Screening of arterial blood pressure is carried out in 964 students (423 boys and 541 girls) aged 14 to 18 years from randomly selected schools in Sofia and Varna. The predictors of arterial hypertension in adolescence such as positive family history, increased body mass, nutrition patterns, hypokinesia and stress are studied by means of questionnaire interview. The results show that 57,4% of the adolescents with elevated systolic and diastolic arterial blood pressure have positive family history. In girls, a positive family history is found out by 2,3 times more often (p <0,001). In 19,1% of the adolescents an increased body mass combined with hypokinesia (in 61,4% of the boys and in 72,8% of the girls) and non-balanced nutrition is established. Every second girl and every third boy are under distress conditions. Data of the present study show that prevention of arterial hypertension in adolescence must be carried out individually according to the predictor significance of medico-biological and behavioural risk factors

Arabadzhieva, D.

Manolova, A.

Yustinianova, B.

English

Varna Medical University Press: Journals

Scripta Scientifica Medica, vol . 34 (2002). pp 67-71 Copyright © Medical University, Varna A B O U T E L E V A T E D A R T E R I A L B L O O D P R E S S U R E AND T H E P R E D I C T I V E R O L E O F S O M E R I S K F A C T O R S IN A D O L E S C E N C E B. Yustinianova, A. Manolova1, D. Arabadzhieva Department of Hygiene and Disaster Medicine, Prof. Paraskev Stoyanov Medical University of Varna and National Centre of Hygiene, Medical Ecology and Nutrition, Sofia A B S T R A C T Screening of arterial blood pressure is carried out in 964 students (423 boys and 541 girls) aged 14 to 18 years from randomly selected schools in Sofia and Varna. The predictors of arterial hypertension in adolescence such as positive family history, increased body mass, nutrition patterns, hypokinesia and stress are studied by means of questionnaire interview. The results show that 57,4% of the adolescents with elevated systolic and di­astolic arterial blood pressure have positive family history. In girls, a positive family history is found out by 2,3 times more often (p <0,001). In 19,1% of the adolescents an increased body mass combined with hypokinesia (in 61,4% of the boys and in 72,8% of the girls) and non-balanced nutrition is established. Every second girl and every third boy are under distress conditions. Data of the present study show that prevention of arterial hypertension in adolescence must be carried out individually according to the predictor significance of med­ico-biological and behavioural risk factors. Key words: arterial hypertension, r i sk factors, adolescents, prevention, t own o f V a r n a I N T R O D U C T I O N Cardiovascular diseases are a serious health, demographic and social problem and cause the highest relative part of mortality rate at active age. Among cardiovascular pathol­ogy, arterial hypertension ( A H ) occupies a particularly im­portant place as a nosologic unit, on the one hand, and as a leading etiological factor for other cardiovascular diseases, on the other. According to statistical data available, the re­cent prevalence of A H in our country approaches 12-16% and is characterized by "rejuvenating' (5). Longitudinal studies prove that the risk of developing A H in adults is al­ready predetermined in childhood and adolescence. In ado­lescence, A H is a premise for worsening the quality o f life in the next generations, i . e. genetic loading o f the genera­tions (4,6,12). For this reason the recognition o f the risk and the necessity of prevention of the serious problems of A H is defined as a 'pediatric responsibility'. The preventive strat­egy must be oriented towards the main determinants of the elevated arterial blood pressure ( E A B P ) in childhood and adolescence (2,13). The aim of this study is to investigate A B P in teenagers aged 14 to 18 years and the influence of the basic med­ico-biological and behavioural risk factors in terms o f A H prevention in school age. A preliminary hypothesis of the study is that family history, elevated body mass, nutrition Address for correspondence: Я Yustinianova, Dept.of Hygiene and Disaster Medicine, Prof. P. Stoyanov Medical University of Varna. 