Niger J Paed 2015; 42 (1): 21 – 27
ORIGINAL
Okagua J
Adolescent blood pressure
Anochie IC
pattern in Rivers State, Nigeria:
Akani NA
A rural - urban comparison
DOI:http://dx.doi.org/10.4314/njp.v42i1,6
Accepted: 1st October 2014
Abstract: Background: Child-
readings was taken as the actual
hood and adolescent blood
blood pressure.
Okagua J
(
)
pressure pattern have been known
Results: Systolic and diastolic
Anochie IC, Akani NA
to predict adult blood pressure
blood pressure increased with age
Department of Paediatrics,
University of Port Harcourt Teaching
levels and development of
in both rural and urban subjects.
Hospital, Port Harcourt.
hypertension. Hypertension, once
The mean systolic blood pressure
Rivers State, Nigeria.
rare in traditional African
of the rural subjects (111.10 ±
Email: joyceokagua@yahoo.com
societies, is now the commonest
14.72 mm Hg) was significantly
non-communicable disease in
(p= < 0.001) higher than that of the
Nigeria. There are few studies on
urban subjects (108.09 ±15.40 mm
adolescent blood pressure pattern,
Hg), whilst the mean diastolic
especially in adolescents living in
blood pressure of the urban sub-
rural areas. It is therefore impor-
jects (66.88 ± 11.27 mmHg) was
tant to identify blood pressure
slightly higher than those of the
differences, if any, between ado-
rural
subjects
(66.32±11.71
lescents living in rural areas com-
mmHg. Urban subjects had a
pared to their urban counterparts.
higher mean body mass index
(19.82± 3.57kg/m ) than their rural
2
Objective: To determine and com-
pare the blood pressure pattern of
counterparts
(19.59±2.78
kg/
m ).Systolic and diastolic blood
2
apparently healthy adolescents in
rural and urban areas, and to de-
pressure showed a positive signifi-
termine the association between
cant (p= <0.001) correlation with
blood pressure and body mass
BMI in subjects in rural and urban
index in these children.
schools.
Subjects and Methods: A cross
Conclusion:
Significant
differ-
sectional population based blood
ences in blood pressure were ob-
pressure survey was carried out
served between rural and urban
on 2,136 Nigerian school adoles-
adolescents in Rivers State, with a
cents (1080 were resident in rural
positive
significant
correlation
areas and 1056 in urban areas)
between BMI and blood pressure.
aged 10-18 years, selected from
We recommend blood pressure
26 secondary schools using a
surveillance as part of the School
multi-stage
stratified
sampling
Health Programme.
technique. Blood pressure meas-
urements were taken by ausculta-
Key words: adolescent, blood
tory method. An average of three
pressure, rural-urban, Nigeria.
Introduction
thus the development of high blood pressure 3-5 . High
blood pressure is a major public health problem in Nige-
Adolescence is a stage between childhood and adult-
ria and its prevalence is rapidly increasing among rural
and urban populations . Several factors have been
6,7
hood, and a period of rapid biological, intellectual and
psychosocial development largely initiated by and
shown to affect blood pressure pattern among adoles-
dependent on hormonal influences, but highly influ-
cents including age, sex, environmental factors and obe-
. In Africa, Agyemang et al reported an increase
12
sity
8-11
enced by the environment. Certain chronic diseases,
1
including cardiovascular diseases, affecting adults have
in blood pressure with age in rural, semi-urban and ur-
their origins during adolescence. As a result adolescence
2
ban children in Ghana, which is similar to reports by
Obika et al in rural and urban children in Nigeria. Gen-
13
is a unique and important developmental period requir-
ing specific attention.
der differences in blood pressure have been reported in
. Nur et al
14
adolescents irrespective of age and race
10,12,14
Childhood and adolescent blood pressure pattern have
reported significantly higher blood pressures in adoles-
been shown to predict adult blood pressure pattern and
cent males than females in Turkey, while Akinkugbe et
22
al reported higher blood pressure levels in adolescent
10
Subjects and methods
females in Nigeria. Several workers have alluded to the
fact that environmental factors affect blood pressure in
Rivers State is located in the South-South geo-political
children
12,15-17
. Interestingly, studies in childhood have
zone of Nigeria. There are 23 local government areas
confirmed this rural-urban blood pressure disparity
12,16
.
