This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Jafar, T. H. Articles by Chaturvedi, N. Search for Related Content PubMed PubMed Citation Articles by Jafar, T. H. Articles by Chaturvedi, N. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information High Blood Pressure Related Collections Other hypertension Epidemiology

(Circulation. 2005;111:1291-1297.)
© 2005 American Heart Association, Inc.

Pediatric Cardiology

Children in South Asia Have Higher Body Mass–Adjusted Blood Pressure Levels Than White Children in the United States

A Comparative Study

Tazeen H. Jafar, MD, MPH; Muhammad Islam, BSc; Neil Poulter, MD; Juanita Hatcher, PhD; Christopher H. Schmid, PhD; Andrew S. Levey, MD; Nish Chaturvedi, MD

From the Clinical Epidemiology Unit, Department of Community Health Sciences (T.H.J., J.H.), the Section of Nephrology, Department of Medicine (T.H.J.), and the Department of Medicine (M.I.), Aga Khan University, Karachi, Pakistan; the Division of Nephrology (T.H.J., A.S.L.) and the Division of Clinical Care Research (C.H.S.), Tufts-New England Medical Center, Department of Medicine, Tufts University School of Medicine School, Boston, Mass; and the National Heart and Lung Institute, Imperial College London, UK (N.P., N.C.).

Correspondence to Dr Tazeen H. Jafar, Head, Section of Nephrology, and Director, Clinical Epidemiology Unit, Associate Professor, Medicine and Community Health Sciences, Aga Khan University, PO Box 3500, Stadium Road, Karachi, Pakistan. E-mail tazeen.jafar{at}aku.edu

Received September 21, 2004; revision received January 9, 2005; accepted January 11, 2005.

Background— Blood pressure during childhood is an established predictor of adult blood pressure, which in turn increases mortality as a result of cardiovascular disease. Adult South Asian populations are particularly predisposed to cardiovascular disease compared with whites, but the prevalence of high blood pressure and determinants of blood pressure in South Asian children have not been explored or compared with those of white children.

Methods and Results— Analyses were performed on 5641 South Asian children 5 to 14 years old included in the nationally representative National Health Survey of Pakistan (NHSP) (1990–1994) and on 4756 white children 5 to 14 years old included in Third National Health and Nutrition Examination Survey (NHANES III) (1988–1994). Anthropometric measurements were obtained. Blood pressure was measured twice in the seated position with a mercury sphygmomanometer and an appropriate-size cuff. High blood pressure was defined as a systolic or diastolic blood pressure level that was 95th percentile of age-, sex-, and height-percentile–specific reference level for the US population. Mean body mass index (BMI)–adjusted blood pressure values were compared among children in 2 data sets by use of linear regression analysis. The overall prevalence (95% CI) of high blood pressure in South Asian children 5 to 14 years old was 12.2% (11.3% to 13.1%): 15.8% (14.5% to 17.1%) in boys and 8.7% (7.6% to 9.8%) in girls. This is in sharp contrast with the predicted 5% prevalence of high blood pressure in children in the United States (P<0.001). The mean BMI-adjusted systolic blood pressure levels (SD) were 100 (11) versus 99 (11) mm Hg (P<0.001), and diastolic blood pressure levels (SD) were 63 (10) versus 52 (12) mm Hg (P<0.001) in NHSP versus NHANES III, respectively.

Conclusions— South Asian children have higher body-mass–adjusted blood pressure levels than white children in the United States. Further studies are needed to determine factors responsible for these differences. Immediate attention is needed to address high blood pressure and its risk factors in native South Asian children.

Key Words: blood pressure • pediatrics • epidemiology • ethnic groups

This article has been cited by other articles:

				T H Jafar, Z Qadri, M Islam, J Hatcher, Z A Bhutta, and N Chaturvedi Rise in childhood obesity with persistently high rates of undernutrition among urban school-aged Indo-Asian children Arch. Dis. Child., May 1, 2008; 93(5): 373 - 378. [Abstract] [Full Text] [PDF]

				A. Chiolero, P. Bovet, G. Paradis, and F. Paccaud Has Blood Pressure Increased in Children in Response to the Obesity Epidemic? Pediatrics, March 1, 2007; 119(3): 544 - 553. [Abstract] [Full Text] [PDF]

				T. H. Jafar The Growing Burden of Chronic Kidney Disease in Pakistan N. Engl. J. Med., March 9, 2006; 354(10): 995 - 997. [Full Text] [PDF]