Chapter 3 Methodology
3.5 Phi losophical basis of the study
4.2.1 Choosing the study setting
c
with hypertension. This study also did not find a significant association between physical activity and hypertension. It has been documented that spending more time in physical activity plays an important role in preventing and delaying the onset of hypertension.
The prevalence of micro albuminuria in the general population is reported to be 10 – 15%. In the United States of America (USA), a lower prevalence of 7.8% was reported in the general population of children, adolescents and adults. 146 In Africa there is paucity of data on the prevalence of microalbuminuria among adolescents .In Nigeria, a study in Benin City reported a 19% prevalence of micro albuminuria among healthy adolescents and young adult offspring of hypertensive parents.126 This study noted a high prevalence of micro albuminuria 13.8% rural and 6.9% urban. These findings are lower than a prevalence of 33.2% found in a study among adolescents in Port Harcourt, Nigeria 127and the prevalence of 19% reported in Benin City, Nigeria. The lower prevalence observed in this study may be due to the methodology used.
ci
The results of this study suggest thatawareness about hypertension ishigh among the rural and urban study participantswith a higher proportion of rural study participants being more aware of hypertension. Specific knowledge of hypertension was poor among the rural and urban study participants. This study revealed a relatively high prevalence of hypertension among rural and urban respondents. The following risk factors of hypertension were found among the study participants, A family history of hypertension, always adding extra salt to food, taking sugary drinks every day, eating only 1-3 portions of fruits/vegetables per day, engaging in physical activity 1-3 times a week, engaging in physical activity for less than 30 minutes a day, history of ever smoking, history of ever using alcohol with rural respondents having slightly higher scores for the first three variables and urban respondents having slightly higher scores for the last four variables. A family history of hypertension was found to be the major determinant of adolescent hypertension. The prevalence of microalbuminuria was high among rural and urban respondents.
RECOMMENDATIONS
cii
1) It is therefore recommended that periodic screening and monitoring of the blood pressure of adolescents should be incorporated into the school health programme.
2) General public health education on adolescent hypertension and its associated risk factors should be strengthened as complications of hypertension may negatively influence qualityof life.
3) Public health programmes that aim to reduce hypertension should focus primarily on adolescents in rural and urban areas
4) Children should be educated about good lifestyle and healthy food habits.
5) Awareness programmes should encourage parents and guardians to continue to educatetheir children about hypertension at home.
6) Furthermore, routine urine screening for microalbuminuriain adolescents in rural and urban areas should becarried out regularly for early detection of microalbuminuria andprevention of renal damage.
REFERENCES
ciii
1. Singh AK,Maheshwari A, Sharma N andAnand K.Lifestyle Associated Risk Factors in Adolescents. Indian J Pediatrics. 2006; 73(0): 901-906.
2. Maiyaki MB, Garbati MA The burden of non–communicable diseases in Nigeria; in the context of globalization Annals of African Medicine. 2014; 13 (1) 1 – 10.
3. Wokoma FS, Alasia DD, Blood pressure patterns in Barako, a rural community in Rivers State, Nigeria. Niger Health J 2011; 11: 3 – 13.
4. AdefuyeBO, Adefuye PO, Oladapo OT, Familoni OB, Olunuga TO. Prevalence of hypertension and other cardiovascular risk factors in an African sub urban religious community. Nigerian Med Pract. 2009; 55: 4–8.
5. World Health Organization. Facing the facts: The impact of Chronic Disease in Nigeria. Geneva:World Health Organization: 2005. Available at:
http//www.who.int/chp/chronic disease report/en/ Accessed March 26, 2017.
6. Unachukwu CN, Agomuoh DI, Alasia DD. Pattern of non–communicable diseases amongmedical admissions in Port Harcourt, Nigeria. Niger J ClinPract 2008; 11: 14 – 17.
7. Kearrey PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide Prevalence of hypertension. A systematic review. J Hypertens 2004; 22: 11 – 9.
8. Ezzati M, Lopez AD, Rodgers A, Hoom SR, Murray CJL. The comparative risk assessment collaborating Group. Selected major risk factors and global and regional
burden of disease. Lancet 2002; 360:1347 – 6.