(LGAs) with 8 being mainly urban, and constitutes 28%
Blood pressures were reported to be higher in urban than
of the State’s population (according to the 1991 popula-
tion census). This translates to a rural- urban ratio of
21
in semi-urban and rural children in Ghana . In Nigerian
12
children, there have been varied reports by different
2:1. Port Harcourt City LGA (PHALGA) was randomly
researchers. Ejike et al
16
reported higher blood pressure
selected to represent the urban LGA, while Emohua and
levels in urban than in non-urban children in Kogi State,
Abua-Odual LGAs (EMOLGA and ABOLGA) were
whilst Obika et al reported no difference in blood pres-
13
randomly selected to represent the rural LGAs.
sure levels of rural and urban children in Ilorin. Oviasu
PHALGA has a population of 541,115 according to the
population census of 1991.
21
et al in Benin reported higher mean systolic BP levels
11
Oil and gas exploration is
in urban children aged 6-11years after which a reversal
the mainstay of the economy. Emohua and Abua-Odual
occurred at 11years with rural children having higher
LGAs have a population of 201,901 and 282,988 respec-
tively.
18
blood pressures than their urban counterparts. Since the
Situated about 150km apart, subsistence farm-
ddifference in blood pressure could not be accounted for
ing and fishing dominates both areas. Ethical clearance
by body build as the BMI were not significantly differ-
was obtained from the Research and Ethics Committee
ent in the urban and rural subjects, they suggested that
of the University of Port Harcourt Teaching Hospital.
environmental factors could account for the differences
Notification and permission to carry out the study was
observed even though these factors were not studied.
11
obtained from the Rivers State Ministry of Education,
Local Government Council and from the Head teachers
In an attempt to study which environmental factors are
of the 26 selected schools and the parents or guardians
responsible for the rural-urban difference in BP, Ekpo et
and assent from the selected students.
al
18
studied rural and urban children aged 5-16years in
Calabar and found that the systolic and diastolic blood
The schools in each LGA were first stratified into public
pressures were higher in urban than in rural children
and private schools and further into co-educational
until the age of 11-12years, after which this rural-urban
(mixed), all boys and all girls schools respectively, and
difference disappears. They suggested that the rural-
finally selected by simple random sampling. Eight
urban disparity in BP was multi-factorial, and may
schools
(4private,
4public)
were
selected
from
partly be dependent on BMI, electrolyte consumption
PHALGA, 8 schools (3private, 5public) from EMOLGA
(particularly salt) and salt/potassium ratio as well as an
and 10 schools (3private, 7public) from ABOLGA re-
increase in exposure to western type of education.
spectively. A total of 26 schools comprising of 18 rural
schools and 8 urban schools were selected for this study.
Body weight and body mass index have been shown to
One thousand and eighty subjects were randomly se-
correlate strongly with blood pressure and thus the de-
lected from the 18 rural schools whilst 1056 subjects
. Sinaiko et al
20
velopment of hypertension
8,19
reported
were from the 8 urban schools respectively. In each se-
that increases in weight and body mass index in child-
lected rural school, 60 students were recruited. Using
hood were significantly associated with an increased risk
simple random sampling, an arm was selected to repre-
of high blood pressure and other cardiovascular diseases
sent the class from each of the 6 classes (JS1-3 and SS1-
in adulthood. Moreover, adult blood pressure has been
3). In each class selected, 10 students were randomly
shown to correlate with childhood blood pressure and
selected from the class register. In each selected urban
body size . It is therefore important to study the charac-
3
school, 132 students were recruited. Using simple ran-
teristics of the blood pressure pattern of these rural and
dom sampling, an arm was selected to represent the
urban adolescents to find out disparities, if any, occurs,
class from each of the 6 classes. In each class selected,
and if it begins in adolescence. Moreover, there is a
22 students were randomly selected from the class regis-
dearth of information on adolescent blood pressure lev-
ter. A total of 2136 students were recruited for this
els in Nigeria, especially in those living in rural areas. It
study. Apparently healthy secondary school students
is therefore expedient that the blood pressure of these
aged 10 to 18 years in the selected schools, who gave
rural adolescents is studied and compared with those of
assent for the study, and whose parents/ guardians gave
their urban counterparts to identify if any differences
consent made up the study population. Students on
exist between them. The present study intends to deter-
drugs known to affect blood pressure such as steroids or
mine and compare the blood pressure pattern in appar-
propanolol and those with histories or known chronic
ently healthy adolescents in rural and urban areas of
illnesses such as cardiac, renal and endocrine diseases
Rivers State, and to determine the association between
were excluded. Each selected school was visited twice.
blood pressure and body mass index in these adoles-
Blood pressure (BP) was measured using the mercury
cents.
sphygmomanometer (Accoson, London, England) with
an appropriate cuff size in conjunction with the bell of
the Littmann stethoscope (USA). The cuff size selected
for each student had a bladder that covered at least 80%
of the length of the right upper arm without obstructing
the antecubital fossa and at least 40% of the
23
circumference of the right arm. The students had been
Female subjects irrespective of location had a higher
seated for at least 5minutes with their back supported on
mean systolic BP than males. The mean systolic BP of
the chair and the upper arm bared without constrictive
the female subjects in the rural schools of 111.75 ±
clothing. The right arm of each student was placed on a
13.91 mm Hg was significantly higher than the 109.30 ±
table with the cubital fossa supported at the level of the
15.19 mm Hg in those of their urban counterparts (p=
heart. The first Korotkoff sound was recorded as the
0.007). Similarly, the mean systolic BP of male subjects
systolic BP while the diastolic BP was recorded at the
in the rural schools of 110.48 ± 15.45 mm Hg was sig-
point of disappearance of the sounds (phase V). Three
nificantly (p = 0.000) higher than the 106.67 ± 15.54
readings were taken with at least 1 minute in between
mm Hg of their urban counterparts.
them while making sure that the cuff was completely
deflated between readings and approximated to the near-
Table 1: Mean systolic blood pressure of the subjects accord-
est 2 mm Hg.
22
The average of the three readings was
ing to age by school location
taken as the BP and recorded for each student. Weight
Age
Rural
Urban
was measured using a well-calibrated, portable bath-
p value
(years)
Mean ± SD (mmHg)
Mean ± SD (mmHg)
room scale (Hana scale, model BR-9011) in kilograms.
10
99.17 ±13.79
94.62 ±10.97
0.208
Height was measured using a portable stadiometer well
11
102.12 ±12.10
100.10 ±14.59
0.303
calibrated up to 2 meters. The body mass index (BMI)
12
104.09 ±13.25
102.40 ±13.31
0.358
for each student was calculated using the formula
13
105.61 ±11.60
107.12 ±14.06
0.310
weight/height (kg/m ).
2
2
14
111.79 ±15.06
110.73 ±14.66
0.545
15
112.66 ±12.21
112.80 ±13.11
0.920
Data analysis
16
115.05 ±15.40
116.52 ±14.31
0.447
17
117.04 ±14.88
114.68 ±17.20
0.303
Data entry and analysis was done using SPSS software
18
119.34 ±14.91
114.05 ±11.63
0.049*
version 15 and EPI-INFO version 6.04. Distributions
Total
111.10 ±14.72
108.09 ±15.40
0.000*
were described as means and standard deviations. These
results are presented a stables and charts in simple pro-
*significant
portions. The Chi-square (c ) test and Fisher’s exact test
2
were used where appropriate to test proportions. One-
Table 2 showed that the mean diastolic BP of subjects in
way analysis of variance (ANOVA) and student’s t-test
rural schools increased with age from 60.36 ± 10.55 mm
were used to compare the difference in means. In all
Hg at 10 years to 72.20 ± 10.95 mm Hg at 18 years.
cases, a probability value (p value) of < 0.05 was re-
However, in urban subjects, the mean diastolic BP in-
garded as statistically significant.
creased from 61.81 ± 11.08 mm Hg at 10 years to 72.26
± 9.49 mm Hg at 18 years with a slight drop at 17 years.
The diastolic BP ranged from 40-110 mmHg with a
mean diastolic BP of 66.32 ± 11.71 mm Hg in subjects
in rural schools whilst in urban subjects, it ranged from
Results
30 -100 mm Hg with a mean diastolic BP of 66.88 ±
11.27mmHg. This difference was however, not statisti-
Two thousand one hundred and thirty six subjects par-
cally significant (p=0.277). Diastolic BP differed signifi-
ticipated in the present study. One thousand and eighty
cantly between rural and urban subjects at ages 12 and
(50.6%) subjects were from schools in the rural areas
15-17 years respectively as shown in Table 2
while 1056 (49.4%) subjects were from schools in the
urban area respectively, giving a rural-urban ratio of 1:1.
