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BMC Public Health. 2012; 12: 98.
Published online Feb 3, 2012. doi:  10.1186/1471-2458-12-98
PMCID: PMC3331812
Blood pressure and associated factors in a North African adolescent population. a national cross-sectional study in Tunisia
Hajer Aounallah-Skhiri,corresponding author1,2 Jalila El Ati,3 Pierre Traissac,4 Habiba Ben Romdhane,1 Sabrina Eymard-Duvernay,4 Francis Delpeuch,4 Noureddine Achour,1 and Bernard Maire4
1National Institute of Public Health (INSP), 5-7 rue El-Khartoum, Tunis, Tunisie
2Doctoral School 393, Université Pierre et Marie Curie, Paris, France
3National Institute of Nutrition and Food Technology (INNTA), 11 rue Jebel Lakhdar, Tunis, Tunisia
4IRD (Institut de Recherche pour le Developpement), UMR 204 NUTRIPASS, IRD-UM2-UM1, 911 av. Agropolis, 34394 Montpellier, France
corresponding authorCorresponding author.
Hajer Aounallah-Skhiri: hajer.skhiri/at/rns.tn; Jalila El Ati: jalila.elati/at/yahoo.fr; Pierre Traissac: pierre.traissac/at/ird.fr; Habiba Ben Romdhane: habiba.benromdhane/at/rns.tn; Sabrina Eymard-Duvernay: Sabrina.Eymard-duvernay/at/ird.fr; Francis Delpeuch: francis.delpeuch/at/ird.fr; Noureddine Achour: noureddine.achour/at/rns.tn; Bernard Maire: bernard.maire/at/ird.fr
Received August 2, 2011; Accepted February 3, 2012.
Abstract
Background
In southern and eastern Mediterranean countries, changes in lifestyle and the increasing prevalence of excess weight in childhood are risk factors for high blood pressure (BP) during adolescence and adulthood. The aim of this study was to evaluate the BP status of Tunisian adolescents and to identify associated factors.
Methods
A cross-sectional study in 2005, based on a national, stratified, random cluster sample of 1294 boys and 1576 girls aged 15-19 surveyed in home visits. The socio-economic and behavioral characteristics of the adolescents were recorded. Overweight/obesity were assessed by Body Mass Index (BMI) from measured height and weight (WHO, 2007), abdominal obesity by waist circumference (WC). BP was measured twice during the same visit. Elevated BP was systolic (SBP) or diastolic blood pressure (DBP) ≥ 90th of the international reference or ≥ 120/80 mm Hg for 15-17 y., and SBP/DBP ≥ 120/80 mm Hg for 18-19 y.; hypertension was SBP/DBP ≥ 95th for 15-17 y. and ≥ 140/90 mm Hg for 18-19 y. Adjusted associations were assessed by logistic regression.
Results
The prevalence of elevated BP was 35.1%[32.9-37.4]: higher among boys (46.1% vs. 33.3%; P < 0.0001); 4.7%[3.8-5.9] of adolescents had hypertension. Associations adjusted for all covariates showed independent relationships with BMI and WC: - obesity vs. no excess weight increased elevated BP (boys OR = 2.1[1.0-4.2], girls OR = 2.3[1.3-3.9]) and hypertension (boys OR = 3.5[1.4-8.9], girls OR = 5.4[2.2-13.4]), - abdominal obesity (WC) was also associated with elevated BP in both genders (for boys: 2nd vs. 1st tertile OR = 1.7[1.3-2.3], 3rd vs.1st tertile OR = 2.8[1.9-4.2]; for girls: 2nd vs. 1st tertile OR = 1.6[1.2-2.1], 3rd vs.1st tertile OR = 2.1[1.5-3.0]) but only among boys for hypertension. Associations with other covariates were weaker: for boys, hypertension increased somewhat with sedentary lifestyle, while elevated BP was slightly more prevalent among urban girls and those not attending school.
Conclusion
Within the limits of BP measurement on one visit only, these results suggest that Tunisian adolescents of both genders are likely not spared from early elevated BP. Though further assessment is likely needed, the strong association with overweight/obesity observed suggests that interventions aimed at changing lifestyles to reduce this main risk factor may also be appropriate for the prevention of elevated BP.
Keywords: Adolescent, Blood pressure, Tunisia, Prevalence, Risk factors
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