9. Ekwunife OI, Udeogaranya PO, Nwatu IL. Prevalence, awareness, treatment and control of hypertension in a Nigerian Population. Health 2010; 7: 731-735.
10. Eriki Silva Magliano, Luciane Gasper Guedes, Evandro Silva FriereCoutinho and Katia Vergetti Bloch. Prevalence of arterial hypertension among Brazilian adolescents:A Systematic review and Meta-analysis. BMC Public Health 2013; 13:
833-410.
civ
11. Ordinoha B. The prevalence of hypertension and its modifiable risk factors among lecturers of a medical school in Port – Harcourt, South -south, Nigeria: Implications for control effort. Nigerian J ClinPract 2013; 16 (1): 1-14.
12. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J Global burden of hypertension: analysis of worldwide data Lancet 2005; 365 (9455): 217-23.
13. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuiya K, Adair – Rohani H, et al A comparative risk assessment of the burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions: a systematic analysis of the Global burden of Disease study The Lancet 2012 ; 380 (9859): 2224 – 60.
14. Sani MU, Mohammed AZ, Bapp A, Borodo MM. A three year review of mortality patterns in the medical wards of Aminu Kano Teaching Hospital Kano, Nigeria. Niger J ClinPract 2009; 12: 153 – 62.
15. Arodiwe EB, Ikeo SO, Nwokediuko SC. Case fatality among hypertension related admissions in Enugu, Nigeria. Niger J ClinPract. 2009; 12: 153.
16. Also U, Asani M, Ibrahim M. Prevalence of elevated blood pressure among primary school children in Kano metropolis, Nigeria.Nig J. Cardiol 2016; 13:57 – 61.
17. Sunder JS, Adakalam SJM, Parameswari S, Kalpana VSS, Shantharam D. Prevalence and determinants of hypertension among urban school children in the age group of 13 – 17 years in Chennai Tamilnadu. J DentMedSci2013; 8 (3): 14-20.
18. Akgun C, Dogan M, Akbayram S, Tuncer O, Peker E, Taskin G. The incidence of asymptomatic hypertension in school children. J Nippon Med Sch 2010; 77: 160 – 5.
19. Falkner B, Luibe E, Schaefer F. High blood pressure in children, Clinical and health policy implications. J. ClinHypertens 2010; 12: 261 – 76.
20. Hanssen ML, Gunn PW, Kaelpar DC. Underdiagnosis of hypertension in children and adolescents. JAMA 2007; 298:874 – 879.
cv
21. Karey RE, Daniels SR, Flyn JT. Management of high blood pressure in children and adolescents. CardiolClin 2010; 28 (4): 597 – 607
22. Tellez-Plaza M, Orozco-Beltran D, Gil-Guillen V, Pita-Fernandez S, Navaro-Perez, Pallares V, Valls F.Renal function and attributable risk of death and cardiovascular hospitalization in patients with cardiovascular risk factors from a registry-based cohort: the Estudio Cardiovascular Valencia-risk study. J Hypertens. 2016. 34(11):
2266-73.
23. Kennel WB. Risk stratification in hypertension: a new insight from Framingham study. Amer J Hyperten. 2000;13(1): 3-10.
24. World Health Organisation. Adolescent Health. World Health Organisation, Geneva, 2015. Available at: http: // www.who.int/topics/adolescent health/en. Accessed March 15, 2016.
25. Bonsu WK. The Prevalence, Awareness and Control of Hypertension among workersin West Africa: A systematic review. Global Health Action 2015; 8:10.
26. Mensah GA. Epidemiology of Stroke and High blood pressure in Africa. Heart 2008;
94:697 -705.
27. Nwazor FOO, Oputa SC. Blood pressure among young people in south eastern Nigeria. A cross sectional survey. Ebonyi Medical J2012; 11: 77-83.
28. Kills – Pstrusisnka K, Zwolinska O. Primary hypertension as a growing problem in Pediatrics. Fam Med Prim Care Rev 2007; 9: 809-819.
29. Lima EM. Assessment of risk factors associated with elevated blood pressure in children and adolescents. J. Pediatr 2004; 80 (1): 3-4.
30. Falkner B. Hypertension in children and adolescents. Epidemiology and Natural history. PediatrNephrols 2010; 25: 1219-24.
31. Ajayi IO, Sowemimo IO, Akpa OM, Ossai NE. Prevalence of hypertension and associated factors among residents of Ibadan – North Local Government Area of Nigeria.Nig J Cardiol 2016; 13(1): 67-75.
cvi
32. Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ. Overweight, ethnicity and the prevalence of hypertension in school aged children. Pediatrics 2004; 113: 475-82.
33. Ingelfinger JR. Pediatric antecedents of adult cardiovascular disease – Awareness and Intervention. N. Engl J Med 2004; 350: 2123-2126.
34. Ogah OS, Maduekwe OO, Chukwuonye I, Onyenoro UU, Ukaegbu AU, AkhimienMO, Onwubere BJC, Okpechi IG. Prevalence and determinants of hypertension in Abia State. Non communicable diseases and cardiovascular risk factors survey. EthnDis 2013; 23 (2): 161-7.
35. Kevin D Hill, Jennifer S Li. Childhood hypertension. An Underappreciated Epidemic. Paediatrics 2016; 138 (6): 28-37.
36. Moore WE, Stephens A, Wilson T, Wilson W, Eichner JE. Body mass index and blood pressure screening in a rural public school system: The Healthy Kids Project.
Prev Chronic Dis 2006; 3 (4): 1-2.
37. Franco MC, Christofelo DM, Sawaya AL, Ajzen SA, Sesso R. Effects of Low Birth Weight on 8 – 13 year old children: Implications in endothelial function and Uric acid levels. Hypertens 2000; 48 (1): 45-50.
38. Raitakari OT, Juonala M, Kahonen M, Tailtonen L, Laitinen T. Cardiovascular risk factors in childhood and carotid artery intima – media thickness in adulthood. The Cardiovascular Risk in Young Finns study. JAMA 2003; 290: 2277 – 2283.
39. La Rosa C, Meyers K, Epidemiology of hypertension in children and adolescents. J.
Med Liban 2010; 58 (3): 132 - 136.
40. Siniako AR, hypertension in children. New England J Med 1996; 336 (26): 1968-1973.
41. Munger RG, Prineas RJ, Gomez – Marin O. Persistent elevation of blood pressure among children with a family history of hypertension: Minneapolis Children’s Blood Pressure Study. J Hyperten1988; 6 (8): 647-653.
cvii
42. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM.
Prevalence of overweight and obesity in the United States, 1999 – 2004, JAMA 2006;
295 (13): 1549-1555.
43. Cappucio FP, Micah FB, Emmett L, Kerry SM, AntwiS,Martin – Peprah R,Phillips RO, Plange – Rhile J, Eastwood JB. Prevalence, Detection, Management and Control of Hypertension in Ashanti, West Africa. Hyperten2004; 43: 1017 – 1022.
44. Luibe E, TorroI,AlvarezV,NawortT,Paya Redon J, Steessen AJ: Prevalence of persistence, and clinical significance of masked hypertension in youth.
Hypertens2005; 45: 454:493-498.
45. Chen X, Wang Y. Tracking of blood pressure from childhood to adulthood.
Circulation2008; 117(25):3171-3180.
46. Essunge PM. From blood pressure to hypertension: the history of research. J Royal SocMed1991; 84: 621-632.
47. StamlerJ,Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks: US population data. Arch Intern Med 1993; 153:598-615.
48. Sundar JS, Adaikalam SJM, Parameswari S, et al. Prevalence and determinants of hypertension among urban school children in the age group 13 – 17 years in Channai, Tamilnadu. IOSR J Den and Med Sci 2013; 8 (3): 14-20.
49. Riley M, Bluhm B, High blood pressure in children and adolescents. Am FamPhys2012; 85 (7): 693 -700.
50. Magliano ES, Guedes LG, Countinho ESF, Bloch KV. Prevalence of arterial hypertension among Brazilian adolescents. Implications for preventive education programmes inprimary care. BMC Public Health 2013; 13: 833.