Table 2: Mean diastolic blood pressure of the subjects accord-
ing to age by school location
The mean ages of the subjects in the rural and urban
schools were 14.55 ± 2.1 years and 13.73 ± 2.2 years
Age
Rural
Urban
respectively. This difference was statistically significant
(years)
Mean ± SD (mmHg)
Mean ± SD (mmHg)
p value
(t = 7.872, p = <0.001).
10
60.36 ±10.55
61.81 ±11.08
0.351
11
61.67 ±11.93
63.18 ±10.06
0.643
Table 1 showed that the mean systolic BP increased
12
61.87 ±10.20
64.88 ±11.06
0.043*
with age in subjects in rural schools, from 99.17 ± 13.79
13
62.93 ±10.77
64.74 ±11.51
0.162
mm Hg at 10 years to 119.34 ± 14.91 mm Hg at 18
14
66.02 ±11.76
68.22 ±10.62
0.096
years. In urban subjects, the mean systolic BP increased
15
66.80 ±11.37
69.75 ±10.67
0.016*
16
68.12 ±11.67
71.51 ±11.00
0.022*
from 94.62 ± 10.97 at 10 years to a peak at 16 years of
17
71.68 ±11.13
68.16 ±10.48
0.026*
116.52 ± 14.31mm Hg. The subjects in rural schools had
18
72.20 ±10.95
72.26 ± 9.49
0.976
significantly higher systolic BP at 18 years (p= 0.049)
Total
66.32 ±11.71
66.88 ±11.27
0.277
compared with their urban counterparts. The systolic BP
of the rural subjects ranged from 70 – 180 mmHg, with
*significant
a mean systolic BP of 111.10 ± 14.72 mmHg, whilst in
the urban subjects, the systolic BP ranged from 60 – 165
The mean diastolic BP of the female subjects in rural
mm Hg with a mean systolic BP of 108.09±15.40
schools was 67.07±11.98 mmHg compared to 66.87 ±
mmHg. This difference was statistically significant (p=
11.47 mmHg in those in urban schools. However, this
0.000).
difference was not statistically significant (p=0.785).
24
The mean diastolic BP of the male subjects in the urban
Table 5: Mean BMI- for-age of the subjects by school location
schools of 66.90 ± 11.05mm Hg was higher than the
Rural
Urban
65.60 ± 11.42 mmHg of their rural counterparts. How-
Age
Mean ± SD
Mean ± SD
P value
ever, this difference was not statistically significant
(years)
( kg/m )
2
( kg/m )
2
(p=0.072).
10
16.84± 1.61
17.48± 2.84
0.306
The mean weight of the subjects in rural and urban
11
17.22± 2.17
18.17± 4.25
0.066
schools were 48.51 ± 10.14 kg (range 22 -110 kg) and
12
17.67± 2.23
19.08± 3.10
0.000*
49.91 ± 11.78 kg (range 26 – 120 kg) respectively. This
13
18.55± 2.24
20.26± 3.81
0.000*
observed difference was statistically significant
14
18.85± 2.93
19.87± 2.97
0.956
(p = 0.005).
15
19.75± 2.11
20.47± 2.78
0.009*
The mean height of the subjects in the rural and urban
16
20.80± 2.69
20.96± 2.92
0.655
schools were 1.56 ± 0.09 m (range 1.2-1.9 m) and 1.57±
17
20.76± 2.39
21.33± 4.57
0.251
0.10 m (range 1.3-1.9 m) respectively. This difference
18
21.62± 2.44
21.16± 2.23
0.589
Total
19.59± 2.78
19.82± 3.57
0.097
was not statistically significant (p=0.337).
Subjects in urban schools were significantly heavier and
*significant
taller than their rural counterparts at ages 11-13, 15-16
years and 11-16years respectively as shown in Table 3
The mean BMI of the female subjects in the urban
and Table 4.
