Journal of Human Hypertension (2004) 18, 229–237 & 2004 Nature Publishing Group All rights reserved 0950-9240/04 $25

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ORIGINAL ARTICLE

Do variations in blood pressures of South Asian, African and Chinese descent children reflect those of the adult populations in the UK? A review of cross-sectional data
C Agyemang1, R Bhopal2 and M Bruijnzeels1
1

Institute of Health Policy and Management, Erasmus Medical Center, The Netherlands; 2Public Health Sciences, Division of Community Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, UK

The objective of this study was to assess whether variations in BP in children of UK ethnic minority populations correspond to those seen in adults. A systematic literature review was carried out using MEDLINE 1966–2003 and EMBASE 1980–2003, supplemented by correspondence with expert informants, and citations from references. Five studies were identified. There were important differences between studies in terms of age and sex of samples, definition of ethnic minority children and methods of evaluating BP. Three studies of children of African descent reported lower mean SBP in boys from African descent compared to white boys, the differences being significant only in one study. In African descent girls, the mean SBP was significantly lower in one study, while DBP was significantly higher in one study. Four studies included children of South Asian origin. The Health Survey for England ‘99 reported on South Asian groups separately. Pakistani boys had a significantly higher age- and

height-standardised mean SBP than the general population. The mean DBP was significantly higher in Indian and Pakistani boys than the general population. Pakistani and Bangladeshi girls had a significantly higher mean DBP than the general population. The other three studies, which combined South Asian subgroups found no significant differences in the mean BP between South Asians and white subjects. One study included children of Chinese descent and reported significantly higher mean DBP in Chinese boys and girls compared to the general population. Overall, BP across ethnic groups was similar. These similarities in BP patterns particularly in African, Bangladeshi and Pakistani descent children contrasts with those in the corresponding adult populations in the UK where BP is comparatively high in those of African descent and comparatively low in those of Bangladeshi and Pakistani descent. Journal of Human Hypertension (2004) 18, 229–237. doi:10.1038/sj.jhh.1001658

Keywords: ethnic variations; African descent; South Asian descent; Chinese; children descent; blood pressure

Introduction
Systematic reviews on adult populations in the UK have shown that compared to the white, European origin populations, the mean SBP and DBP are similar in people of South Asian descent1 but higher in those of African descent.2 However, there was a stark heterogeneity among South Asian subgroups, with Indians having similar BP, Pakistanis having

Correspondence: C Agyemang, Department of Health Policy and Management, Erasmus Medical Center, Burg. Oudlaan 50, L-gebouw, 3000 DR Rotterdam, The Netherlands. E-mail: Agyemang@bmg.eur.nl Received 5 August 2003; revised 4 October 2003; accepted 4 October 2003

slightly lower BP and Bangladeshis having much lower BP than whites.1 Two adult studies on Chinese origin populations in the UK have given inconsistent results.3,4 In Harland et al’s study, the mean SBP and DBP were lower in Chinese men but higher in Chinese women compared to white people,3 whereas in the Health Survey for England ‘99, Chinese men and women had a lower mean SBP and DBP than for men and women in the general population.4 BP levels were comparatively high in Chinese adults living in Manchester, UK than in Chinese adults living in mainland China in all age groups.5 This review investigates whether ethnic variations in BP in children (p16 years of age) of ethnic minority populations reflect those of the adult populations in the UK.