55 Marin DrinovSt, BG-9002 Varna. BULGARIA patterns, hypokinesia and psychosocial distress are directly related with E A B P . M A T E R I A L AND M E T H O D S Screening of A B P is carried out in 964 students (423 boys and 541 girls) aged 14 to 18 years, at mean age of 15,9+1,2 years, or of 8^ to 12й1 school class, from randomly selected schools in Sofia and Varna. A B P is measured with standard methods (7). The mean value of three measurements is ana­lyzed and on its basis according to the recently accepted methods (12) the students are divided into 2 groups: group one - with normal systolic and diastolic A B P ( S A B P , D A B P ) values in the referent range for age and gender, i . е., under 90 t h percentile; group two - with elevated S A B P and D A B P values, i.e., above 90* percentile. Children and par­ents are interviewed by questionnaire for determination of the following risk factors: i ) medico-biological - age, gen­der, and family history and ii) behavioural - nutrition pat­terns, physical activity, and psychosocial stress. The estimation of the body mass index ( B M I ) is perfonned on the basis of the normal values for age and gender. In the groups designed as "underweight", 'normal weight" and "overweight', the adolescents with B M I values of "X'<1S, " X ' l S , and "X">1S, respectively, are included. Distress is determined by evaluation stage scale (11). Data processing is carried out by means of SPSS PC+ statistical package. The method of chi2 and Cramer's coefficient of V 2 assess­ing the links and relations of category signs are used. The level o f significance is determined for p <0,05. 67 В. Yustinianova. A . Manolova, D. Arabadzhieva R E S U L T S AND D I S C I S S I O N Familial predisposition for E A B P is a prognostic criterion for the development of A H . Data analysis shows that 57,4% of the pupils with elevated S A B P and D A B P are with family history for A H , while those with nonnal S A B P and D A B P present with family history rate that is lower by 2,3 times (p<0,001) (Fig. 1). • with norma! SABP and DABP values • with elevated SABP and D A B P values Fig. 1. Family history of AH according to anamnestic data available According to some authors (6,8,10), parents with E A B P have children, who being even nomiotensive, bare a risk o f elevating the A B P later on. Gender distribution of the pupils with E A B P and positive family history for A H shows that family history for A H in girls is by 2,3 times more frequent as compared to that in boys (78,4% versus 34,5%; p<0,001) (Fig . 2). This fact confirms a commonly accepted statement that women are a more susceptible gender and thus they bare a higher genetic risk to develop A H . In girls with elevated S A B P and D A B P the relative part o f those with family his­tory for A H originating on the side o f the mother (mother-grandmother and grandfather) is by 2,2 times • boys Q girls Fig. 2. Gender distribution of the pupils with positive family history of elevated SABP and DABP higher when compared to that in boys (p<0,001). Family histoiy originating on the side o f the father (fa­ther-grandmother and grandfather) is reported by 6 5 % of the boys and by 50% of the girls, i.e., almost by every sec­ond boy and girl. The relative part is significantly higher in boys than in girls (p<0,01) (Fig. 3). % m ^—.— 65 m 34 I generation II generation • boys В girls Fig. 3. Positive family histoiy in pupils with EABP according to first and second generation lines Our results are in agreement with data of other authors (5,8) according to which the relative genetic risk for developing A H in adolescents with family history is by 2 times higher compared to the other populations and women are the more susceptible gender in respect o f hereditary A H . Obesity is one o f the most common risk factors for A H in early childhood. The increased B M enhances the coronary risk and it is an important predictor for A H in males and fe­males (3,5,14). The analysis o f the results indicates that increased B M I has been found out in 19,5% of the studied contingent. It has been established that more than half o f the pupils with ele­vated S A B P and D A B P ( 5 5 % of the cases) present with ab­normally high B M I (p<0,001) (Fig . 