schools of 20.57 ± 3.74 kg/m was significantly (p =
2
0.002) higher than the 19.91 ± 3.01 kg/m in their rural
2
counterparts. However, the mean BMI of the male sub-
Age
Rural
Urban
jects in the rural schools of 19.27 ± 2.50 kg/m was
2
(years)
Mean ± SD (Kg)
Mean ± SD (Kg)
p value
higher than the 18.96 ± 3.15 kg/m in those in urban
2
10
35.17 ± 5.44
37.76 ± 8.99
0.338
schools. This difference was not statistically significant
11
36.51 ± 6.59
40.86 ± 10.59
0.001*
(p=0.087). Figures 1- 4 show the correlation between
12
39.99 ± 7.18
44.98 ± 8.78
0.000*
systolic and diastolic BP and BMI in rural and urban
13
43.74 ± 8.03
49.98 ± 12.32
0.000*
subjects. Both systolic and diastolic BP showed a posi-
14
49.13 ± 10.27
50.91 ± 8.86
0.118
tive significant correlation with BMI in rural subjects
15
49.29 ± 6.77
55.07 ± 8.02
0.000*
16
53.64 ± 7.22
56.90 ± 9.79
0.003*
(R= 0.386, p= <0.001 and R= 0.314, p= <0.001) and
17
55.10 ± 7.38
57.81 ± 13.13
0.065
urban subjects (R= 0.316, p= <0.001 and R= 0.228, p=
18
58.64 ± 7.90
56.37 ± 6.71
0.116
<0.001) respectively.
Total
48.51 ± 10.14
49.91 ± 11.78
0.005*
Fig 1: Corre-
Table 3: Mean weight- for- age of the subjects by school
lation be-
location
tween BMI
*significant
and systolic
BP in rural
subjects
Rural
Urban
Age
Mean ± SD(m)
Mean ± SD(m)
10
1.43± 0.07
1.45± 0.08
0.362
11
1.45± 0.08
1.49±0.07
0.000*
12
1.49± 0.07
1.53± 0.07
0.000*
13
1.53± 0.07
1.56± 0.09
0.000*
14
1.56± 0.08
1.60± 0.07
0.000*
Fig 2: Corre-
lation be-
15
1.57± 0.06
1.63± 0.08
0.000*
tween BMI
16
1.60± 0.07
1.63± 0.09
0.001*
and diastolic
17
1.62± 0.07
1.64± 0.09
0.293
BP in rural
18
1.64± 0.07
1.63± 0.09
0.398
subjects
Total
1.56± 0.09
1.57± 0.10
0.337
Table 4: Mean height for age of the subjects by school
location
*significant
Fig 3: Corre-
The mean BMI was 19.59 ± 2.78 kg/m in subjects from
2
lation between
rural schools (range 12.2-38.1 kg/m ) and 19.82± 3.57
2
BMI and sys-
tolic BP in
kg/m (range 13.3-44.4kg/m ) in subjects from urban
2
2
urban subjects
schools. This observed difference was not statistically
significant (p=0.097).The mean BMI showed a gradual
increase with age as shown in Table 5, except at 17
years in subjects in rural schools and at 14 years in sub-
jects in urban schools. Subjects in urban schools had
higher mean BMI than their rural counterparts from 10
years to 17 years with significantly higher mean BMI
25
Fig 4: Correla-
events than their urban counterparts. However, further
tion between
studies are needed to identify the factors that may con-
BMI and dia-
tribute to these rural-urban disparities.
stolic BP in
urban subjects
In the present study, female subjects had higher blood
pressure profiles than males in both rural and urban ar-
eas. This finding compares favourably with reports by
Okonofua in children and adolescents aged 3-20 years
29
in Benin City and Akinkugbe et al in adolescents aged
10
11-19 years in Ibadan. The higher blood pressure pro-
files in females in the present study may be due to the
fact that females had higher BMI (19.91 ± 3.01kg/m and
2
20.57 ± 3.74kg/m ) than their male counterparts (19.27
2
Discussion
± 2.50 kg/m and 18.96 ± 3.15 kg/m ) in both rural and
2
2
urban areas respectively. It however contrasts with re-
The finding in the present study that blood pressure in-
ports by Balogun et al who reported higher BP profiles
30
creased with age in both rural and urban subjects is con-
in males than females aged 8-20 years in Ile-Ife. How-
sistent with earlier reports by Bugage et al and Ak-
9
and Obika et al studied Nigerian
13
ever, Hamidu et al
17
inkugbe et al in urban adolescents in Zaria and Ibadan
10
school children aged 5-16 years and 1-14 years in rural,
respectively. Other studies in rural and urban children in
semi-urban and urban areas of Zaria and Ilorin respec-
Nigeria
11,13
and Ghana
12
reported a similar pattern. The
tively and found no significant gender difference in BP.
