الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hypertension is a growing concern among adolescents throughout the world because of its high prevalence and its association with the obesity epidemic. Hypertension is often thought of as a disease of adults, but it can be a problem in adolescents. According to American heart association, the leading type of childhood hypertension is primary hypertension, especially in adolescence. The diagnosis of hypertension in adolescents is complicated because normal blood pressure values differ according at age, sex, and height as a result, significant percent of hypertensive adolescents remain undiagnosed. Hypertension accounted for roughly a quarter of cardiovascular disease fatalities and 1.9 percent of all deaths in Saudi Arabia in 2010. One of the most preventable risk factors of hypertension is obesity, especially central obesity. Both obesity and hypertension can track into adulthood, making adolescents more liable to cardiovascular risk.
Ambulatory blood pressure monitoring is a useful method in risk evaluation in adolescents. Early identification of HTN risk factors and advancing the window for prevention and treatment in adolescence hold significant clinical and public health implications. The main lines of prevention and treatment in hypertensive adolescents are weight loss, healthy lifestyle, reduced salt intake and regular physical activity. Prevention of obesity will be accompanied by a reduction in BP. Treating hypertension might decrease the risk of developing cardiovascular disease in adulthood.
The purpose of the study is to evaluate the relationship between central obesity and hypertension among school adolescents in Damanhur city, El -Behira Governorate. Through estimating the prevalence of general and central obesity, the prevalence of hypertension and determining the relation in the progress.
The study was carried out during the scholastic year of 2018-2019 using a cross-sectional approach. A multistage random sample of 1203 school adolescents was selected from three educational districts which were selected randomly out of seven educational district in Al-Behria. Schools of each district were classified into preparatory and secondary schools. Each category was classified into private for males and females and public for males and public for females. A school was selected at random from each list. Eight schools were selected to represent all school categories. The sample size was allocated proportionally according to numbers of students in each school and the sample of each school was selected randomly.
Data was then collected from all boys and girls using a predesigned interviewing questionnaire concerning personal information, family history, dietary habits, physical activity, food frequency tables. Anthropometric measurements in the form of weight, height, waist circumference and neck circumference were taken. The body mass index was calculated. Obesity was defined as BMI more than two standard deviations above the mean for their gender and age, and overweight as BMI one standard deviation over the mean for their age and sex. Waist circumference was classified as < 90 percentiles and ≥ 90 percentile. Neck circumference the mean and standard deviation of present study was used. Blood pressure measurements were taken. Blood pressure percentile was determined using “The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, 2004” was classified into the following categories: Normal: BP < the 90th percentile; Prehypertension: BP between 90th and 95th percentiles; and hypertension: BP > the 95th percentile. When readings are > the 95th percentile, BP should be staged as follows: Stage 1: BP from 95th percentile to 99th + 5 mmHg; and Stage 2: BP > 99th percentile + 5 mmHg.
Results of this study revealed that:
The studied sample age ranged from 12 to 18 in which 739 aged 12-14 and 464 aged 15+. As for, sex 53% were males and 47% were females. Among the studied sample 64.6% were in preparatory stage and 35.4% were in secondary stage. While 66.9% attended governmental schools and only 33.1% attended private schools. More than half of the sample their fathers had university education (56.3%), also 48.8% of their mothers had university education.
Nearly half of the studied sample had family history of hypertension (45.3%). As for obesity only 37.7% of the studied sample had a family history of obesity, and 47.2% had family history of diabetes.
The majority of the studied sample were physically active (80.3%). They practiced activities such as walking, running, swimming, football, and others. The majority of the sample spent more than two hours daily on TV (81.8%).
Males had significant higher weight than females in the age group 15+. Males were significantly taller than females in both age group. The prevalence of obesity among the studied sample of preparatory and secondary schools in Al-Behria was 19.8% and overweight was 26.4%. The prevalence of overweight and obesity was significantly higher in males than females while the prevalence of overweight was higher in females than males. Both overweight and obesity were significantly higher among students aged 12-14 than students aged 15+.
Among students who had waist circumference more than 90 percentiles, males had significantly higher WC than females (p=0,025) A higher percent of male students had waist circumference ≥ 90 (9.7%) as compared to females (6.2%), and students aged 15+ had a non-significant higher WC compered to students aged 12-14. Neck circumference was significantly higher among males than females. Also, it was significantly higher among students aged 15+ than students aged 12-14.
The prevalence of elevated blood pressure among the studied sample was 44.1% (19.9% were pre-hypertensive, 24.2% were hypertensive). Hypertension was significantly higher among females than males, and significantly higher among students aged 12-14 than students aged 15+. As for pre-hypertension males were significantly higher than females. Also, hypertension was significantly higher among students aged 12-14 than students aged 15+, while prehypertension was significantly higher among students aged 15+ than students aged 12-14.
Hypertension was significantly higher among governmental school students than private school students, while pre-hypertension was higher among private school adolescents than governmental school adolescents. Hypertension was significantly higher among Preparatory school students than secondary school students, while pre-hypertension was significantly higher among secondary school students than preparatory school students.
Breakfast skippers had significantly higher blood pressure than non-skippers. Students who consumed salted fish had significantly higher blood pressure compared to those who didn’t. also, adding salt was higher among hypertensive group but it wasn’t statistically significant.
Prehypertension and hypertension were significantly high among overweight and obese students. Waist circumference ≥ 90 was significantly associated with both hypertension and obesity. Students who had waist circumference more than 90 percentiles were significantly higher among overweight and obese students than normal weight students. Students who were physically active had significantly lower waist circumference than those who were non physically active.
Hypertensive adolescent had a significantly higher neck circumference. Neck circumference was positively correlated to waist circumference, BMI, systolic blood pressure and diastolic blood pressure.
6.2. Conclusion
from the present study, the following can be concluded:
Hypertension was prevalent among preparatory and secondary school adolescents in Al-Behira. Obesity, especially central obesity, is a significant risk factor for hypertension. The prevalence of hypertension among the study sample of preparatory and secondary school children in Al-Behira was 19.9%, 24.2% pre-hypertension, hypertension respectively.
Hypertension was more common among females (28.5%) than in males (20.4%) with significant statistical difference. In addition, hypertension was more common among students aged 12-14 (26.7%) than students aged 15+ (20.3%). Also, it was significantly higher among governmental school students (26%) than private school students (20.6%). And significantly higher among preparatory school students (26.3%) than secondary school students (20.4%).
Waist circumference can be used as an indicator for hypertension as there was a statistically significant relation between blood pressure and WC. Among students who had WC more the 90 percentile 44.3% had hypertension while among students had WC less than 90 percentiles 22.4% had hypertension. This can be also applied to neck circumference measures as it was significantly higher among hypertensive adolescents.
The prevalence of obesity among the study sample of preparatory and secondary school students in Al-Behira was19.8% and that of overweight was26.4%. with a total of overweight and obesity of 46.2%. Overweight was higher among females 30.8% than males 22.4% and obesity was higher among males 21.3% than females 18.1% which was statistically significant.
There was a significantly positive association between obesity and elevated blood pressure among adolescents. Moreover, higher rates of overweight and obesity was noted among hypertensive and pre-hypertensive adolescents compared to normotensive adolescents.
Family history of hypertension was higher among pre-hypertensive and hypertensive adolescents. Although, it was not statistically significant.
The risk of hypertension increased upon skipping breakfast. Adding salt was high among pre-hypertensive and hypertensive adolescents but it was not statistically significant.
Adolescents who were physically active had a lower percentage of prehypertension and hypertension than those who were not physically active. Although, it was not statistically significant.
6.3. Recommendations
from the current study, it is evident that the problem of hypertension is prevalent among school adolescents in Behria, and central obesity is a significant risk factor for hypertension. Therefore, several recommendations were forwarded. These recommendations can be implemented through three approaches:
Ministerial approach:
-Ministry of Education:
• School administrators should be educated about the importance of availability of healthy food choices and restrict fast/unhealthy food.
• Implementing school strategies to improve knowledge and attitude of the school adolescents towards preventive healthy behaviours (nutritional education, physical activity).
• Incorporating healthy lifestyle education in school curriculum.
- Ministry of Health:
• Incorporation of preparatory school students and secondary school students in the presidential initiative “100 million health”.
• Adolescents should have their blood pressure measured at least once per year as a routine procedure for early detection of high blood pressures.
• Close monitoring and follow up of blood pressure of obese adolescents (especially those with abdominal obesity and who had family history) as they are at higher risk for developing hypertension.
-Parents approach:
• Parents should be advised to encourage adolescents with high blood pressure to avoid sedentary life and follow a healthy lifestyle, such as regular and continuous physical activity, maintain healthy weight, avoid smoking, and intake of food rich in fresh fruits, vegetables, fiber and low in fat, and sodium.
- Researchers approach:
• More research is recommended on a wider scale to involve different Egyptian governorates.
• Long term prospective study to address the association between neck circumference and blood pressure in Egypt.
• Further research to study the effect of different prevention modalities (weight loss, regular and continuous physical activity, avoidance of smoking, and a diet rich in fresh fruits, vegetables, and fiber and low in fat, dairy products, and sodium).