of BP measurement on one visit only, these results suggest that Tunisian adolescents of both genders are likely not spared from early elevated BP. Though further assessment is likely needed, the strong association with overweight/obesity observed suggests that interventions aimed at changing lifestyles to reduce this main risk factor may also be appropriate for the prevention of elevated BP.

【 授权许可】

   
2012 Aounallah-Skhiri et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Mehio Sibai A, Nasreddine L, Mokdad AH, Adra N, Tabet M, Hwalla N: Nutrition transition and cardiovascular disease risk factors in Middle East and North Africa countries: reviewing the evidence. Ann Nutr Metab 2010, 57:193-203.
• [2]Mittal BV, Singh AK: Hypertension in the developing world: challenges and opportunities. Am J Kidney Dis 2010, 55:590-598.
• [3]Lee DE, Cooper RS: Recommendations for global hypertension monitoring and prevention. Curr Hypertens Rep 2009, 11:444-449.
• [4]Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama 2003, 289:2560-2572.
• [5]Lauer RM, Clarke WR, Mahoney LT, Witt J: Childhood predictors for high adult blood pressure. The Muscatine Study. Pediatr Clin North Am 1993, 40:23-40.
• [6]Couch SC, Daniels SR: Diet and blood pressure elevation in children and adolescents. Arch Pediatr Adolesc Med 2004, 158:418-419.
• [7]Couch SC, Daniels SR: Diet and blood pressure in children. Curr Opin Pediatr 2005, 17:642-647.
• [8]Sugiyama T, Xie D, Graham-Maar RC, Inoue K, Kobayashi Y, Stettler N: Dietary and lifestyle factors associated with blood pressure among U.S. adolescents. J Adolesc Health 2007, 40:166-172.
• [9]Ebbeling CB, Pawlak DB, Ludwig DS: Childhood obesity: public-health crisis, common sense cure. Lancet 2002, 360:473-482.
• [10]Beunza JJ, Martinez-Gonzalez MA, Ebrahim S, Bes-Rastrollo M, Nunez J, Martinez JA, Alonso A: Sedentary behaviors and the risk of incident hypertension: the SUN Cohort. Am J Hypertens 2007, 20:1156-1162.
• [11]Brion MA, Ness AR, Davey Smith G, Leary SD: Association between body composition and blood pressure in a contemporary cohort of 9-year-old children. J Hum Hypertens 2007, 21:283-290.
• [12]Luepker RV, Jacobs DR, Prineas RJ, Sinaiko AR: Secular trends of blood pressure and body size in a multi-ethnic adolescent population: 1986 to 1996. J Pediatr 1999, 134:668-674.
• [13]Veber VP, Kazymov MS, Kopina MN, Rubanova MP, Shmat'ko DP, Zakharova Iu V, Mishkina Mlu: [Age- and sex-related prevalence of overweight, arterial hypertension, hyperglycemia and their combinations]. Ter Arkh 2008, 80:76-78.
• [14]Chiolero A, Madeleine G, Gabriel A, Burnier M, Paccaud F, Bovet P: Prevalence of elevated blood pressure and association with overweight in children of a rapidly developing country. J Hum Hypertens 2007, 21:120-127.
• [15]McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ: Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 2007, 150:640-4. 644 e1
• [16]Sorof J, Daniels S: Obesity hypertension in children: a problem of epidemic proportions. Hypertension 2002, 40:441-447.
• [17]Liang YJ, Xi B, Hu YH, Wang C, Liu JT, Yan YK, Xu T, Wang RQ: Trends in blood pressure and hypertension among Chinese children and adolescents: China Health and Nutrition Surveys 1991-2004. Blood Press 2011, 20:45-53.
• [18]Traissac P, El Ati J, Delpeuch F, Beji C, Aounallah-Skhiri H, Ben Romdhane H, Maire B: Overall vs abdominal obesity: difference in prevalence, geographic distribution and associated socio-economic factors among Tunisian women. Obesity Facts 2009, 2(Suppl 2):103.