black subjects had a lower mean SBP but a higher DBP compared to the white subjects. However.10 Three study samples were based in schools. For girls. or ‘ethnic minority population’ were combined with ‘blood pressure’ and ‘hypertension’.7.7 a Dinamap 1846SX8. After controlling for age and height. The readings reported varied—mean SBP and DBP of the first reading. For girls. Five studies were examined.6.7 the rest had broad aims relating to a range of cardiovascular risk factors.9 De Giovanni et al reported lower mean SBP and DBP in black boys compared to white boys. four were cross-sectional surveys6.6.10 and a Dinamap 8100 monitor9 all in a sitting position. The reference list of all known primary studies and review articles were scrutinised and additional relevant citations were identified. black Caribbean girls had a significantly lower SBP than for girls in the general population. in ethnicity and health to advise us if they knew of any other studies.10 Two studies reported the time the field work was conducted.10 and one study reported cross-sectional data from a cohort design. or ‘Africans’ or ‘African Caribbean’.Variations in blood pressures C Agyemang et al 230 Methods Search strategy Blood pressure EMBASE and MEDLINE searches identified papers published from 1980 to 2003 and 1966 to 2003.9 Journal of Human Hypertension Three studies included children of African descent. The mean DBP was lower in KDC School but higher in BHS School in black boys compared to white boys. Nazroo et al reported a higher mean SBP and DBP in black Caribbean boys than for boys in the general population. or ‘Chinese’. Black girls at the KDC School had a significantly higher DBP compared to white girls. Whincup et al10 reported a higher mean SBP and DBP in South Asian boys compared to white boys but the differences were not significant.9 and appearance cross-checked with surname and parental place of birth10 were the indicators of ethnicity. listed in the acknowledgements.7 The age range varied between studies.9. or ‘blacks’. after controlling for age and height using linear regression. black Caribbeans had a lower mean SBP but a higher DBP compared to the general population. Table 2 shows that BP was measured in three studies at school6.7 The largest and the most representative sample came from the Health Survey for England ‘99.7.8–10 Results Methods of the review studies Table 1 shows that four studies were carried out in England. or ‘Pakistanis’.8 The investigators’ observation of appearance. For girls. Medical Subject Heading (MeSH) ‘Asians’ or ‘South Asians’ or ‘Caribbean and Asian’ or ‘Indians’.7. We contacted five experts.6. the mean SBP was higher in KDC School but lower in BHS School.8 Two studies were designed specifically to focus on BP levels.10 but one study combined them.8–10 Clark et al’s study was based on boys and girls combined.6 the mean SBP and DBP of the two readings taken. The .9 BP in children of South Asian descent Four studies included children of South Asian origin.10 and the mean SBP and DBP of the last two readings of three.9 BP in children of African descent Study selection and data extraction Of the five studies included in the final analysis.6. the mean SBP was lower by 0.8 The response rate varied from 59%8 to 87%.9. The search was limited to the UK and papers published in English. We included studies that reported BP and/or prevalence data on community-based samples of ethnic minority children in comparison with a white or general population in the UK. respectively. For girls.6 There was no significant difference in either SBP or DBP between these ethnic groups.6–9 and one study was carried out in England and Wales. although the differences were not significant in both schools.6.8 and reported higher SBP and DBP in South Asian children compared to white children. the indicator of ethnicity was not given.9 using a Hawskley random zero sphygmomanometer. The mean DBP in BHS School was lower in black girls but the differences were not significant. De Giovanni et al6 reported lower mean SBP and DBP in Asian boys and girls than in their white counterparts. In Khaw and Marmot’s study. Khaw and Marmot’s study showed that black boys had a significantly lower mean SBP in both schools compared to white boys.7. or ‘West Africans’.7.8. or ‘Bangladeshis’.9.7.22 mmHg in black Caribbean boys compared to boys in the general population.10 and in two studies at home8. but none was identified.10 None of these three studies6.6–10 One author10 supplied unpublished data.6 country of origin.6.8 selfreported ethnic origin or parental report. South Asians had a lower mean SBP but a higher DBP compared to the white subjects. Four studies assessed boys and girls separately. All studies based on clinically selected patients and on adults were excluded.10 one study was based on the Local Child Health and National Health Service Central Register8 and one study used community-based sampling.10 found significant differences in mean SBP and DBP between South Asian and white children.

cross checked with surname and parental place of birth 8–11 General population Boys 2429. female 70 Asian 178 Male 76. girls 194 Bangladeshi 294 Boys 152. aims. timing.4–15. Cross-sectional study d. Cross-sectional study d. sample identification and size and response rate a. Not given c. location. 1999 c. girls 118 Pakistanis 387 Boys 193. female 70 White 177 Male 100. England b. sampling frame. Place b. Cohort d. resting pulse rate and general anthropometric characteristics To determine if ethnic differences in mean blood pressures were discernible in adolescent school children To determine whether women who are poorly nourished in early pregnancy or who have poor pregnancy weight gain have offspring with higher blood pressure General health survey for England Observation by observers Not given 15–16 White 138 Male 68. girls 174 Indian 267 Boys 149.Table 1 Contextual details—publication. Local Child Health and NHS Central Register a. Two schools a. Birmingham b. Ten towns in England & Wales To examine whether British South Asian children differ in insulin resistance. girls 106 60% for ethnic minority groups 73% for white and 80% for South Asians Journal of Human Hypertension 231 . 1994 c. Not given c. girls 142 Chinese 162 Boys 85. London b. female 77 Black 118 Male 60.7 Sample size by ethnic group Response rate First author surname and date of publication De Giovanni et al (1983)6 Khaw and Marmot (1983)7 Clark et al (1998)8 Nazroo et al (2001)9 To screen school leavers of three ethnic groups for blood pressure. girls 2425 Black Caribbean 335 Boys 161. girls 1646 South Asian 227 Boys 121.0 59% Variations in blood pressures C Agyemang et al Self reported or parent reported on ethnic origin 5–15 Whincup et al (2002)10 a. female 102 Black 110 Male 68. female 58 White 137 Asian 159 Not given 87% Country of origin 11. West Midlands b. Not given c. adiposity. Four schools a. girls 77 White 3415 Boys 1769. Time of study c. design. England and Wales b. Cross-sectional study d. and cardiovascular risk profiles from white children Appearance. Sampling frame a. Study design d. Postcode address File Aim Indicator of ethnicity Age group studied (years) 15. Cross-sectional study d.