more rapid increase in blood pressure noted at mid-
Subjects of different age range and therefore of different
adolescence in the present study has also been noted by
body sizes and sexual maturation were studied by these
other researchers
9,10,12,23
. It seems to coincide with peri-
researchers and this may explain the disparities in their
ods of rapid physical development and hormonal
reports. In explaining the inconsistent findings in differ-
changes in children. Several studies attest to the rural-
9
ent studies, Szklo attributed the findings to the varying
31
urban difference in blood pressure levels throughout Sub
pattern of growth in boys and girls amongst various
-Saharan Africa
24,25
. Previous studies in adults have re-
populations. Nonetheless gender differences in blood
ported higher blood pressure levels in urban than in rural
pressure have been reported by different researchers in
subjects, and the higher blood pressure levels in adults
different populations
12,13,31
.
in urban subjects have been attributed to the stress of
acculturation
26-28
. Studies in childhood have reported
In the present study, blood pressure increased with in-
similar rural-urban blood pressure disparity with urban
creasing BMI in both rural and urban subjects. This is
children having higher blood pressure levels than rural
similar to findings by other researchers in Nigeria,
32
children.
11,12
In the present study, there were marked
Ghana and United States of America . The relationship
12
8
differences in blood pressure especially in systolic BP of
between blood pressure and increasing BMI in children
rural and urban adolescents. Rural adolescents had sig-
and adolescents have been demonstrated in several stud-
nificantly higher mean systolic BP than their urban
. Alabi et al in Port Harcourt, Nigeria reported
32
ies
8,13,28
counterparts. This could be attributed to the fact that the
a positive significant relationship between BP and BMI
mean age of the rural children was significantly higher
in adolescents aged 10-19 years. Similar findings were
than that of the urban children, as age positively corre-
reported by Agyemang et al
12
in Ghanian children aged
lates with blood pressure. However, the difference in
8-16 years in rural, semi-urban and urban areas of
mean systolic BP between rural and urban adolescents
Ashanti region of Ghana and by Sorof et al in American
8
was not significant for most ages. This is similar to find-
children aged 11-15 years. However, Antia-Obong and
ings by Okonofua who reported higher mean systolic
29
Antia-Obong in their study of younger urban and rural
15
blood pressures in rural than in urban children and ado-
children aged 6-14 years found no relationship between
lescents aged 3-20 years in Benin City, Nigeria. In con-
blood pressure and BMI. This finding gives credence to
and Agyemang et al
12
trasts, Ejike et al
16
reported sig-
the observation by Lauer et al that the correlation be-
3
nificantly higher systolic BP in urban adolescents com-
tween BMI and blood pressure is stronger in adoles-
pared to non-urban adolescents in Kogi State, Nigeria,
cence than in childhood. There is strong evidence that
and in Ashanti, Ghana respectively. The reasons for
high adult blood pressure levels correlate significantly
these differences are unclear, however, further studies
with an increase in adiposity from childhood to adult-
are needed to identify the factors that may contribute to
hood, and that there is a moderate risk that excess body
these rural-urban disparities, as the present study and the
fat acquired during childhood will persist into adult
Benin study were done in the same South-South geo-
29
political zone whilst the Kogi
12
life
3,33
. Therefore, efforts should be made at educating
study was done in the
these young ones on the risks of overweight status irre-
North Central region of Nigeria.
spective of location (rural or urban) as westernization
and adoption of unhealthy lifestyle habits may further
However, the findings in the present study may be a
lead to an increase in the prevalence of high blood pres-
pointer that the seeming protection from blood pressure
sure levels in adult Nigerians in the future.
elevations which rural subjects enjoyed may be fading
away, and indeed adolescents living in the rural areas of
Rivers State may be exposed to more stressful life
26
Conclusion
form part of the medical evaluation for School Health
Programme for all secondary school students in both
In conclusion, the present study showed an increase in
rural and urban areas, and health education on lifestyle
blood pressure with age with marked differences in
modification to avoid overweight and obesity should be
blood pressure of rural and urban adolescents in Rivers
incorporated into the school curriculum in secondary
State. Also, blood pressure showed a significant positive
schools in Nigeria.
correlation with BMI among these adolescents. How-
ever, more work needs to be done to investigate the fac-
Conflict of interest: None
tors responsible for the rural-urban disparities found in
Funding: None
the present study.
We recommend that blood pressure measurement should
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