4) . Incorrect nutrition patterns and hypokinesia are predictors o f the increased B M I . normal S A B P high S A B P normal D A B P high D A B P • below normal values • normal \ alues Q above normal values Fig. 4. BMI in adolescents with different ABP values 68 About elevated arterial blood pressure and the predictive role of some risk factors. Table 1. Average daily consumption of food products by boys and girls with elevated SABP Boys Girls Product Recommended quantities (g/day) Daily intake (g) % of pupils with intake below the recommended Recommended quantities (g/day) Daily intake (g) % of pupils with intake below the recommended milk 400 302 80,0 380 213 100,0 diary products 40 26 88.6 40 30 76,5 eggs 40 22 91,4 25 13 92,5 meat, meat diet 120 140 60,0 80 83 60,0 30 26 82,9 30 10 %,3 fats 36 31 68,6 11 34 36,1 sugar products 165 199 cereals and paste products 417 592 22,9 296 390 32,2 fruits 300 295 54,3 300 310 88,0 juice, compote, nectar 200 200 65,7 150 234 48,2 vegetables 320 167 91,4 310 193 92,1 legumen 15 21 57,1 11 14 36,0 potatoes 160 149 85,7 160 131 56,3 Table 2. Average daily consumption offood products by boys and girls with elevated DABP Boys Girls Product Recommended quantities (g/day) Daily intake (g) % of pupils with intake below the recommended Recommended quantities (g/day) Daily intake (g) % of pupils with intake below the recommended milk 400 288 78,4 380 227 92,7 diary products 40 30 83,8 40 30 83,3 40 14 97,3 25 10 95,4 meat, meat diet 120 129 56,8 80 92 54,8 fish 30 16 82,7 30 17 88,1 fats 36 39 56,8 27 32 42,9 sugar products 183 178 cereals and paste products 417 647 24,2 296 392 26,2 fruits 300 248 54,1 300 305 54,8 juice, compote, nectar 200 166 73,0 150 273 35,7 vegetables 320 165 86,5 310 199 85,7 legumen 15 24 51,4 11 14 42,9 potatoes 160 119 86,5 160 146 50,0 69 В. Yustinianova, A . Manolova. D. Arabadzhieva Table 3. Answers to the question "Have you the habit of adding salt to the food" by adolescents with different SABP and DA BP values (in %) SABP DABP Answer boys girls boys girls normal high normal high normal high normal high Add before tasting 6,8 26.3 7,8 39,5 5.1 30,2 6.4 27.6 ' J| Taste and then add 30,7 57,3 40.3 39.0 36,6 47.3 39,5 42.8 Very rarely or never add 62,5 16,4 51,9 21,5 58,3 1— 22,5 54,1 29.6 chi 2 = 43,1 j V 2 = 0,374 chi 2 =53,4 V 2 = 0,339 chi 2 = 34,9 V = 0,336 chi 2 = 30,6 V 2 = 0,256 P <0,001 <0,00l <0,001 <0,00l . J The analysis of the nutrition patterns of the adolescents with elevated S A B P and D A B P demonstrates that the insuffi­cient daily intake of milk, dairy products, eggs and fresh vegetables is combined with considerable consumption of fats, mainly of animal origin, corn, paste and sugar products (Table 1 and Table 2). It s noteworthy that in 39,5%-62,7% of the adolescents with E A B P the consumption o f fats of animal origin predominates. More than one third of the consumed meat is pork and meat products. The ratio o f ani­mal to plant fats is 1:1,2 at a standard 1:2. According to the literature available, the established considerable intake of saturated fatty acids and the disturbed proportion with the polyunsaturated ones exerts a negative effect on cholesterol level that increases the risk for A H (5,15). The strongly de­creased daily intake offish is an unfavourable nutrition fac­tor because of the established preventive effect o f the omega-3-polyunsaturated fattv acids contained in fish fats (15). Data from the inquiry demonstrate a considerably higher relative part of the boys and girls with E A B P (26,3%-39,5%) who 'add salt to the food before tasting it" compared to the pupils with normal A B P (5 , l%-7 ,8%, re­spectively) (Table 3). More than half of the adolescents with normal A B P 'very rarely or never add salt to the food'. The examination of the moderating interactions of the risk factors shows that the high intake of energy foods, fats and carbohydrates has no direct effect on A B P and leads to E A B P only in the presence of family history for A H , in­creased B M I and hypokinesia. When there is high intake of fats and carbohydrates with food, sport activities (regular or as leisure activity) act as a protector for E A B P (13,14). Physical inactivity is a behavioural pattern that increases the risk for A H (Fig . 