51. Aglony M, Acevedo M, Ambrosio G. Hypertension in Adolescents. Expert RevCardiovascTher 2009; 7(12): 1595 – 603
cviii
52. The Medieval origins of the concept of hypertension. Heart views 2014; 15(3): 96–98.
Available atWikipedia.orghttps://en.wikipedia.org/wiki/hypertension. Accessed Feb 23,2016.
53. Lawlor DA, Smith GD. Early life determinants of adult blood pressure.Curr OpNephrolHypertens2005; 14(3): 259 -264
54. Swales JD. Manual of hypertension. Oxford: Blackwell Science 1995 p. 1. Available at https://en.wikipedia.org/wiki/History of hypertension. Accessed Feb 23,2016.
55. Saklayen MG, Deshpande NV. Timeline of History of Hypertension Treatment. Frontiers CardiovasMed2016; 3: 3-7.
56. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertes 2008; 51(6): 1403-1419.
57. Maloney WJ, Resiljez UF, Maloney M. The hypertension of president Franklin Roosevelt. The president as casualty of war. N Y State Dent J. 2012; 78(6): 37-40.
58. Kaplan NM, Bakris GL, Sullivan DJ, Basile J, Foreman JP. Overview of Hypertension in adults.Available athttp://www.up to date.com/contents/overview of hypertension inadults.Accessed Feb 24, 2016.
59. Kotchen TA. Historical trends and milestones in hypertension research: a model of the process of translational research. Hypertens2011; 58(4): 522 - 538.
60. White PD Heart Disease (2nded) New York. NY Macmillan Co. 1937; p.326Available athttps://en.wikipedia.org/wiki/History of hypertension Assessed Feb 17,2016.
61. Friedberg CK Diseases of the Heart. Philadelphia.PA: WB Saunders Co. 1949.
Available athttps://en.wikipedia.org/wiki/History of hypertension Assessed Feb24, 2016.
cix
62. Gan SK, Lon CY, Seet B. Hypertension in young adults: an underestimated problem.Singapore Med J 2003; 44: 448 – 52.
63. Pickering GW. The natural history of hypertension. Brit Med Bull 1952 ; 8(4): 305-9.
64. PoulterNR,Prabhakavan D, Caulifield M. Hypertension. Lancet 2015; 386(9995): 801 - 812.
65. Rodriguez MA, Kumar SK, DeCaro M. Hypertensive crisis. Cardiol Rev2010; 18(2): 102 - 107.
66. Mosen M. Historical perspectives on the management of hypertension J ClinHypertens 2006; 8 (2): 15 – 20.
67. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Miller NH, Hubbards VS. 2013 AHA/ACC Guideline on lifestyle management to reduce cardiovascular risk. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. JAmCollCardiol2014; 129(25): 76 –79.
68. National High Blood Pressure Education Programme Working Group on High Blood Pressure in Children and Adolescents. The Fourth Report on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents. 2004; 114: 555 - 575.
69. JNC National Institutes of Health National Heart, Lung, and Blood institute. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and
Treatment of High Blood Pressure. Available
athttp://www.nhlbi.nih.gov/files/docs/guidelines/jnc7full.pdfAccessed in March 2016.
Accessed 23, February 2016.
70. Hypertension in adults: diagnosis and management: Guidelines. National Institute for Health and Care Excellence (NICE), 2013. Available at https://www.nice.org.uk/guidance/cg 127 Accessed March 16 2016.Accessed 23, February 2016.
cx
71. Kornen PI. Essential Hypertension and its causes: Neural and Non – NeuralMechanisms Oxford University Press USA 2007; pg. 4.
72. Carretero OA, OpavilS.Essential Hypertension Part 1: Definition andaetiology.Circulation 2000;101(3): 329 -335.
73. World Health Organization. A Global Brief on HYPERTENSION – Silent Killer, Global Public Health Crisis (World Health Day 2013), Geneva. Available atwww.who.int/cardiovascular disease/publications/global brief hypertension/en/Accessed in March 16, 2016.
