As far as we know, this is the first study on BP patterns amongst adolescents in Suriname, and one of the few studies in adolescents comparing different ethnic groups in a non-industrialised country. Maroon boys had a lower BP than all ethnic groups including Creoles with similar West African descent. The lower BP in Maroon boys as compared to other ethnic groups was accounted for by their lower BMI. This might reflect differences in environmental factors such as lifestyle between Maroons and other ethnic groups. Maroon adolescents moved from the Suriname interior to Paramaribo to continue their education. Most Maroon people in Suriname interior still live traditional African lifestyles with female subsistence horticulture and male hunting and fishing. [22
] Most Maroon villages are located along the rivers of the interior of Suriname and access is heavily dependent on canoes and other watercraft. [22
] This population is therefore isolated and is less exposed to unhealthy urban lifestyles such as excessive consumption of energy-dense foods and frequent use of automobiles [23
] in urban Paramaribo. It is possible they were still benefiting from their earlier exposure to the traditional lifestyles, which have been suggested to be protective against high BP. [25
] Maroon girls, however, had relatively high prevalence of overweight and obesity compared with other ethnic groups. The lower BP in Maroon girls became apparent only after further adjustment for BMI. It is possible that they have adopted different lifestyles such as excessive energy intake and decreasing physical activity once in unban Paramaribo, which may contribute to their rapid increase in BMI and subsequently higher BP. In this study, only 4% of Maroon girls reported ≥ 5–7 days/week physical activity outside of school. These findings clearly indicate the need to promote physical activity among this group in Suriname.
Studies in adults have consistently shown higher BP levels in African descent people than in other ethnic groups. [5
] Studies in Suriname and the Netherlands, for example, showed higher BP levels in African-Surinamese than in other ethnic groups. [8
] In this present study, however, African descent adolescents in Suriname (both Creoles and Maroons) had lower mean diastolic BP levels than other ethnic groups. The lack of higher BP levels in African descent adolescents in Suriname is consistent with the findings in the UK. Studies in the UK show higher BP levels in African descent adults than in other ethnic groups. [10
] By contrast, in adolescents, BP levels were either lower or similar in African descent youth than in other ethnic groups. [13
] A recent study, for example, found that BP in ethnic minority adolescents was generally lower than in White adolescents except for diastolic BP among Indian girls in the UK. [13
The explanations for the different patterns of BP in adolescents and adulthood among African descent populations are unclear and require a cohort study to unravel the possible mechanisms underlying these differences. These observations suggest that environmental factors may be very important. The higher BP among Javanese adolescents was unexpected given the lower BP reported among the Javanese adult population in Suriname. The reason for the higher mean BP among Javanese adolescents is unclear. One possible explanation may relate to generational differences or changes in lifestyles. This requires further study. Left unchecked, the comparatively high BP among Javanese adolescents may abolish or reverse the current lower BP advantage enjoyed by the Javanese adult population in Suriname. These observations clearly indicate the need for early intervention in adolescents for preventing high BP in later life. [13
The relationship between BMI and BP is well established in children and adolescents. [15
] The strong and independent relationship between BMI and BP in our present study is consistent with previous findings. Although the mechanisms by which BMI may lead to high BP are not well understood, it is now generally recognised that high BMI significantly increases the risk of high BP. [27
] Sinaiko and colleagues' prospective study showed that increases in BMI in early life were significantly related to an increased risk of high BP and other CVD in adulthood. [27
] Our findings clearly indicate the need to prevent the increasing prevalence of overweight and obesity especially in Maroon girls early in life to prevent future sequelae of overweight/obesity related diseases.
Our study has limitations. As in many epidemiological studies, our BP level was based on an average of two measurements at a single visit. A more precise estimate of BP level would be obtained by multiple measurements obtained during several visits. Also, evidence suggests that during puberty BP increases more rapidly, with a significant gender difference in the age of onset. [28
] In the present study, pubertal status was not assessed and this may affect the study conclusions. Nevertheless, in the recent UK study, late puberty was not associated with high BP in ethnic minority groups. [13
] Another possible limitation is the combined mixed-ethnicities due to the small study samples. It is possible that BP patterns differ among these different ethnic groups. [29
] Future studies should assess this possibility. In addition, social circumstances between the groups were not assessed, which might also affect our study conclusions. Despite these limitations, our present findings provide very important insights into ethnic differences in BP in adolescents in non-industrialised setting.