1 59.8 (12.8 and (SE).7 113. b Stated that the difference was significant but the level was not given.2 59.0) 110.9) 63.5 65. measurement technique and mean systolic and diastolic pressure by sex and ethnic group Setting of measurement a.9)* 72.42 1.0 110.8) 103.2 60.Journal of Human Hypertension 232 Table 2 Setting.9) 117.3) (1.9 111.1 112.1 (10.9 (9.0 (11.8) 102.14 2.3) 64.9 (11.2 (12. Sphygmomanometer b.9) 121.1 (13.8 (12.5 112. Dinamap 8100 monitor b.0 RC 0 À0.1) 112.9 (9.1) 119.8) 117. equivalent to absolute difference in mean SBP and DBP standardised for age and height.9 (14. *Po0.9 (13.8 (15. comparing ethnic groups.3) (0. Values in parentheses are (SD’s)6. Average of the two readings Blood pressure levels by sex and ethnic group Boys Girls Ethnic groups White Black Asian KDC School White Black BHS School White Black White Asian Gen.2) (0.27b 2.6) 108.0) 107.0 (13.3 RCa 0 À1.4 65.1) 72.1) Diastolic 65.4) 114.3) De Giovanni et al (1983) 6 School Variations in blood pressures C Agyemang et al Khaw and Marmot (1983)7 School Clark et al (1998)8 Home a.42 0.0) 112.5 112.3 111.2 59.6 (10.1 RC 0 0.9)* 104.0 (7. Average of the last two readings (Boys and girls mixed) 2425 174 118 194 142 77 1646 106 111.7 (11.1 65. Sitting c.68 (0.0) 111.3 (11.70 0.7. Population Black Caribbean Indian Pakistani Bangladeshi Chinese White South Asian n 68 76 68 81 38 57 19 137 159 2429 161 149 193 152 85 1769 121 Systolic 122.14b (0. Sitting c.6 (11.4 (13.4 (9.9 111.9 111.8) a n 70 102 70 19 22 20 39 Systolic 118.4) 64. Sitting c. Hawksley random zero b.0) 63. Reading taken for analysis a.8) 66.6 110.89b À1.22 1.3) 57. Average of the three readings a.5 58.17 À0.48 3. First reading (of two taken) a.8) 67.1) 70.3 (11.5 (11. Dinamap 1846 SX recorder b. Sitting c.0 (12.8) a First author surname and date of publication Diastolic 66.7 (11.1) 60. Average of the two readings a RC=regression coefficient.43 1.5) 60.0 113.3) 71.5 67.9 58. compared with the general population.9) 63.87b 4. Dinamap 1846 SX recorder b.52b 3.8 (12.05.0 (13.0 59.2) (0.2) 60.0 (6.9 RCa 0 0. Position c.44 2. Hawksley random zero b.23b 1.79b (0.0 (11.6 111.97 (0.7 60.87 1.8 57.5 108.7) Nazroo et al (2001)9 Home Whincup et al (2002)10 School a.3 109.88b 1. The reference value for the general population is 0.1 (12.0 (11.0) 56.2 (11. Sitting c.5 (13.5 60.10 .2) 115.