74. British Heart Foundation. Hypertension. Available at https://www.bhf.org.uk/heart - health/risk - factors/high - blood - pressure Accessed in March 17, 2016.
75. National Lung and Blood Institute. Description of the DASH Eating Plan. Available at:
httpswww.nhlbi.nih.gov/health/health - topics/topics/dash. . Accessed in March 17, 2016.
76. European Society of Cardiology. Management of Arterial Hypertension. Available athttp:
//www.escardio.org/Guidelines - & - Education/Clinical – Practice – Guidelines/Arterial – Hypertension – Management – of. Accessed in March 17, 2016.
77. Grad I, Masterlez – Migaz A, KilisPstrusinka K. Factors associated with Knowledge of hypertension among adolescents. Implications for preventive education programmes in primary care. BMC Public Health 2015; 15: 463 – 470.
78. Vanhecke TE, Miller WM, Franklin BA, Weber JE, McCullough PAAwareness, Knowledge and Perception of heart disease among adolescents. Eur.J.CardiovascPrev Rehabil.2006; 13: 718 – 723.
79. Borges TT, Rombaldi AJ, Knuth AG, Hallal PC. Knowledge on risk factors of chronic diseases: A population based study. Cad Saude Publica.2009; 25(7): 1511 - 1520.
80. Nti CA, Brown A, Danquah A. Adolescents’ knowledge of Diet related Chronic Diseases and Dietary Practices in Ghana.Food Nutrition Sci2012; 3:1527 –1532.
cxi
81. Shaikh RB, Mathew E, Sreedharan J, Muttappallymyalil J, Al Sharbatti S and Basha SA Knowledge regarding the risk factors of hypertension among entry year students of a medical university. J Fam CommMed 2011; 18(3): 124 – 129.
82. Essouama M, Noubiap JJN, Bigna JJ, Nansseu JRN, Jingi AM, Aminde LN, Zafack J.
Hypertension Prevalence, incidence and risk factors among children and adolescents in Africa: a systematic review and meta – analysis protocol BMJ Open 2015; 5: 1136.
83. McNeice KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ.
Prevalence of hypertension and Pre hypertension among adolescents. J Pediatr 2007;
150 (6): 640 - 644.
84. Buch N, Goyal JP, Kumar N, Parmar I, Shah VB and Charan J. Prevalence of hypertension in school going children of Surart city, Western India J. Cardiovascular Disease Research 2011; 2 (4):228 - 132.
85. Nam EW, Sharma B, Kim HY, Paja DJ. Obesity and hypertension among school going adolescents in Peru J Lifestyle Med 2015; 5 (2): 60–7.
86. Rinaldi AEM, Noguerra PCK, Riyuzo MC, Olbrich – Neto J, Gleice F C et al. Prevalence of elevated blood pressure in children and adolescents attending high school.Rev. Paul.
Pediatr 2012; 30:1-9.
87. Ujunwa FA, Ikefuna AN, Nwokocha AR, Chinawa JM. Hypertension and prehypertension among adolescents in secondary schools in Enugu, South East Nigeria.
Italian J Pediatrics. 2013; 39: 70 – 75.
88. Mijinyawa MS, Iliyasu Z, Borodo MM. Prevalence of hypertension among teenage students in Kano Nigeria. Niger J Med 2008; 17 (2): 173 – 8.
89. Oduwole AA, Ladapo TA, Fajolu IB, Ekure EN, AdeniyiOF.Obesity and elevated blood pressure among adolescents in Lagos,Nigeria: A cross – sectional study. BMC Public Health 2012;12:616.
90. Okpere AN, AnochieIC,Eke FU. Pattern of blood pressure and hypertension in adolescents in Port Harcourt, Nigeria. West Afr J Med 2013; 32 (2): 93 – 8.
cxii
91. Oyeyemi AY, Usman MA, Oyeyemi AL, Jaiyeola OA. Casual blood pressure of adolescents attending public secondary schools in Maiduguri, Nigeria Clin Hypertens2015; 21:16.
92. Emmanuel EE, Dada SA, Amu EO, Aduayi VA, Atoyebi OA et al. Hypertension and its correlates among in school adolescents in Ekiti State, South–WestNigeria.
