Paediatric hypertension in South Africa: An underestimated problem calling for action

Kagura, Juliana; Ong, Ken K.; Adair, Linda S.; Pettifor, John M.; Norris, Shane A.

doi:10.7196/samj.2018.v108i9.13317

Cited by 12 publications

(14 citation statements)

References 15 publications

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“…As such, although we are confident in our results, our findings do not reflect clinical prevalence rates. It is crucial for future research that South Africa joins ongoing work to create international blood pressure references, measurement guidelines and appropriate cut-points for defining hypertension, particularly for children [4].…”

Section: Discussionmentioning

confidence: 99%

The impact of maternal hyperglycaemia first detected in pregnancy on offspring blood pressure in Soweto, South Africa

Boerstra

Soepnel

Nicolaou

et al. 2022

Journal of Hypertension

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Background: The long-term consequences for offspring born to mothers with hyperglycaemia first detected in pregnancy (HFDP) are not yet well understood and its influence on childhood blood pressure has not previously been assessed in sub-Saharan Africa.Objective: The objective of this study was to evaluate the association between maternal HFDP and offspring blood pressure in 3 to 6-year-old children in Soweto, South Africa.Methods: Oscillometric blood pressure was measured in 189 children born to mothers with and without HFDP diagnosed by 75 g 2-h oral glucose tolerance test. The 2017 AAP Guidelines for Childhood Hypertension were used as reference standard, and the term 'elevated blood pressure' referred to blood pressure readings above the 90th percentile for age, height and sex. The association between maternal HFDP and offspring blood pressure was analysed using multivariable linear regression.Results: Elevated blood pressure was identified in 49.7% of children. Maternal hyperglycaemia was not associated with offspring blood pressure when adjusted for offspring age, height and sex (SBP: 0.199, P ¼ 0.888; DBP: 0.185, P ¼ 0.837) or after multivariable adjustment (SBP: -0.286, P ¼ 0.854; DBP: 0.215, P ¼ 0.833). In the full model for SBP, child BMI age z-score was a significant predictor of blood pressure at 3-6years (1.916, P ¼ 0.008). Conclusion:Although maternal HFDP was not associated with childhood blood pressure at 3-6 years, the prevalence of elevated blood pressure in this group of preschool-aged children is concerning. Future research is needed to further evaluate childhood obesity as a modifiable risk factor to reduce hypertension and cardiovascular risk in an African setting.

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Section: Discussionmentioning

confidence: 99%

The impact of maternal hyperglycaemia first detected in pregnancy on offspring blood pressure in Soweto, South Africa

Boerstra

Soepnel

Nicolaou

et al. 2022

Journal of Hypertension

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“…As new research emerges, we are gaining awareness of the extent of a long underappreciated problem and the consequences of its (mis)management, such as impaired development, economic burden, years of life lost, etc. ( 5 ). A recent meta-analysis revealed that global hypertension rates among children have increased about 75% over the past 20 years ( 6 ), which has been partially attributed to the steep escalation in childhood obesity, an early-life risk factor for CVD.…”

Section: Introductionmentioning

confidence: 99%

Practice Change Needed for the Identification of Pediatric Hypertension in Marginalized Populations: An Example From South Africa

