Arnaiz Patricia, Müller Ivan, Seelig Harald, Gerber Markus, Bosma Jacob, Dolley Danielle, Adams Larissa, Degen Jan, Gall Stefanie, Joubert Nandi, Nienaber Madeleine, Nqweniso Siphesihle, Aerts Ann, Steinmann Peter, du Randt Rosa, Walter Cheryl, Utzinger Jürg, Pühse Uwe
Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa.
Front Pediatr. 2022 May 11;10:877431. doi: 10.3389/fped.2022.877431. eCollection 2022.
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.
Blood 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.
Hypertension 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.
Our 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.
在过去20年里，全球儿童高血压发病率呈上升趋势；然而，关于低收入和中等收入国家弱势群体的这一问题，我们所知甚少。年龄、性别和身高调整后的标准表是全球儿科高血压诊断和评估的“金”标准，但尚不清楚国际标准的使用是否适用于所有情况。本研究的目的是评估和比较不同的国际参考标准，以确定南非弱势群体中学龄儿童的高血压情况。
对来自南非东开普省8所城郊学校的897名8至16岁儿童进行了血压、体重和身高测量。根据美国、德国和全球标准表以及本研究人群的伪标准数据计算高血压的横断面患病率。孤立性收缩期高血压和体重指数（BMI）被视为心血管疾病的标志物。采用多项逻辑回归比较随着BMI水平升高血压分类的可能性。
高血压患病率从伪标准研究表的11.4%到基于德国参考标准的28.8%不等。全球指南在国际标准中一致性最高（与美国指南一致率为92.5%），与研究参考标准一致率为72.5%。虽然全球和美国参考标准的收缩期高血压与舒张期高血压发生率更高（分别为23.6%对10.6%和24.2%对14.7%），但美国指南预测随着BMI水平升高，高血压2期风险增加最高[比值比，1.72（95%置信区间：1.43 - 2.07）]。
我们的结果支持了南非文献中血压估计的异质性，并强调了非洲儿童在国际指南中代表性不足的问题。我们呼吁在不同情况下使用国际标准时要谨慎，并主张制定代表南非儿科人群的标准表，这对于从临床和流行病学角度准确识别高血压是必要的。