AsianJMedSci2017; 8: 4-9.
93. Adeloye D, Basquill CA, Chan KY, Rudan I et al. An estimate of the Prevalence of Hypertension in Nigeria. A systematic Review and Meta Analysis. J. Hypertens2015;
33(2) 230- 242.
94. Akinlua JT, Meakin R, Umar AM, Freemantle N. Current Prevalence Pattern of Hypertension in Nigeria. A systematic Review. PLoS One 2015; 10(10):19-23.
95. Rodriguez Perez M O, Cabrera de Leon A, Morales Tores R M, Coello S D, Aleman Sanchez J J, Diaz B B, Hernandez A G, Gonzalez D A.Factors Associated with Knowledge and Control of Arterial Hypertension in the Canary Islands. Rev EspCardiol 2012; 65 (3): 234 – 240.
96. Albert UK, Effiong JH. Risk Factors and Anthropometric variables of Young people with Essential Hypertension in Uyo, AkwaIbom State. Br J Med and Med Res 2015; 10(8): 1-8.
97. Ulasi II, Ijoma CK, Onwubere BJC, ArodiweE,OnodugoOD,OkaforC.Highprevalence and low awareness of hypertension in a market population in Enugu, Nigeria. Int J Hypertens2011; article ID 869675.
98. Kelly RK, Magnussen CG, Sabin MA, Cheung M and JuonalaM.Development of hypertension in overweight adolescents. A review. Adolesc Health Med Ther.2015; 6:171 -187.
99. Ikeoluwapo O Ajayi, IbukunOpeyemiSowemimo, Onoja Mathew Akpa, NdudiEdmund Ossai.Prevalence of hypertension and associated factors among residents of Ibadan – North Local Government Area of Nigeria. Nig J Cardiol 2016; 13(1): 67 – 75.
cxiii
100. Olack B, Wabuire – MargenF,Montgomery JM, Kiwanuka N, Breiman RF Risk factors of hypertension among adults aged 35 – 64 years living in an urban slum in Nairobi, Kenya BMC Public Health 2015; 15: 1251.
101. Flynn JT, Falkner BE. Obesity and hypertension in adolescents: Epidemiology, evaluation and management.J ClinHypertens 2011; 13(5): 323 -31.
102. Kuschnir MC, Mendonca GA. Risk factors associated with arterial hypertension inadolescents. JPediatria 2007; 83(4):78-84.
103. Goel M, Pal P, Agrawal A, Ashok C. Relationship of body mass index and other life style factors with hypertension in adolescents.AmPediatrCardiol 2016; 9(11); 29 – 34.
104. Balogun JA, Obajuluwa VA, Olaogun MO, Abereoje OK, Oyeyemi AY et al.Influence of Parental Socioeconomic status on casual blood pressures of Nigerianschool children.
Intern J Cardiol 1990; 29: 63 – 69.
105. McBride P, Einerson J, Hanson P, Heindel K. Exercise and the primary prevention of coronary heart disease. MedExercise, Nutrition and Health 1992; 1: 5-10.
106. Haskell WL, Leon AS, Caspersen CJ. Cardiovascular benefits and assessment of physical activity and physical fitness in adults. Med Sci Sports Exerc1992; 24(6 ):S201-2.
107. Gersh BJ, Sliwa K, Mayosi BM, Yusuf S. Novel therapeutic concepts. The epidemic of cardiovascular disease in the developing world: global implications. EuropHeart J2010;
31(6):642.
108. Cappuccio FP, Sally MK, Frank BM, Jacob P-R, John BE. A community programme to reduce salt intake and blood pressure in Ghana. BMC Public Health 2006;6:13-18.
109. Law MR, Frost CD, Wald NJ. By how much does dietary salt reduction lower blood pressure. Ill: Analysis of data from trials of Salt reduction. BMJ. 1991; 302 (6780):819 – 24.
cxiv
110. Beaglehole R, Bonita R, Horton R, Adams C et al. Priority actions for the non communicable disease crisis The Lancet 2011; 377(9775): 438-47.
