Dear Editor,

In Volume 3, No. 11 (2010) of the Australasian Medical Journal (AMJ), Kamath et al. published a paper entitled "Prevalence of Hypertension in the Paediatric Population in Coastal South India".1 The authors raised a number of issues regarding paediatric hypertension in India, which may also be applicable to other developing countries. In this cross- sectional study, a total of 2,067 students between the ages of 5-16 years from rural schools in Udupi taluk, Karnataka were studied as part of school health services. In Kamath and colleagues' study, the total prevalence of hypertension was 2.2%. Prevalence of hypertension among females was 2.4% and 2.1% in males. There was no significant difference between the prevalence of hypertension between males and females. In the paper, the prevalence of hypertension was seen to increase with an increase in body mass index (BMI). Of the total study population, 2.0% girls and 1.6% boys were found to have systolic hypertension. The diastolic hypertension was similar in both girls and boys with a prevalence of 0.8%.1 Due to the nutritional transition and lifestyle changes in developing countries, hypertension epidemia is repeatedly reported in paediatrics. Considering the racial, geographical, and nutritional differences between the Iranian people and Indian society and influential effects of these risk factors on blood pressure (BP), this study aimed to notify the hypertension among children and adolescents in Iran. However in Iran, and to our knowledge in Asian countries, only a few precise studies have been conducted about this issue. Ashrafi et al.2 in their study conducted from 1998 to 2000; on 10,288 students (from 125 schools) aged 6- 13 in Tehran, Iran reported the prevalence of systolic hypertension in 4.9% of boys and 3.5% of girls, whereas diastolic hypertension was reported in 10.1% boys and 3.3% girls. Furthermore, mean systolic and diastolic blood pressure showed incremental increase with age, weight and height in both sexes. 2 The noted systolic and diastolic hypertension prevalence rates were more than that reported by Kamath et al. In a multicentre national cross- sectional survey by Kelishadi et al.3 on 21,111 students aged 6-18 in 23 (out of 28) provinces of Iran, the reported systolic and diastolic hypertension rates were more than the findings reported by Kamath et al. Kelishadi et al. selected the samples as a representative sample of nearly 16 million Iranian school students with different ethnicities. However, in both the studies, prevalence of hypertension was seen to increase with weight and height. On the other hand, the overall prevalence of systolic, diastolic as well as systolic or diastolic hypertension was 4.2%, 5.4% and 7.7%, respectively in Kelishadi and colleagues' study.3 In the other cross- sectional research, Mirhosseini et al. studied a total of 622 adolescent girls (15-17 years old) in Mashhad, the second biggest city in Iran.4 They reported the prevalence of combined hypertension at 6.1%, which increased with the severity of obesity. Furthermore, approximately 24.1% and 7.2% of subjects suffered from isolated diastolic and systolic hypertension, respectively.4 The noted prevalence rates were not consistent with the study by Kamath et al. A thorough analysis of these studies shows that BP is not distributed similarly between the different districts of Iran and India. However, this non- communicable disease should be strictly followed as a medical problem. Moreover, monitoring of BP among children and adolescents is important for preventing hypertension in adults. According to the scientific researches, BP measurements should be incorporated into the routine paediatric examination of children aged three years or more.

References

1. Veena Kamath G, Prasanna Mithra P, Sanjay P, Asha K, Anuja B, Tinny M, Nisha S, Leena A. Prevalence of hypertension in the paediatric population in coastal South India. Australasian Medical Journal. 2010; 3(11): 695-8.

2. Ashrafi MR, Abdolahi M, Ahraniani BM, Shabanian R. Blood Pressure Distribution among Healthy School children Aged 6- 13 Years in Tehran. East Mediterr Health J. 2005; 11(5-6): 968- 76.

3. Kelishadi R, Ardalan G, Gheiratmand R, Majdzadeh R, Delavari A, Heshmat R, Gouya MM, Razaghi EM, Motaghian M, Mokhtari MR, Barekati H, Sadat Mahmoud Arabi M. Blood pressure and its influencing factors in a national representative sample of Iranian children and adolescents: The CASPIAN Study. Eur J Cardiovasc Prev Rehabil. 2006; 13(6): 956-63.

4. Mirhosseini NZ, Yusoff NA, Shahar S, Parizadeh SM, Mobarhen MG, Shakery MT. Prevalence of the metabolic syndrome and its influencing factors among adolescent girls in Mashhad, Iran. Asia Pac J Clin Nutr. 2009; 18(1): 131-6.

Author affiliation:

Corresponding Author:

Dr Ali Malekshahi Moghadam

Email: malekshahiali@yahoo.com

Author affiliation:

Sincerely,

Malekshahi Moghadam A1, Emami HR2, Djalali M3, Saedisomeolia A3

1Private Veterinary Practitioner, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.

2General Practitioner, School of Medicine, Kermanshah University of Medical sciences, Kermanshah, Iran.

3Department of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran