Abstract
The prevalence of hypertension in childhood is increasing, and investigation of its distribution is important for planning timely interventions. This study assessed the prevalence of high blood pressure (HBP) and associated factors in students between 9 and 11 years of age enrolled in public and private schools in Maceió, Brazil. A cross-sectional study was performed in a probabilistic sample of students (10.3 ± 0.5 years). The students were selected from a systematic sampling of 80 schools (40 public and 40 private). To maintain similar proportions of students existing in public and private schools in Maceió, 21 and 14 students were randomly selected from each public and private school, respectively. The prevalence ratio (PR) was estimated using Poisson regression. A total of 1,338 students were evaluated (800 from public schools and 538 from private schools). No differences were observed between school types in terms of student age and gender (p > 0.05). The prevalence of obesity (19.9% vs. 9.0%; PR = 2.2; 95% CI = 1.67–2.92) and hypertension (21.2% vs. 11.4%; PR = 1.86; 95% CI = 1.45–2.40) were higher in private schools. The association between high blood pressure and type of school (public or private) remained statistically significant even after adjustment for obesity (PR = 1.53; 95% CI = 1.19–1.97). In conclusion: (a) students from private schools have higher socioeconomic status, BMI, and HBP prevalence compared to those of public school; (b) among the evaluated students, the prevalence of obesity only partially explained the higher prevalence of high blood pressure among students from private schools. Other factors related to lifestyle of children from private schools may explain the higher prevalence of HBP. This results show the need to implement measures to promote healthy lifestyles in the school environment, since children with HBP are more likely to become hypertensive adults. Therefore, early detection and intervention in children with HBP is an important action for the prevention of hypertension in adulthood.
Highlights
The increasing prevalence of obesity worldwide is concerning owing to its association with multiple comorbid conditions, especially cardiovascular diseases such as hypertension [1]
Due to unreturned parent/representative questionnaires, information on socioeconomic and demographic indicators was unavailable for 34.2% of students from public schools and 7.1% of students from private schools
The high blood pressure (HBP) prevalence observed in this study (15.3%) is within the range of values reported in other studies performed in different regions of the country over the last decade, with prevalence ranging from 2.3% to 44.7% [18,19,20,21,22,23,24,25]
Summary
The increasing prevalence of obesity worldwide is concerning owing to its association with multiple comorbid conditions, especially cardiovascular diseases such as hypertension [1]. Hypertension is a key public health issue, accounting for 7.6 million deaths worldwide annually, 80% of which occur in developing countries such as Brazil. Studies on the prevalence of high blood pressure (HBP) in children are important for revealing the magnitude of the issue and identifying target groups for timely intervention. Most studies in Brazil have been performed in school settings. Magalhães et al [3] observed that 19 of 21 articles on HBP prevalence in Brazilian children and adolescents published between 1995 and 2010, were performed on schoolchildren. About half of these studies evaluated only students from a single type of school (public or private). The others used samples from both types of schools, but they did not stratify the analysis by type of school
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