• [19]Ben Romdhane H, Ben Ali S, Skhiri H, Traissac P, Bougatef S, Maire B, Delpeuch F, Achour N: Hypertension among Tunisian adults: results of the TAHINA project. Hypertens Res 2011, in press. 198
• [20]Aounallah-Skhiri H, Romdhane HB, Traissac P, Eymard-Duvernay S, Delpeuch F, Achour N, Maire B: Nutritional status of Tunisian adolescents: associated gender, environmental and socio-economic factors. Public Health Nutr 2008, 11:1306-1317.
• [21]National Statistics Institute of Tunisia: Results of the 2004 census:. [http://www.ins.nat.tn/indexen.php] webcite (accessed october 2010)
• [22]United Nations Development Program: Human Development Report 2005. New York: United Nations; 2005:372.
• [23]Mejean C, Traissac P, Eymard-Duvernay S, El Ati J, Delpeuch F, Maire B: Influence of socio-economic and lifestyle factors on overweight and nutrition-related diseases among Tunisian migrants versus non-migrant Tunisians and French. BMC Pub Health 2007, 7:265. BioMed Central Full Text
• [24]Delpeuch F, Cornu A, Massamba JP, Traissac P, Maire B: Is body mass index sensitively related to socio-economic status and to economic adjustment? A case study from the Congo. Eur J Clin Nutr 1994, 48(Suppl 3):S141-S147.
• [25]El Ati J, Houti L, Farhat A, Nguyen-Than V, Eymard-Duvernay S, Beji C, Kolsteren P, Chougrani S, Gaigi S, Maire B: Development, reproducibility and validity of a physical activity frequency questionnaire in North Africa. Arab J Food Nutrition 2004, 5:148-167.
• [26]Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O'Brien WL, Bassett DR, Bassett DR Jr, Schmitz KH, Emplaincourt PO, et al.: Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000, 32(Suppl 9):S498-504.
• [27]Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A: Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007, 39:1423-1434.
• [28]Cohen S, Kamarck T, Mermelstein R: A global measure of perceived stress. J Health Soc Behav 1983, 24:385-396.
• [29]De Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J: Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007, 85(9):660-667.
• [30]National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents: The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004, 114(2 Suppl 4th Report):555-76.
• [31]Paradis G, Tremblay MS, Janssen I, Chiolero A, Bushnik T: Blood pressure in Canadian children and adolescents. Health Rep 2010, 21(2):15-22.
• [32]Falkner B: Hypertension in children and adolescents: epidemiology and natural history. Pediatr Nephrol 2010, 25:1219-1224.
• [33]Lauritsen JM, Bruus M, Myatt M: EpiData, a tool for validated data entry and documentation of data. Version 3.1. UK: County of Denmark and Brixton Health. 2000.
• [34]StataCorp: Stata Statistical Software/SE 11.2. College Station, TX: Stata Corporation; 2009.
• [35]Pall D, Katona E, Paragh G, Zrinyi M, Zatik J, Fulesdi B: [Epidemiological data of 15-18 year adolescents and the prevalence of hypertension in Debrecen. The DebrecenHypertension Study]. Orv Hetil 2005, 146:127-132.
• [36]Rosa ML, Fonseca VM, Oigman G, Mesquita ET: Arterial prehypertension and elevated pulse pressure in adolescents: prevalence and associated factors. Arq Bras Cardiol 2006, 87:46-53.
• [37]Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS: Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens 2009, 23:385-390.
• [38]Andrade H, Antonio N, Rodrigues D, Da Silva M, Pego M, Providencia LA: High blood pressure in the pediatric age group. Rev Port Cardiol 2010, 29:413-432.
• [39]Drukteinis JS, Roman MJ, Fabsitz RR, Lee ET, Best LG, Russell M, Devereux RB: Cardiac and systemic hemodynamic characteristics of hypertension and prehypertension in adolescents and young adults: the Strong Heart Study. Circulation 2007, 115:221-227.
