Abstract
Secular trends in blood pressure (BP) and body mass index (BMI) during childhood and adolescence are sentinels for the future population cardiovascular disease burden. We examined trends in BP z-score (ages 9–18 years from 1999 to 2014) and BMI z-score (ages 6–18 years from 1996 to 2014) in Hong Kong, China. Overall, BP z-score fell, systolic BP from 0.08 to −0.01 in girls and from 0.31 to 0.25 in boys. However, the trends were not consistent, for both sexes, systolic BP z-score was stable from 1999, decreased slightly from 2002 to 2005 and increased slightly to 2014, diastolic BP z-score decreased slightly from 1999 to 2004 and then remained stable to 2014. In contrast, BMI z-score rose from −0.15 to −0.01 in girls and from 0.14 to 0.34 in boys, mainly during 1997 to 2010. The upper tail of the systolic (except boys) and diastolic BP distribution shifted downwards, whereas the entire BMI distribution shifted upward. BP declined slightly whereas BMI rose in Hong Kong children and adolescents during the last 20 years, with systolic BP and BMI in boys above the reference. This warrants dual action in tackling rising BMI and identifying favorable determinants of BP, particularly targeting boys.
Highlights
Secular trends in cardiovascular disease, and its drivers, in non-Western settings are more varied
Group in 2004: 1 unit change in systolic BP z-score is approximated to 10.6 mmHg and 1 unit change in diastolic BP z-score is approximated to 11.3 mmHg. cPrehypertensive BP was defined as systolic or diastolic blood pressure > = 90th percentile but = 120/80 mmHg; Hypertensive BP was defined as systolic or diastolic blood pressure > = 95th percentile
The upper end of the systolic and diastolic BP distributions shifted downward, whereas the entire body mass index (BMI) distribution shifted upward from 1996 to 2014. This is the first large study with novel use of big data based on bi-annual BP and annual BMI measurements comprehensively covering childhood and adolescence, and so adds evidence concerning BP and BMI trends over nearly 20 years
Summary
Secular trends in cardiovascular disease, and its drivers, in non-Western settings are more varied. Children and adolescents today in Hong Kong represent the first generation of Chinese to grow up in a post-industrial Chinese setting with living standards and social infrastructure similar to Western Europe, but a much more rapid trajectory of economic development[19], which might have consequences for current patterns of disease[20].
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