5). A trial carried out in the outset of S I N D Y program indicates that 35.2% of the Bulgarian adolescent boys and 53,7% of the girls do not go or go occasionally for physical exercises (1). Our present study confirms these data. A total of 61,4% of the boys and 72,8% of the girls with E A B P are with de­creased physical activity (on daily basis, when at leisure there is no physical activity for at least 35 min), or when not going for any sports at all (regularly or as leisure activity). Physical inactivity is by 9,4% more common in girls than in boys (p<0,01). hypokinesia going tor spoils • bovs • airls Fig. 5. Physical activity of pupils with EABP % PO.01 37 3<0.05 P<0.01 15 32 m psychosocial decreased sleep distress self-confidence disorders • bovs D girl-Fig. 6. Self assessment of psychosocial distress, self-confidence, and sleep of pupils with EABP 70 About elevated arterial blood pressure and the predictive role of some risk factors е results from the self-evaluation of the psychosocial dis­tress, self-confidence and sleep of pupils with E A B P are presented on Fig. 6. Every second girl and third boy are un­der condition of distress. The relative part of the girls who present with psychosocial distress and diminished self-confidence is significantly higher than that of the boys ( p O . O l ) . Subjective complains of sleep disturbances are reported by 32% of the boys and 4 1 % of the girls (p<0,001). The sleep of the students in distress is character-Bed by difficulties in falling asleep, troubled sleep and a feeling of fatigue after sleep. C O N C L U S I O N ^ur results demonstrate that 57,4% of the adolescents with elevated S A B P and D A B P present with family histoiy of H , 19 ,1% with increased B M I combined with low physi-' activity, non-balanced nutrition. The relative part of the students adding salt to the food prevails in this group. Therefore, our hypothesis about these main predictors for E A B P in adolescence is confimied. Having in mind the multifactorial genesis of A H , positive results from the ap­plication of preventive programs in adolescence may be ex­pected only i f they consider the predictor significance of the medico-biological and behavioural risk factors. The proper organization of A H prevention in childhood and adoles­cence requires the creation of a vast functional network of active interaction between the family, school, health institu­tions and the public. R E F E R E N C E S В а с и л е в с к и . H . , T . Т р о е в а . Двигателна активност на българското население.- В: М о з ъ ч е н инсулт и пътищата за профилактика в България. София, 1994, 50-52. В и т л я н о в а , К. Комбинирано влияние на биосоциалните фактори върху формирането на коронарния риск.-Сои. мед., 2001, № 1. 19-21. 3. Д о й ч и н о в а . А. Повишено артериално налягане и наднормена телесна маса при деца в училищна възраст.- Хиг. и здравеоп., 1996, № 4, 30-33. 4. М а з о . Р. Э . , Е. А. Н а д е ж д и на . Актуальная гипертензия у детей. Минск, Наука и техника, 1990. 5. М е р д ж а н о в , Ч . Едно компрометиращо първенство. София. Св. Кл. Охридски, 1995. 6. М и х о в , М . Лонгитудинално проследяване на деца с артериална хипертония и хипертонични реакции, установени във възрастта до 6 години.-Педиатрия, 1990, № 1.61-67. 7. Наредба № 9/11.IV.1996 г. за провеждане на профилактичните прегледи и диспансерното наблюдение на деца от 0 до 18 години.- Служ. бюя. МЗ, 1996. № 9-10. с. 102. 8. Р а Х н е в а , Р . Артериална хипертония в детството. София, Медицина и физкултура, 1990. 9. Т о р б о в а , С . Хипертонична болест. София, Медицина и физкултура, 1994. 10. B e r e n s o n , С , D . L a w r e n c e . - Int. Child Health. 4, 1993, No 3,3-15. 11. He rnandez . P . A . , et a l . Manual de recomendaciones para la evaluacion psicologica. Habana, 1997. 12. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The Sixth Re­port of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNCV1), 1997. 13. R i d d o c h , C . J . , C . A . B o r e h a m . T h e health-related physical activity of children.- Sports Med. 1995, No 2, 86-102. 14. S a l i s , J . F . Epidemiology of physical activity and fitness in children and adolescents.- Crit. Rev. Food Xutr., 33, 1993, No 4-5, 403-408. 15. The Trials of Hypertension Prevention Collaborative Research Group. The effects of non-pharmacologic interventions on blood pressure of persons with high normal levels. Results of the trial of hypertension pre­vention. Phase I . - JAMA, 267, 1992, 1213-1220. 71 

ABOUT ELEVATED ARTERIAL BLOOD PRESSURE AND THE PREDICTIVE ROLE OF SOME RISK FACTORS IN ADOLESCENCE

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ABOUT ELEVATED ARTERIAL BLOOD PRESSURE AND THE PREDICTIVE ROLE OF SOME RISK FACTORS IN ADOLESCENCE

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