et al. 2022

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Introduction:Hypertension in children has increased globally over the past 20 years; yet, little is known about this issue among disadvantaged communities from low- and middle-income countries. Age-, sex-, and height-adjusted normative tables are the “gold” standard for the diagnosis and estimation of pediatric hypertension worldwide, but it is unclear whether the use of international standards is appropriate for all contexts. The purpose of this study was to evaluate and compare different international references to identify hypertension among South African school-aged children from disadvantaged communities.MethodsBlood pressure, weight, and height were measured in a cohort of 897 children aged 8–16 years from eight peri-urban schools in the Eastern Cape of South Africa. Cross-sectional prevalence of hypertension was calculated according to American, German, and global normative tables, as well as pseudo-normative data from the own study population. Isolated systolic hypertension and body mass index (BMI) were considered markers for cardiovascular disease. Multinomial logistic regression was used to compare the likelihood of blood pressure categorization with increasing BMI levels.ResultsHypertension prevalence ranged from 11.4% with the pseudo-normative study tables to 28.8% based on the German reference. Global guidelines showed the highest agreement both among international standards (92.5% with American guidelines) and with the study reference (72.5%). While the global and the American references presented higher systolic over diastolic hypertension rates (23.6 vs. 10.6% and 24.2 vs. 14.7%, respectively), the American guidelines predicted the highest increased risk for hypertension stage 2 [odds ratio, 1.72 (95% confidence interval: 1.43–2.07)] with raising levels of BMI.ConclusionOur results support the heterogeneity of blood pressure estimates found in the South African literature, and highlight the underrepresentation of African children in international guidelines. We call for caution in the use of international standards in different contexts and advocate for the development of normative tables that are representative of the South African pediatric population necessary to ensure an accurate identification of hypertension both from the clinical and epidemiological perspective.

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“…elevated blood pressure) [6][7][8][9][10] . Hypertension is the largest contributor to CVD in Africa, with research showing elevated blood pressure in children as young as 5 years of age 11 . Studies of mono-and dizygotic twins have shown high heritability of systolic and diastolic blood pressure in populations of both African and European decent 12 13 , though heritability may be lower for individuals of African decent 14 .…”

Section: Introductionmentioning

confidence: 99%

Heritability of cardiovascular health across three generations in South Africa: the Birth to Twenty-Plus cohort

Ware

Maposa

Kolkenbeck‐Ruh

et al. 2022

Preprint

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ObjectivesCardiovascular disease is increasing in many low-middle income countries, including those in Africa. To inform strategies for the prevention of cardiovascular disease in South Africa, we sought to determine the broad heritability of phenotypic markers of cardiovascular risk across three generations.DesignA cross-sectional study conducted in a longitudinal family cohort.SettingResearch unit within a tertiary hospital in a historically disadvantaged, large urban township of South Africa.Participants195 individuals from 65 biological families with all three generations including third generation children aged 4-10 years were recruited from the longest running intergenerational cohort study in Africa, the Birth to Twenty Plus cohort. All adults (grandparents and parents) were female, while children were male or female.Primary and secondary outcome measuresThe primary outcome was heritability of blood pressure (BP, brachial and central pressures). Secondary outcomes were heritability of arterial stiffness (pulse wave velocity), carotid intima media thickness (cIMT), and left ventricular mass indexed to body surface area (LVMI).ResultsWhile no significant intergenerational relationships of BP or arterial stiffness were found, there were significant relationships in LVMI across all three generations (p<0.04), and in cIMT between grandparents and parents (p=0.0166). Heritability estimates were 23-44% for cIMT and 21-39% for LVMI.ConclusionsStructural indicators of vascular health, which are strong markers of future clinical cardiovascular outcomes transmit between generations within African families. Identification of these markers in parents may be useful to trigger assessments of preventable risk factors for cardiovascular disease in offspring.StrengthsIntergenerational transmission was evaluated for a range of indicators of cardiovascular health within urban African familiesThe sample included biological family members from three generationsHeritability estimates were compared for three commonly used statistical methods.LimitationsThe sample size is a limitation with the random family statistical method used to increase the numbers of comparisons available.Only maternal family members were included.

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Paediatric hypertension in South Africa: An underestimated problem calling for action

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 12 publications

References 15 publications

The impact of maternal hyperglycaemia first detected in pregnancy on offspring blood pressure in Soweto, South Africa

The impact of maternal hyperglycaemia first detected in pregnancy on offspring blood pressure in Soweto, South Africa

Practice Change Needed for the Identification of Pediatric Hypertension in Marginalized Populations: An Example From South Africa

Heritability of cardiovascular health across three generations in South Africa: the Birth to Twenty-Plus cohort

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