Sustained high blood pressure and 24-h ambulatory blood pressure monitoring in Tanzanian adolescents

Mussa K Nsanya,Daniel Fitzgerald,Ezekiel Mgema,Saidi Kapiga,Robert N Peck,Ramadhan Hashim,Philip Ayieko

doi:10.1038/s41598-021-87996-0

Abstract

Estimates for prevalence of high blood pressure (BP) among adolescents in Africa vary widely and few studies, if any, have documented the results of the recommended stepwise BP screening. In this cross-sectional study in Tanzania, we aimed to estimate prevalence of sustained high BP in 3 public secondary schools using the American Academy of Pediatrics BP screening strategy. On Day 1, one screening automated office BP (AOBP) measurement (Step 1) was followed by two more AOBP measurements (Step 2). Repeat AOBP measurements were obtained after about one month on adolescents with high AOBP measurements on Day 1 (Step 3). Participants with sustained high BP underwent 24-h ambulatory BP monitoring (step 4). Of all 500 enrolled participants, the prevalence of high blood pressure at each step in the process was 36.6% (183), 25.6% (128), 10.2% (51), and 2.6%(13) respectively for Steps 1–4. All except 6 students completed all 4 steps of the BP screening algorithm as indicated. We conclude that diagnosis of hypertension in African adolescents should use multiple AOBP measurements over multiple days followed by 24-h ABPM. Screening for high BP in school settings appears to be feasible and could provide a platform for cardiovascular disease education and health promotion.

Highlights

Background characteristicswe present the overall background characteristics of the 500 enrolled study participants by their gender groups
There were no systematic differences in age, sex and level of education between participants who were enrolled from those who declined to participate
automated office BP (AOBP) measurements at day 1 were available for all 500 enrolled participants and 128 participants who were eligible for repeat blood pressure (BP) measurements at day 2

Summary

Introduction

Background characteristicsIn Table 1, we present the overall background characteristics of the 500 enrolled study participants by their gender groups. Majority of the participants were females (56.6%); had lived in Mwanza city for more than 10 years (85.2%); were in lower wealth index (57.6%) and had their BP being measured for the first time in this study (91.2%). 62.2% and 79.9% never consumed fruits and vegetables respectively in a typical week. Similar proportion of participants reported less than the recommended levels of moderate and vigorous physical activity respectively. 59% reported using an equivalent of 10 or more teaspoons of sugar in a typical day. 14% of all participants were stunted and majority of them (70%) were males. Alcohol drinking (p = 0.0006), vigorous physical activity (p < 0.0001) and resting pulse rate ≥ 90 beats/min (p < 0.0001) showed significant statistical difference between males and females

Objectives

Methods

Results

Conclusion