Paediatric hypertension in Iraq

Sir,

The interesting study by Borah et al1 has inspired me to throw light on paediatric hypertension (HT) in Iraq and compare it with that reported in India.

First, Borah et al1 did well in addressing four study limitations. I presume that there is another important methodological limitation. Borah et al1 mentioned that the overweight and obesity were assessed by body mass index (BMI) percentiles for age based on Centers for Disease Control (CDC) 2000 dataset for both genders. It is noteworthy that obesity prevalence in a given population can be determined using four different diagnostic criteria namely, International Obesity Task Force reference, CDC2000 dataset, World Health Organization reference 2007, and national reference2. Applying different BMI references could result in marked differences in obesity prevalence. To my knowledge, no Indian sex- specific BMI-for-age references are yet constructed to be employed. On the other hand, I presume that the studied Indian population is polygenetic. This is important to be considered as significant differences in BMI among different ethnic groups exist2. If so, this methodological limitation might cast suspicions on the reported HT prevalence, blood pressure (BP) distribution, and HT correlates in this study1.

Second, HT prevalence and the pattern of distribution of systolic BP (SBP) and diastolic BP (DBP) in both genders are quite different1 compared to that reported in Iraq3. Borah et al reported that girl children had significantly higher mean SBP (104.2 ± 12.0 vs. 103.2 ± 11.6 mmHg, P<0.001) than boys. With increase of age, there was a gradual rise in both SBP and DBP in boys and girls1. In Iraq, there were no significant differences noted with respect to SBP and DBP among boys and girls except at the age range of 10-12 yr, where girls manifested higher SBP (P<0.01) and DBP (P<0.05) than boys3. The reported HT prevalence (7.6%) in Borah et al study1 is higher than 1.7 per cent reported in Iraq3. This difference might be attributed to the variations in study design, definition of HT, methods of BP recording, observer effect, age range, sample size, ethnicity, and socio-economic class4 as well as the preponderance of obesity among Iraqi children (7.3%)3 compared to the low obesity prevalence reported by Borah et al (2.9%)1.

Third, I agree with Borah et al1 that strengthening of school health programme is fundamental to prevent future epidemic and complications of HT. Actually, implementing a school-based intervention to teach children on the healthy heart has shown improvement in their knowledge, increasing their awareness on healthy lifestyles, and has the potential to reduce the risk of atherosclerosis in both the individual child and the population at large5. In Iraq, a school-based heart health curriculum has been launched and the results of evaluating its impact on awareness and HT prevalence are to be shortly addressed.