• [40]Al Salloum AA, El Mouzan MI, Al Herbish AS, Al Omar AA, Qurashi MM: Blood pressure standards for Saudi children and adolescents. Ann Saudi Med 2009, 29:173-8.
• [41]Aglony M, Acevedo M, Ambrosio G: Hypertension in adolescents. Expert Rev Cardiovasc Ther 2009, 7:1595-1603.
• [42]Hansen ML, Gunn PW, Kaelber DC: Underdiagnosis of hypertension in children and adolescents. Jama 2007, 298:874-879.
• [43]Al-Sendi AM, Shetty P, Musaiger AO, Myatt M: Relationship between body composition and blood pressure in Bahraini adolescents. Br J Nutr 2003, 90:837-844.
• [44]Dasgupta K, O'Loughlin J, Chen S, Karp I, Paradis G, Tremblay J, Hamet P, Pilote L: Emergence of sex differences in prevalence of high systolic blood pressure: analysis of a longitudinal adolescent cohort. Circulation 2006, 114:2663-2670.
• [45]Tirosh A, Afek A, Rudich A, Percik R, Gordon B, Ayalon N, Derazne E, Tzur D, Gershnabel D, Grossman E, et al.: Progression of normotensive adolescents to hypertensive adults: a study of 26,980 teenagers. Hypertension 2010, 56:203-209.
• [46]Grigore D, Ojeda NB, Alexander BT: Sex differences in the fetal programming of hypertension. Gend Med 2008, 5(Suppl A):S121-32.
• [47]Kawabe H, Shibata H, Hirose H, Tsujioka M, Saito I, Saruta T: Determinants for the development of hypertension in adolescents. A 6-year follow-up. J Hypertens 2000, 18:1557-1561.
• [48]Eisenmann JC, Wrede J, Heelan KA: Associations between adiposity, family history of CHD and blood pressure in 3-8 year-old children. J Hum Hypertens 2005, 19:675-681.
• [49]Costanzi CB, Halpern R, Rech RR, Bergmann ML, Alli LR, Mattos AP: Associated factors in high blood pressure among schoolchildren in a middle size city, southern Brazil. J Pediatr (Rio J) 2009, 85:335-340.
• [50]Kotsis V, Stabouli S, Papakatsika S, Rizos Z, Parati G: Mechanisms of obesity-induced hypertension. Hypertens Res 2010, 33:386-393.
• [51]Couch SC, Saelens BE: Factors associated with pediatric hypertension in Mexico. J Am Diet Assoc 2009, 109:992-995.
• [52]Colin-Ramirez E, Castillo-Martinez L, Orea-Tejeda A, Villa Romero AR, Vergara Castaneda A, Asensio Lafuente E: Waist circumference and fat intake are associated with high blood pressure in Mexican children aged 8 to 10 years. J Am Diet Assoc 2009, 109:996-1003.
• [53]Guimaraes IC, de Almeida AM, Santos AS, Barbosa DB, Guimaraes AC: Blood pressure: effect of body mass index and of waist circumference on adolescents. Arq Bras Cardiol 2008, 90:393-399.
• [54]Goran MI: Visceral fat in prepubertal children: Influence of obesity, anthropometry, ethnicity, gender, diet, and growth. Am J Hum Biol 1999, 11:201-207.
• [55]Lee S, Bacha F, Gungor N, Arslanian SA: Waist circumference is an independent predictor of insulin resistance in black and white youths. J Pediatr 2006, 148:188-194.
• [56]Cornier MA, Dabelea D, Hernandez TL, Lindstrom RC, Steig AJ, Stob NR, Van Pelt RE, Wang H, Eckel RH: The metabolic syndrome. Endocr Rev 2008, 29:777-822.
