Abstract
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. 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. 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). 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. None.
Highlights
Hypertension is the greatest modifiable risk factor for cardiovascular disease, disability, and deaths worldwide
Our study shows that elevated blood pressure is not infrequent in these populations, with overweight and obesity being a driver of the condition
Search strategy and selection criteria For this systematic review and meta-analysis, JJN, ME, and LNA, with the help of an expert librarian, did a comprehensive search of PubMed, Embase, African Journals Online, and African Index Medicus to identify all relevant articles on elevated blood pressure in children and adolescents in Africa published in English and French from Jan 1, 1996, to Feb 2, 2017
Summary
Hypertension is the greatest modifiable risk factor for cardiovascular disease, disability, and deaths worldwide. It affects about 1 billion adults and is associated with more than 9 million deaths annually.[1] hypertension was the largest contributor to global disability-adjusted life-years (DALYs) in 2015, accounting for 9·2% (95% uncertainty interval 8·3–10·2) of DALYs for men and 7·8% (6·9–8·7) of DALYs for women.[2] Once uncommon in African populations, the burden of hypertension has been continuously rising over the past decades in these populations, driven by reduced physical activity, unhealthy diet, and obesity.[3] According to WHO, Africa has the highest age-standardised prevalence of hypertension, with 46% of adults older than 25 years being affected.[1]. Hypertension is less common in children than in adults, its burden has increased in children and adolescents in some high-income countries over the past decade, mainly due to the surge in obesity prevalence.[4,5,6,7,8,9,10] reports from epidemiological studies on blood pressure in children and adolescents done during the past decade have shown a substantial increase in blood pressure levels and in the prevalence of hypertension in these age groups, with rates ranging from 1% to 5% in some western countries.[4,5,6,7,8,9,10] these increasing trends have not been observed in all countries studied.[11]
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