Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
Lancet Public Health. 2017 Aug;2(8):e375-e386. doi: 10.1016/S2468-2667(17)30123-8. Epub 2017 Jul 31.
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 (I) was assessed via the χ 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.
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尽管高收入国家高度关注儿童和青少年高血压的威胁以及非洲成人高血压流行情况，但有关非洲儿童和青少年高血压负担的数据尚未得到综合分析。我们进行了一项系统评价和荟萃分析，以提供非洲儿童和青少年高血压患病率的估计值，并评估相关因素。
我们检索了 Embase、PubMed、African Journals Online 和 African Index Medicus，以获取 1996 年 1 月 1 日至 2017 年 2 月 2 日发表的文章，并检索了检索到的文章的参考文献列表。每篇文章均由独立的评审员进行方法学质量评估。我们使用随机效应模型来估计各研究之间高血压患病率的差异，并通过 Cochran's Q 统计量的 χ 检验评估异质性（I）。本综述已在 PROSPERO 注册，注册号为 CRD42015019029。
我们纳入了 51 项定性综合研究和 25 项荟萃分析，这些研究报告了汇总的 54196 名 2-19 岁参与者的数据。研究质量较高，仅有 4 项为中等质量研究，没有低质量研究。高血压患病率在各研究之间差异很大（范围为 0.2-24.8%）。高血压（收缩压或舒张压≥第 95 百分位数）的总体患病率为 5.5%（95%CI 4.2-6.9），而轻度高血压（收缩压或舒张压≥第 90 百分位数且<第 95 百分位数）的患病率为 12.7%（2.1-30.4）。高血压的患病率与体重指数（BMI）密切相关，肥胖儿童（30.8%，95%CI 20.1-42.6）高血压的患病率是正常体重儿童（5.5%，3.1-8.4）的 6 倍（p<0.0001）。
本研究表明，非洲儿童和青少年高血压的患病率较高，超重和肥胖是一个重要的危险因素。应对儿童和青少年高血压负担的努力应主要侧重于社区一级的一级预防，通过促进健康的生活方式和避免其他心血管危险因素，特别是超重和肥胖。本研究还强调需要进行更详细的研究，使用统一和可靠的诊断方法，以可靠地描绘非洲儿童和青少年高血压的负担。
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