Prevalence of hypertension among adolescents: systematic review and meta-analysis

Gonçalves, Vivian Siqueira Santos; Galvão, Taís Freire; Andrade, Keitty Regina Cordeiro de; Dutra, Eliane Said; Bertolin, Maria Natacha Toral; Carvalho, Kenia Mara Baiocchi de; Pereira, Mauricio Gomes

doi:10.1590/S1518-8787.2016050006236

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Sumário

Review • Rev. Saúde Pública 50 • 2016 • https://doi.org/10.1590/S1518-8787.2016050006236 copy

Prevalence of hypertension among adolescents: systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To estimate the prevalence of hypertension among adolescent Brazilian students.

METHODS

A systematic review of school-based cross-sectional studies was conducted. The articles were searched in the databases MEDLINE, Embase, Scopus, LILACS, SciELO, Web of Science, CAPES thesis database and Trip Database. In addition, we examined the lists of references of relevant studies to identify potentially eligible articles. No restrictions regarding publication date, language, or status applied. The studies were selected by two independent evaluators, who also extracted the data and assessed the methodological quality following eight criteria related to sampling, measuring blood pressure, and presenting results. The meta-analysis was calculated using a random effects model and analyses were performed to investigate heterogeneity.

RESULTS

We retrieved 1,577 articles from the search and included 22 in the review. The included articles corresponded to 14,115 adolescents, 51.2% (n = 7,230) female. We observed a variety of techniques, equipment, and references used. The prevalence of hypertension was 8.0% (95%CI 5.0–11.0; I² = 97.6%), 9.3% (95%CI 5.6–13.6; I² = 96.4%) in males and 6.5% (95%CI 4.2–9.1; I² = 94.2%) in females. The meta-regression failed to identify the causes of the heterogeneity among studies.

CONCLUSIONS

Despite the differences found in the methodologies of the included studies, the results of this systematic review indicate that hypertension is prevalent in the Brazilian adolescent school population. For future investigations, we suggest the standardization of techniques, equipment, and references, aiming at improving the methodological quality of the studies.

Adolescent; Hypertension, epidemiology; Prevalence; Meta-Analysis

Study	Research year	City, Federative Unit	Age group (years)	Sample size	Method of blood pressure measurement	Number of measurements	Reference or criterion used	Quality score
Almeida FA et al.² (2011)	-	Sorocaba, SP	15-19	410	Auscultatory	3	SBC⁴² (2006); NHBPEP³⁰ (2004)	4
Burgos MS et al.⁵ (2010)	2008	Santa Cruz do Sul, RS	10-17	1,251	Auscultatory	3	SBC⁴² (2006)	4
Burgos MS et al.⁶ (2013)	2005	Santa Cruz do Sul, RS	10-18	1,437	Auscultatory	3	SBC⁴³ (2010)	5
Cândido AP et al.⁷ (2009)	2006	Ouro Preto, MG	10-14	487	Oscillometric	3	SBC⁴² (2006)	6
Christofaro DGD et al.^8,10,11,12 (2009; 2011; 2013; 2014)	2008	Londrina, PR	10-17	1,021	Oscillometric	2	SBC⁴¹ (2005); NHBPEP³⁰ (2004)	8
Cruz LL et al.¹³ (2013)	2010-2011	Alegre, ES	11-15	521	Auscultatory	3	SBC⁴³ (2010)	4
Cureau FV et al.^14,15 (2013;2014)	2011	Santa Maria, RS	14-19	1,072	Oscillometric	2	SBC⁴³ (2010)	6
Faria ER et al.¹⁶ (2014)	2011-2012	Viçosa, MG	10-19	800	Oscillometric	3	SBC⁴³ (2010)	6
Monego ET et al.²⁷ (2006)	2001-2002	Goiania, GO (2011-2012)	10-14	2,118	Auscultatory	2	NHBPEP²⁹ (1996)	5
Moura AA et al.²⁸ (2004)	2000-2002	Maceio, AL	11-17	898	Auscultatory	2	NHBPEP²⁹ (1996)	6
Polderman J et al.³³ (2011); Roelofs et al.³⁷ (2010)	2008	Aracaju, SE	12-17	1,002	Oscillometric	3	NHBPEP³⁰ (2004)	7
Ribas AS et al.³⁴ (2014)	2005	Belem, PA	10-19	420	Auscultatory	2	Koch VH³⁹ (2000)	7
Rinaldi AEM et al.³⁵ (2012)	2006-2007	Botucatu, SP	10-14	389	Auscultatory	3	NHBPEP³⁰ (2004)	4
Rosa MLG et al.³⁸ (2007)	2003-2004	Niteroi, RJ	12-17	456	Oscillometric	6	NHBPEP³⁰ (2004)	8
Silva KS et al.⁴⁰ (2009)	2005	Joao Pessoa, PB	10-12	705	Auscultatory	2	NHBPEP³⁰ (2004)	6
Silva KSS et al.³⁶ (2007)	2005	Joao Pessoa, PB	14-17	674	Auscultatory	2	NHBPEP³⁰ (2004)	5
Stabelini Neto A et al.⁴⁴ (2011)	2009	Curitiba, PR	10-17	454	Auscultatory	2	NHBPEP³⁰ (2004)	7

Subgroup	Number of studies	Total number of participants	Prevalence (%)	95%CI	I² (%)	p (Chi-squared)
Sex
Female	16	7,230	6.5	4.2–9.1	94.2	< 0.001
Male	16	6,887	9.3	5.6–13.6	96.9	< 0.001
Quality
High	5	3,353	8.4	4.9–12.5	93.6	< 0.001
Moderate	12	10,762	7.5	4.1–11.6	98.2	< 0.001
Method of measurement
Auscultatory	11	10,349	7.4	4.9–10.4	96.0	< 0.001
Oscillometric	6	3,766	8.2	2.6–16.5	98.7	< 0.001
Number of measurements
Three or more	9	6,753	6.7	3.3–11.2	97.6	< 0.001
Two	8	7,362	8.9	4.8–14.1	98.0	< 0.001
Sample estimation
Yes	12	9,556	6.0	3.7–8.8	96.4	< 0.001
No	5	4,559	12.6	6.9–19.7	97.6	< 0.001
Region
North	1	420	6.9	4.7–9.5	-	-
Northeast	4	3,279	10.0	6.9–13.5	90.1	< 0.001
Midwest	1	2,118	3.0	2.3–3.8	-	-
Southeast	6	3,063	4.3	1.4–8.5	95.8	< 0.001
South	5	5,235	12.4	7.4–18.3	97.3	< 0.001

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[1] Correspondence: Vivian Siqueira Santos Gonçalves. Faculdade de Ciências da Saúde – UnB. Programa de Pós-graduação em Nutrição Humana Campus Universitário Darcy Ribeiro Gleba A-FM/FS, Asa Norte 70910-900 Brasília, DF, Brasil. E-mail: vinut.bsb@gmail.com