Hypertension in adolescents and young adults at a tertiary clinic in Cape Town, South Africa
DOI:
https://doi.org/10.15641/ur-at-uct.v1i2.40Abstract
Background: The prevalence of essential hypertension in children and adolescents has increased dramatically over the past decade attributed to a rising prevalence of obesity, high salt diet and lack of exercise. Traditionally high blood pressure in adolescents required extensive work up to determine a cause, but given the changing demographics this policy needs to be reviewed.
Objectives/method: The study aimed describe the risk factors, demographics, target organ damage and aetiology of hypertension in a cohort of young hypertensives (aged 15 - 30 years) referred to a tertiary hypertension clinic at Groote Schuur Hospital, by retrospectively reviewing the folders over a three-month period. Results: Thirty eight patients were identified with a mean age of 22 years. Essential hypertension was diagnosed in 82% of patients, and 71% of patients had a family history of hypertension. The median systolic blood pressure (BP) at first visit was 132 mmHg and diastolic BP 84mmHg. The median BMI was 25.4 kg/m2 and 68% had some form of target organ damage. Twenty six percent were current smokers and 8% had abused metamphetamines. Recognised secondary causes of hypertension were renal artery stenosis (four) and primary aldosteronism (one).
Conclusions: In a cohort of young hypertensives patients the dominant cause was essential hypertension. Although the prevalence of obesity was surprisingly low compared to previously published studies, significant lifestyle issues were identified. 68% had target organ damage suggesting the disease was not benign. These preliminary results indicate that larger cohorts need to be studied to develop new policies for assessment and treatment of young people with hypertension in South Africa.
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References
Alan, R. 1996. Hypertension in Children. New England Journal of Medicine. 335(26): 1968-1973.
Assadi, F. 2012. The growing epidemic of hypertension among children and adolescents: A challenging road ahead. Pediatric Cardiology. 33:1013-1020.
Bradshaw, D; Steyn, K; Levitt, N and Nojilana, B. Non-Communicable Diseases - A race against time. 2011.
Dong, B; Wang, H; Wang, Z; Liu, J and Ma, J. 2013. Trends in BP and Body Mass Index Among Chinese Children and Adolescents from 2005 to 2010. American Journal of Hypertension. 26(8):997-1004.
Falkner, B and Daniels, S. 2004. Summary of the Fourth Report on the Diagnosis, Evaluation, and Treatment of High BP in Children and Adolescents. American Journal of Hypertension. 44: 387-388.
Feig, D and Johnson, R. 2007. The Role of Uric Acid in Pediatric Hypertension. Journal of Renal Nutrition.17(1): 79-83.
Flynn, J and Tullus, K. 2009. Severe hypertension in children and adolescents: pathophysiology and treatment. Pediatric Nephrology. 24:1101-1112.
Ippisch, H and Daniels, S. Hypertension in overweight and obese children. 2008. Progress in Pediatric Cardiology. 25: 177-182.
Israeli, E; Schochat, T; Korzets, Z; Manova, D; Bernheim, J and Golan, E. Prehypertension and Obesity in Adolescents. American Journal of Hypertension. 2006; 19(7):708-712.
Jones, ESW; Owen, P and Rayner, BL. 2012. The Association of the R563Q Genotype of the ENaC With Phenotypic Variation in Southern Africa. American Journal of Hypertension. 25(12): 1286-1291.
Jones, ESW and Rayner, BL. 2015. Hypertension, end-stage renal disease and mesangiocapillary glomerulonephritis in methamphetamine users. South African Medical Journal.105(3): 199-201.
Kagura, J; Adair, L; Musa, M; Pettifor, J and Norris, S. 2015. BP tracking in urban black South African children: birth to twenty cohort. BMC Pediatrics. 15(78):1-7. [Online]. Available: http://www.biomedcentral.com/1471-2431/15/78 [Accessed 18 July 2015].
Lim, S; Vos, T; Flaxman, A; Danaei, G; Shibuya, K; Adair-Rohani, H et al. 2012. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 380(9859): 2224-2260.
Lu, Q; Ma, CM; Yin, FZ; Liu, BW; Lou, DH and Liu, XL. 2011. How to simplify the diagnostic criteria of hypertension in adolescents. Journal of Human Hypertension. 25:159-163.
Rayner, BL. 2010. Hypertension: Detection and Management in South Africa. Nephron Clinical Practice. 116: 269-c273.
Reddy, S; Resnicow, K; James, S; Funani, I; Kambaran, S; Omardien, RG; et al. 2012. Rapid Increases in Overweight and Obesity Among South African Adolescents: Comparison of Data From the South African National Youth Risk Behaviour Survey in 2002 and 2008. American Journal of Public Health. 102(2): 262-268.
Seedat, YK; Rayner, BL & Veriava, Y. 2014. South African hypertension practice guideline 2014. Cardiovascular Journal of Africa. 25(6): 288.
Tirosh, A; Afek, A; Rudich, A; Percik, R; Gordon, B; Ayalon, N et al. 2010. Progression of Normotensive Adolescents to Hypertensive Adults: A study of 26980 Teenagers. Journal of the American Heart Association. 56:203-209.
Tu, W; Eckert, G; DiMeglio, L; Yu, Z; Jung, J and Pratt, H. Intensified effect of Adiposity on BP in Overweight and Obese Children. American Journal of Hypertension. 2011; 58:818-824
Xi B, Zhang T, Zhang M, Liu F, Zong X, Zhao M, et al. 2015. Trends in Elevated BP Among US Children and Adolescents:1999-2012. American Journal of Hypertension. 2015:1-9.
World Health Organization. Global Status Report on Noncommunicable Diseases. 2014. 67-79.