Blood pressure and body mass index in an ethnically diverse sample of adolescents in Paramaribo, Suriname

Charles Agyemang 1 Eline Oudeman 1 Wilco Zijlmans 0 Johannes Wendte 1 Karien Stronks 1 0 Department of Pediatrics, Diakonessen Hospital , Paramaribo , Suriname 1 Department of Social Medicine, Academic Medical Centre , Amsterdam , The Netherlands Background: High blood pressure (BP) is now an important public health problem in nonindustrialised countries. The limited evidence suggests ethnic inequalities in BP in adults in some non-industrialised countries. However, it is unclear whether these ethnic inequalities in BP patterns in adults reflect on adolescents. Hence, we assessed ethnic differences in BP, and the association of BP with body mass index (BMI) among adolescents aged 12-17 years in Paramaribo, Suriname. Methods: Cross-sectional study with anthropometric and blood pressure measurements. A random sample of 855 adolescents (167 Hindustanis, 169 Creoles, 128 Javanese, 91 Maroons and 300 mixed-ethnicities) were studied. Ethnicity was based on self-reported ethnic origin. Results: Among boys, Maroons had a lower age- and height-adjusted systolic BP than Creoles, and a lower diastolic BP than other ethnic groups. However, after further adjustment for BMI, only diastolic BP in Maroons was significantly lower than in Javanese (67.1 versus 70.9 mmHg). Creole boys had a lower diastolic BP than Hindustani (67.3 versus 70.2 mmHg) and Javanese boys after adjustment for age, height and BMI. Among girls, there were no significant differences in systolic BP between the ethnic groups. Maroon girls, however, had a lower diastolic BP (65.6 mmHg) than Hindustani (69.1 mmHg), Javanese (71.2 mmHg) and Mixed-ethnic (68.3 mmHg) girls, but only after differences in BMI had been adjusted for. Javanese had a higher diastolic BP than Creoles (71.2 versus 66.8 mmHg) and Mixed-ethnicity girls. BMI was positively associated with BP in all the ethnic groups, except for diastolic BP in Maroon girls. Conclusion: The study findings indicate higher mean BP levels among Javanese and Hindustani adolescents compared with their African descent peers. These findings contrast the relatively low BP reported in Javanese and Hindustani adult populations in Suriname and underscore the need for public health measures early in life to prevent high BP and its sequelae in later life. - Background The increasing prevalence of cardiovascular diseases (CVD) is putting a tremendous pressure on already overburdened resources in non-industrialised countries. [1] High blood pressure (BP) is a leading cause of CVD. [2] The rising prevalence of hypertension in non-industrialised countries reflects well on the high prevalence of CVD. [2] In children, BP tracking patterns confirm that persistent BP increase may be related to hypertension in adulthood. [3-5] Increased BP in childhood has also been linked with left ventricular hypertrophy. [6] Consequently, in most industrialised countries assessment and management of BP in childhood is strongly recommended to promote improved cardiovascular health in adulthood. [7] However, in some non-industrialised countries, BP data on children and adolescents are very scarce. In Suriname, for example, there is no published data on BP in children and adolescents. Information on BP in adults in Suriname is also very limited. A report from II PAHO-DOTA Workshop on Quality of Diabetes Care in 2003 indicates that hypertension is a major public health burden with prevalence rates ranging from 24% in Javanese to as high as 33% in African-Surinamese in Suriname. [8] The annual report of the Regional Health Service in 2000 also showed that hypertension care alone accounted for 15% of the total number of consultations. [8] This reflected the mortality data with CVD being the leading cause of death in Suriname. Suriname's population is made up of several ethnic groups. As in industrialised countries, [9-12] the limited data in Suriname suggest ethnic inequalities in BP and hypertension in adults. [8] However, it is unclear whether these BP patterns in adults reflect on adolescents. In some industrialised countries such as the UK, ethnic differences in BP in adults [9-12] do not correspond with children's and adolescents' BP patterns. [13,14] In addition, the prevalence of overweight and obesity in children and adolescent have increased dramatically over the past few decades. This may have an impact on BP. In the United States of America, for example, overweight children have been shown to be 24 times more likely than non-overweight children to have high BP. [15-17] However, information on the relationship between body sizes and BP among different ethnic groups in non industrialised countries is limited. There is an urgent need for research in children and adolescents so that appropriate cost-effective interventions can be introduced early in life to prevent the burden of CVD in adulthood. [18,19] The main objective of this study was to assess BP patterns, and to determine the association of BP with BMI among adolescents from different ethnic backgrounds in Paramaribo, Suriname. We hypothesised that the BP patterns in adults would reflect adolescents' BP patterns in various ethnic groups in Suriname. Methods Study area Suriname is located in Northern South America. It borders French-Guyana to the east, British-Guyana to the west, Brazil to the south and the Atlantic Ocean to the north (Figure 1). It has a total area of 163,820 square kilometres. According to the World Factbook, the total population in 2007 was about 449,000 people. The life expectancy was 66 years for men and 71 years for women. Suriname's population is made up of several ethnic groups: Hindustani, Creoles, Javanese, Maroons, Amerindian, Chinese, White and other. About 28% of the population is under 15 years of age (ca. 132,000). Data for this study were collected between March and June 2007 in Paramaribo, the capital city of Suriname. The vast majority of people (about 90%) live in Paramaribo and its surroundings. Study design Data were collected in nine schools among healthy adolescents between the ages of 12 to17 years. All schools were randomly selected from the 103 government schools' list. The schools were visited prior to data collection to obtain permission from the relevant school principals as well as from the pupils. After agreeing to this, participants were advised not to smoke, drink alcohol or take vigorous exercise during the 30 minutes preceding the BP measurement. Data collection took place during normal school hours. Verbal informed consent was sought from each participant before measurements were taken. None of the children refused to participate in this study. Forty three children were excluded because they were below 12 years old, and one child was excluded because she reported suffering from severe heart disease. The Ethical Board of the Ministry of Education in Suriname approved the study protocols. Measurements Height was measured without shoes with a measuring tape to the nearest 0.01 met (...truncated)