• [57]Aounallah-Skhiri H, El Ati J, Traissac P, Ben Romdhane H, Bougatef S, Beji C, Achour N, Delpeuch F, Maire B: Evolution de la consommation alimentaire et de la corpulence des adolescents tunisiens entre 1996 et 2005. [http:/ / cdn.spluw3.com/ files/ clients/ spluwR/ 4216/ 526/ Docs/ pages/ 1291376310_cHJvZ3JhbW1lIFNGTiAyMDA5 IE1vbnRwZWxsaWVyLnBkZg==.pdf] webcite4ème Congrès de la Société Française de Nutrition, 10-12 décembre 2009
• [58]Chiolero A, Bovet P, Paradis G: Assessing secular trends in blood pressure in children and adolescents. J Hum Hypertens 2009, 23:426-427.
• [59]Alonso A, Beunza JJ, Delgado-Rodriguez M, Martinez JA, Martinez-Gonzalez MA: Low-fat dairy consumption and reduced risk of hypertension: the Seguimiento Universidad de Navarra (SUN) cohort. Am J Clin Nutr 2005, 82:972-979.
• [60]Pereira MA, Jacobs DR Jr, Van Horn L, Slattery ML, Kartashov AI, Ludwig DS: Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the CARDIA Study. Jama 2002, 287:2081-2089.
• [61]Toledo E, Delgado-Rodriguez M, Estruch R, Salas-Salvado J, Corella D, Gomez-Gracia E, Fiol M, Lamuela-Raventos RM, Schroder H, Aros F, et al.: Low-fat dairy products and blood pressure: follow-up of 2290 older persons at high cardiovascular risk participating in the PREDIMED study. Br J Nutr 2009, 101:59-67.
• [62]Aounallah-Skhiri H, Traissac P, El Ati J, Eymard-Duvernay S, Landais E, Achour N, et al.: Nutrition transition among adolescents of a south-Mediterranean country: dietary patterns, association with socioeconomic factors, overweight and blood pressure. A cross-sectional study in Tunisia. Nutr J 2011, 10(1):38. BioMed Central Full Text
• [63]Chiolero A, Bovet P, Paradis G, Paccaud F: Has blood pressure increased in children in response to the obesity epidemic? Pediatrics 2007, 119:544-553.
• [64]Field AE, Cook NR, Gillman MW: Weight status in childhood as a predictor of becoming overweight or hypertensive in early adulthood. Obes Res 2005, 13:163-169.
• [65]Kim KR, Kim MK, Shin YJ, Choi BY: Relationship between the change in overweight status from childhood to adolescence and metabolic syndrome phenotypes: a 9-year retrospective study. Eur J Clin Nutr 2008, 62:748-753.
• [66]Andersen LB, Harro M, Sardinha LB, Froberg K, Ekelund U, Brage S, Anderssen SA: Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study). Lancet 2006, 368:299-304.
• [67]Rodrigues AN, Perez AJ, Carletti L, Bissoli NS, Abreu GR: The association between cardiorespiratory fitness and cardiovascular risk in adolescents. J Pediatr (Rio J) 2007, 83:429-435.
• [68]Caputo JL, Gill DL, Tseh W, Jamurtas AZ, Morgan DW: Perceived stress and blood pressure in early adolescent children. Ann Behav Med 2000, 22:65-70.
• [69]Suter PM, Maire R, Holtz D, Vetter W: Relationship between self-perceived stress and blood pressure. J Hum Hypertens 1997, 11:171-176.
• [70]Nyklicek I, Vingerhoets JJ, Van Heck GL: Hypertension and objective and self- reported stressor exposure: a review. J Psychosom Res 1996, 40:585-601.
• [71]Kerr M: Prehypertension in Teens Likely to Progress. Moderately elevated blood pressure during adolescence a red flag. 2006., 3(8) DOC News
• [72]Chen X, Wang Y, Appel LJ, Mi J: Impacts of measurement protocols on blood pressure tracking from childhood into adulthood: a metaregression analysis. Hypertension 2008, 51:642-649.