Prevalence of high blood pressure in Brazilian adolescents and
          quality of the employed methodological procedures: systematic review

Magalhães, Marina Gabriella Pereira de Andrada; Oliveira, Luciano Machado Ferreira Tenório de; Christofaro, Diego Giulliano Destro; Ritti-Dias, Raphael Mendes

doi:10.1590/S1415-790X2013000400005

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Revista Brasileira de Epidemiologia

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Original Articles • Rev. bras. epidemiol. 16 (04) • Dec 2013 • https://doi.org/10.1590/S1415-790X2013000400005 copy

Prevalence of high blood pressure in Brazilian adolescents and quality of the employed methodological procedures: systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To review the literature on studies that estimated the prevalence of high blood pressure (HBP) or systemic arterial hypertension (SAH) in Brazilian adolescents, considering the employed methodological procedures.

METHODS:

Bibliographical research of prevalence studies of HBP/SAH in adolescents from 1995 to 2010. The search was conducted in the electronic databases PubMed/Medline, Lilacs, SciELO, and Isi Adolec. The descriptors "hypertension", "BP", "teen", "students", "cross-sectional", "prevalence" and "Brazil" were used in Portuguese and English. Furthermore, a score ranging from 0 to 18 based on Recommendations for Blood Pressure Measurement in Humans and Experimental Animals and the VI Brazilian Guidelines of Hypertension was elaborated, in order to analyze the procedures used to measure BP in studies.

RESULTS:

Twenty-one articles were identified, mostly published in the last 10 years, and 90.5% were performed in school-based and regions of the Southeast, Northeast and South. The prevalence of HBP/SAH ranged from 2.5 to 30.9%. The score of the studies ranged from 0 to 16. A significant negative correlation (rho = -0.504; p = 0.020) was observed between the prevalence of HBP/SAH and the score of BP measurement quality.

CONCLUSION:

The great variability of PAE/SAH estimates appears to be influenced by methodological procedures used in the studies.

Adolescent; Hypertension; Arterial pressure; Students; Review; Brazil

Article	Place	n	Age group	Recommendations referred*	Terminology (Diagnostic criteria)	Prevalence of SAH or HBP by gender	Total prevalence
Costa and Sichieri¹⁵Rev Bras Epidemiol, 1998.	Rio de Janeiro (RJ)	646	12 - 19	1	SAH (P = 95)	M - 60.9% F - 39.1%	SAH – 17.9%
Oliveira et al.¹⁹J Pediatr (Rio J), 1999.	Belo Horizonte (MG)	1005	6 - 18	2^#	Borderline BP (= 90 P < 95) SAH (P = 95)	NI	SAH – 3.9%
Rezende et al.⁷Arq Bras Cardiol, 2003.	Barbacena (MG)	611	7 - 14	2	SAH (P = 95)	3^rd measurement: M - 26.7% F - 73.3%	SAH 1^stmeasurement:16.6% 2^ndmeasurement : 4.6% 3^rdmeasurement : 2.5%
Almeida et al.¹³J Bras Nefrol, 2003.	Sorocaba (SP)	633	15 -25	3	SAH (=140x90 mmHg)	M - 75.6% F - 24 .4%	SAH - 14.2%
Moura et al.²⁵J Pediatr (Rio J), 2004.	Maceió (AL)	1253	7 - 17	4, 2^##	SAH (P = 95)	M - 44.1% F - 55.9%	HBP - 9.4%
Silva et al.²²Arq Bras Cardiol, 2005.	Maceió (AL)	1253	7 - 17	4, 2^##	SAH (P = 95)	M - 48.5% F - 51.5%	SAH - 7.7%
Mendes et al.¹⁷Rev Bras SaúdeMater Infant, 2006.	Recife (PE)	421	14 - 19	2##	SAH (P > 90)	NI	SAH - 11.4%
da Silva and Rosa²⁷Arch Latinoam Nutr, 2006.	Porto Alegre (RS)	706	6 - 17	5, 2^##	Borderline BP (= 90 P < 95) SAH (P = 95)	NI	HBP -12.3%
Ribeiro et al.²⁹Arq Bras Cardiol, 2006.	Belo Horizonte (MG)	1450	6 -18	5	Borderline BP (= 90 P < 95) SAH (P = 95)	NI	Borderline BP- 12% SAH - ?
Monego and Jardim¹⁸Arq Bras Cardiol, 2006.	Goiânia (GO)	3.169	7- 14	NI	Borderline BP (= 90 P < 95) SAH (P = 95)	M - 43.7% F - 56.3%	SAH - 5%
Sakamoto et al.⁸Cien Cuid Saude, 2007.	Maringá (PR)	55	15 - 17	6	SAH (SAH or DBP P > 90)	M - 94.0% F - 6.0%	SAH - 30.9%
Rosa et al.²¹Arq Bras Cardiol, 2007.	Niterói (RJ)	456	12 - 17	3	SAH (P = 95)	M - 57.1% F - 42.9%	SAH - 4.6%
Romanzini et al.²⁶Cad Saúde Pública, 2008.	Londrina (PR)	644	15 - 18	6	Pre-hypertension (P = 90 ou = 120/80 mmHg)	NI	HBP - 18.6%
Leite et al.²⁴Fisioter Mov, 2009.	Curitiba (PR)	270	10 - 16	NI	SAH (SBP and/or DBP with P = 90 or BP = 120/80 mmHg)	NI	HBP - 10.7%
Freitas et al.¹¹Rev Bras Enferm, 2010.	Fortaleza (CE)	307	12 - 17	NI	Borderline BP (= 90 P < 95) high BP (P = 95)	NI	HBP - 11.7%
Vieira et al.²⁸Acta Paul Enferm, 2009.	Cuiabá (MT)	329	11-14	7	High BP (P = 90)	M - 48.7% F - 51.3%	HBP -11.2%
Rodrigues et al.²⁰J Pediatr (Rio J), 2009.	Vitória (ES)	380	10 - 14	3	Borderline BP (= 90 P< 95) SAH (P = 95)	M - 50% F - 50%	SAH - 3.4%
Cândido et al.¹⁴Eur J Pediatr, 2009.	Ouro Preto (MG)	780	6 - 14	7	Pre-hypertension (= 90 P < 95) SAH (P =95)	M - 50% F - 50%	SAH - 2.7%
Gomes and Alves²³Cad Saúde Pública, 2009.	Recife (PE)	1878	14 - 20	7	SAH in < 17 years old (P = 95) or 18 – 20 years old (= 140/90 mmHg)	NI	HBP - 17.3%
Cimadon, Geremia and Pellanda¹⁰Arq Bras Cardiol, 2010.	Bento Gonçalves (RS)	590	9 -18	8	NI	NI	HBP - 11.1%
Griz et al.¹⁶Arq Bras EndocrinolMetabol, 2010.	Região Metropolitana de Recife (PE)	1824	14 - 20	9	SAH in < 17 years old (P > 95) or 18 – 20 years old (= 140/90 mmHg)	NI	SAH - 16.9%

