Practice Change Needed for the Identification of Pediatric Hypertension in Marginalized Populations: An Example From South Africa
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...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.877431/full |
| _version_ | 1811307852853149696 |
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| author | Patricia Arnaiz Ivan Müller Harald Seelig Markus Gerber Jacob Bosma Danielle Dolley Larissa Adams Jan Degen Stefanie Gall Nandi Joubert Nandi Joubert Nandi Joubert Madeleine Nienaber Siphesihle Nqweniso Ann Aerts Peter Steinmann Peter Steinmann Rosa du Randt Cheryl Walter Jürg Utzinger Jürg Utzinger Uwe Pühse |
| author_facet | Patricia Arnaiz Ivan Müller Harald Seelig Markus Gerber Jacob Bosma Danielle Dolley Larissa Adams Jan Degen Stefanie Gall Nandi Joubert Nandi Joubert Nandi Joubert Madeleine Nienaber Siphesihle Nqweniso Ann Aerts Peter Steinmann Peter Steinmann Rosa du Randt Cheryl Walter Jürg Utzinger Jürg Utzinger Uwe Pühse |
| author_sort | Patricia Arnaiz |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T09:12:46Z |
| format | Article |
| id | doaj.art-e9aec273590a4a248368a2e1bb9c39ca |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-13T09:12:46Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-e9aec273590a4a248368a2e1bb9c39ca2022-12-22T02:52:51ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-05-011010.3389/fped.2022.877431877431Practice Change Needed for the Identification of Pediatric Hypertension in Marginalized Populations: An Example From South AfricaPatricia Arnaiz0Ivan Müller1Harald Seelig2Markus Gerber3Jacob Bosma4Danielle Dolley5Larissa Adams6Jan Degen7Stefanie Gall8Nandi Joubert9Nandi Joubert10Nandi Joubert11Madeleine Nienaber12Siphesihle Nqweniso13Ann Aerts14Peter Steinmann15Peter Steinmann16Rosa du Randt17Cheryl Walter18Jürg Utzinger19Jürg Utzinger20Uwe Pühse21Department of Sport, Exercise and Health, University of Basel, Basel, SwitzerlandDepartment of Sport, Exercise and Health, University of Basel, Basel, SwitzerlandDepartment of Sport, Exercise and Health, University of Basel, Basel, SwitzerlandDepartment of Sport, Exercise and Health, University of Basel, Basel, SwitzerlandDepartment of Human Movement Science, Nelson Mandela University, Gqeberha, South AfricaDepartment of Human Movement Science, Nelson Mandela University, Gqeberha, South AfricaDepartment of Human Movement Science, Nelson Mandela University, Gqeberha, South AfricaDepartment of Sport, Exercise and Health, University of Basel, Basel, SwitzerlandDepartment of Sport, Exercise and Health, University of Basel, Basel, SwitzerlandDepartment of Sport, Exercise and Health, University of Basel, Basel, SwitzerlandSwiss Tropical and Public Health Institute, Allschwil, SwitzerlandUniversity of Basel, Basel, SwitzerlandDepartment of Human Movement Science, Nelson Mandela University, Gqeberha, South AfricaDepartment of Human Movement Science, Nelson Mandela University, Gqeberha, South AfricaNovartis Foundation, Basel, SwitzerlandSwiss Tropical and Public Health Institute, Allschwil, SwitzerlandUniversity of Basel, Basel, SwitzerlandDepartment of Human Movement Science, Nelson Mandela University, Gqeberha, South AfricaDepartment of Human Movement Science, Nelson Mandela University, Gqeberha, South AfricaSwiss Tropical and Public Health Institute, Allschwil, SwitzerlandUniversity of Basel, Basel, SwitzerlandDepartment of Sport, Exercise and Health, University of Basel, Basel, SwitzerlandIntroduction: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.https://www.frontiersin.org/articles/10.3389/fped.2022.877431/fullpediatric hypertensionprevalenceidentificationnormative blood pressure tablesinternational guidelinesmarginalized settings |
| spellingShingle | Patricia Arnaiz Ivan Müller Harald Seelig Markus Gerber Jacob Bosma Danielle Dolley Larissa Adams Jan Degen Stefanie Gall Nandi Joubert Nandi Joubert Nandi Joubert Madeleine Nienaber Siphesihle Nqweniso Ann Aerts Peter Steinmann Peter Steinmann Rosa du Randt Cheryl Walter Jürg Utzinger Jürg Utzinger Uwe Pühse Practice Change Needed for the Identification of Pediatric Hypertension in Marginalized Populations: An Example From South Africa Frontiers in Pediatrics pediatric hypertension prevalence identification normative blood pressure tables international guidelines marginalized settings |
| title | Practice Change Needed for the Identification of Pediatric Hypertension in Marginalized Populations: An Example From South Africa |
| title_full | Practice Change Needed for the Identification of Pediatric Hypertension in Marginalized Populations: An Example From South Africa |
| title_fullStr | Practice Change Needed for the Identification of Pediatric Hypertension in Marginalized Populations: An Example From South Africa |
| title_full_unstemmed | Practice Change Needed for the Identification of Pediatric Hypertension in Marginalized Populations: An Example From South Africa |
| title_short | Practice Change Needed for the Identification of Pediatric Hypertension in Marginalized Populations: An Example From South Africa |
| title_sort | practice change needed for the identification of pediatric hypertension in marginalized populations an example from south africa |
| topic | pediatric hypertension prevalence identification normative blood pressure tables international guidelines marginalized settings |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.877431/full |
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