111. Mtabaji JP, Nara YM, Mano MM, Yamori Y Ethnic differences in salt sensitivity:Genetic or environmental factors. ClinExpPharmacolPhysiol Suppl 1992; 20: 65-7.
112. Obel AO, Koech DK Potassium supplementation versus bendrofluazide in mildly to moderately hypertensive Kenyans. J CardiovascPharmacol 1991 March; 3 (17): 504 –7s 113. Katzmarzyk PT, Perusse L, Rice T, Rao DC, Bouchard C. Familial aggregation of seven
year changes in blood pressure in Canada.Can J Cardiol 2001; 17: 1267 – 74.
114. Luft FC. Present status of genetic mechanisms in hypertension. Med Clin North Am2004;
88: 1 - 18.
115. Dayanada G, Murtny N. Blood Pressure changes in Normotensive subjects with andwithout family history of hypertension. J Physiol Biomed Sci 2009; 22:35 – 39.
116. Eun Woo Nam, Bimala Sharma, Ha Yun Kim, Doris Jackelin Vasquez Paja, Young Mun Yoon, Sun Ha Lee, Eun Hwan Kim. Obesity and Hypertension among School going Adolescents in Peru. J Lifestyle Med 2015; 5(2): 60 – 67
117. Gee ME, Bienek A, McAlister FA, Robitaille C, Joffres M, Tremblay MS, Johansen H, Campbell NR. Factors associated with lack of awareness and uncontrolled blood pressure among Canadian adults with hypertension. Can J Cardiol. 2012; 28 (3): 375 – 82.
118. Couliffe C, Frankson M, Smith F, Hanna – Mahase C and Oriakhu M. The Prevalence of Elevated blood pressure in Adolescents in Nassau, The Bahamas. West Indian Med J 2015; 64(1) :17–22.
119. Odey F, Anah M, Ansa V, Ogbeche J, Meremikwu M, Ekanem E. Pre – Hypertension and Hypertension in Apparently Healthy Adolescents in Calabar, Global J Comm Med 2009; 2:1 - 2.
120. Virdis A, Giannarelli C, Neves MF, Taddel C, Ghiadoni L Cigarette smoking and hypertension Curr Pharm Des 2010; 16 (23): 2518 – 25.
cxv
121. Beaglehole R, Epping – Jordan J, Patel V, Chopra M, Ebrahim S, Kidd M, et al.
Improving the prevention and management of chronic disease in low- income and middle income countries: A priority for primary health care. Lancet 2008; 372: 940 – 9.
122. Djousse L, Mukamal KJ Alcohol consumption and Risk of hypertension. Does the type of Beverage or Drinking pattern matter Rev EspCardiol 2009; 62 ( 6 ) : 603 – 5.
123. Ness AR, Powles JW Fruit and vegetables and Cardiovacsular disease: A review. Int J Epidemiol 1997; 26 (1): 1 – 13.
124. Popkin BM Global nutrition dynamics: The world is shifting rapidly towards a diet linked with non – communicable diseases. Am J ClinNutr 2006; 84 (2): 289 – 98.
125. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Diseases. Kidney Intern 2013; 3: 1-150.
126. Ibadin OM, Onunu A, Unuigbe F, Ugheoke J. Microalbuminuria in Adolescent/Young Adult Offspings of Hypertensive Nigerian Adults – A Preliminary Report. NigJ ClinPrac 2004; 7(2): 60 - 64.
127. Okpere AN, Anochie IC, Eke FU. Prevalence of Microalbuminuria among secondary school children. African Health Sciences 2012; 12(2); 140 - 147.
128. Learn About Lagos State, Nigeria / People, Local Government and Education.
Available atwww.ngex.com / places / states / Lagos.htm. Accessed in May 17, 2016.
129. Sample size formula for a comparative study. Available athttps://www.mohnhs.uk/sites/default/files/sample. Accessed in May 13, 2016.
130. Uwaezuoke SN, Okoli CV, Ubesie AC, Ikefuna AN. Primary hypertension among a population of Nigerian secondary school adolescents: Prevalence and correlation with anthropometric indices. A cross sectional study. Nig J ClinPract 2016; 19(5): 649 – 654.