Article	Size of the cuffs	Previous rest	Placement during measurement	Type of device	N. of measurements/Interval between measurements	Used value	Score
Costa and Sichieri15	NI	15 min.	Sitting. Without smoking, eating or drinking for at least 15 min.	NI *	2 measurements, and a third one in case the difference was higher than 5 mmHg/10 min. interval.	Mean of 2 meausrements. The first measurement was ignored, in the case of 3 measurements.	10
Oliveira et al.19	25 x 12 cm and 18 x 9 cm	10 min.	Sitting. Right arm at the height of the precordium	Calibrated mercury column	2 measurements/10 min. interval	Mean of 2 measurements	15
Rezende et al.7	Different sizes	3 to 5 min.	Sitting. Right arm at the height of the precordium	Calibrated aneroid	3 measurements on 3 different days/ 2 min. interval	Lowest value	16
Almeida et al.13	26 x 13 cm. When arm circumference is inferior to 25 cm or superior to 32 cm, values were corrected by the Maxwell formula.	30 min.	NI	Mercury column	3 measurements/1 min. interval. When DBP or SBP differed in 6 mmHg or more, 3 new measurements were taken	Mean of 3 measurements	10
Moura et al.25	25 x 12 cm and 18 x 9 cm	NI	NI	Mercury column	2 measurements/2 min. interval	Measurement presenting P = 95	11
Silva et al.22	Different sizes	NI	NI	Mercury column	2 measurements	Mean of 2 measurements	13
Mendes et al.17	NI	NI	NI	NI	NI	NI	0
da Silva and Rosa27	Different sizes	NI	Sitting. Right arm at the heart level. Interval of at least 30 minutes. After exercise or meal.	NI*	2 measurements/1 min. interval	Mean of 2 measurements	13
Ribeiro et al.29	NI	NI	NI	NI	2 measurements	Mean of 2 measurements	7
Monego and Jardim18	Different sizes	2 min.	Sitting	Aneroid	2 meausrements/ 2 min. interval	1st measurement ignored, 2nd measurement used	12
Sakamoto et al.8	NI	5 min.	Sitting. Right arm at the heart level.	Electronic	2 measurements	NI	6
Rosa et al.21	Different sizes	NI	NI	Electronic	3 measurements on 2 different days/1 min. interval	Mean of 6 measurements	14
Romanzini et al.26	Different sizes	5 min.	Sitting	Calibrated aneroid	2 measurements/ 3 min. interval. There could be the third measurement in case there was a 4 mmHg difference between measurements.	Mean of 2 or 3 measurements	11
Leite et al.24	Different sizes	5 min.	Sitting. Right arm at the heart level.	Calibrated mercury column	3 measurements/ 2 min. interval	Mean of 2 last measurements	12
Freitas et al.11	12 x 10 cm and 23 x 17 cm	5 min.	Sitting, uncrossed legs, feet on the floor, back leaning on the chair, empty bladder. Arm at the heart level, hand palm turned up and elbow flexed. The non-use of drugs or stimulating food was observed.	Aneroid	3 measurements /1 min. interval	Mean between the 2 last measurements	16
Vieira et al.28	NI	NI	NI	NI	2 measurements/5 min. interval	NI	3
Rodrigues et al.20	Adequate size	NI	NI	Mercury column	3 measurements /2 min. interval	Mean of 3 measurements	11
Cândido et al.14	NI	NI	Sitting. Left arm at the heart level	Electronic	3 measurements/10 min. When pressure was above the 90 percentile, it was ratified with the auscultatory method	Mean of 3 measurements	11
Gomes and Alves23	NI	NI	Sitting.	Auscultatory method	1 measurement	Measured value	5
Cimadon, Geremia and Pellanda10	NI	NI	NI	Aneroid	NI	NI	1
Griz et al.16	Adequate size	NI	Sitting	Mercury column	2 measurements/1 to 2 min. interval	NI	10

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[1] Corresponding author: Raphael Mendes Ritti Dias Rua Arnóbio Marques 310, Santo Amaro, CEP: 50100-130, Recife, PE, Brasil E-mail: raphaelritti@gmail.com