After age and height had been standardised. lighter and had a lower BMI compared to girls in the general population. The mean SBP was lower but DBP was higher in Chinese girls than girls in the general population. and Indian boys in Nazroo et al’s9 study. the observed mean SBP was lower but DBP was higher in Chinese than for girls in the general population. Nonetheless.9 These differences held and were significant after the age had been standardised. heavier. SBP and DBP were lower in black children compared to white children except in black girls where DBP was higher.8 Anthropometry and mean BP difference in children of Chinese descent In the Health Survey for England ‘99. Pakistani boys were shorter and lighter but had a mean BMI similar to that of boys in the general population. and had a higher mean BMI than boys in the general population. Indian. For girls.9 These differences held after age had been standardised. Indian boys were taller. Anthropometry and mean BP difference in children of African descent The Health Survey for England ‘99 showed that Bangladeshi boys and girls were shorter. Pakistani. Black Caribbean boys and girls were taller. Pakistani. mean DBP was significantly higher in Indian and Pakistani boys than the boys in the general population. after the effect of age had been controlled for.7 The mean SBP difference was particularly marked in boys in both schools being À6 to Chinese boys were shorter. although the differences were not significant. Indian girls were taller. and Bangladeshi girls had higher levels than girls in the general population. De Giovanni et al stated lower6 and Clark et al stated higher8 body weights in South Asian children than their white counterparts although results were not given. the mean DBP was significantly higher in Chinese boys than for boys in the general population.9 Anthropometry data and mean difference in BP Table 3 shows.9 These observations held after age and height standardisation. Black boys and girls were heavier than their white counterparts in both schools. SBP and DBP were higher in Chinese boys than boys in the general population.Variations in blood pressures C Agyemang et al 233 Health Survey for England ‘99 reported on South Asian subgroups separately and reported a higher observed mean SBP in Indian. body mass index (BMI). SBP and DBP were higher in South Asian boys compared to white boys. Indian and Bangladeshi girls had a lower SBP but a higher DBP mean difference compared to the girls in the general population. Anthropometry and mean BP difference in children of South Asian descent Only the Health Survey for England ‘99 included children of Chinese origin and reported higher observed mean SBP and DBP in Chinese boys than for boys in the general population. Chinese girls were taller.9 In Whincup et al. BP in children of Chinese descent À7 mmHg lower in black boys compared to their white counterparts. but the differences were significant only in Pakistani and Bangladeshi girls. Indian. SBP was lower but DBP was higher in black Caribbean boys and girls compared to boys and girls in the general population. For DBP.9 Some patterns of BP were associated with body weight and BMI. after age standardisation. weight. Pakistani and Bangladeshi boys also had a higher observed mean DBP than the general population. However. in studies ranked by ethnic minority children sample size. Pakistani boys had significantly higher mean SBP than the boys in the general population after controlling for age and height. Khaw and Marmot reported on mean weights only. South Asian girls had a lower SBP but a higher DBP compared to white girls. Indian boys and girls were significantly shorter than the boys and girls in the general population. height. heavier. and had a higher mean BMI than boys and girls in the general population. the fit being better on South Asian children in De Giovanni et al6 and Clark et al8 studies. lighter and had a similar BMI compared to boys in the general population. the mean DBP was significantly higher in Chinese girls than for girls in the general population.10 South Asian children were shorter. The mean BP was lower in De Giovanni et al’s study6 and higher in Clark et al’s study. However. and Bangladeshi boys compared to boys in the general population. Among girls. Chinese boys and girls were significantly shorter than the boys and girls in the general population. the observed mean SBP was lower in Indians and Bangladeshis but higher in Pakistanis compared to the general population. De Giovanni et al6 stated that black boys and girls were heavier than their white counterparts although the results were not given. heavier and had a similar mean BMI compared to their counterparts in the general population. lighter and had a lower mean BMI than for boys and girls in the general population. After controlling for age and height. BP was mostly higher in South Asian children than children in the general population except in Indian and Pakistani girls in whom SBP was lower. significantly lighter and had a lower BMI but a higher WHR than white children. waist-to-hip ratio (WHR) and mean difference in SBP and DBP. After age and height had been controlled for. Journal of Human Hypertension .

5 (9.4 17.98 0.0 À2.52c 3.20c 130.3 0.1) 34. DBP=diastolic blood pressure.07 30.4 À3.14 Whincup et al (2002)10 8–11 36.9 (0. a RC=Regression coefficient.11 135.002) 0.97 0.0 3.01 0.2* À0.002) 0. Asian boys and girls were lighter compared to white.57 131.8 given 36.05 1 1.7 White Black Asian White 2429 161 149 193 152 85 1769 121 68 68 76 137 Girls 2425 174 118 194 142 77 1646 106 70 70 102 Figures were not given but stated that Asian children were heavier than white.3 À0. population Black Caribbean Indian Pakistani Bangladeshi Chinese White South Asian De Giovanni et al (1983)6 Clark et al (1998)8 Khaw and Marmot (1983)7 15.6)* 140. body mass index (BMI).42 c 3.5 6. The reference value for the general population is 0.1 19.0 (Boys and girls combined) Not given 57 19 59.788 (0. c Stated that the difference was significant but the level was not given.4* 32.04 1 0. compared to general population.5) Not given Not given 55. equivalent to absolute difference in mean weight/height-standardised for age.5 (0.7) 64.2 1.4– 15.10 .70 4.02 1.7 (9.9 À1.3 RM 1 1.59 0.15c À2.7) 58.9 11 15–16 Asian 157 (Boys and girls combined) KDC School White Black BHS School White Black 81 38 19 22 20 39 À7.5 30.2 À1.5 (0.6 À1.27 (0.15)w RM 1 1.14 2.0) 61.87 127.0 0.5) 33.23c 0.01.Journal of Human Hypertension 234 Table 3 Mean weight (kg).2 SBP=systolic blood pressure.4 2.6 (10.5 0. The reference value for the general population is 0.97 RC 0 b 0 À1.79c 1.4) 59. compared t with general population. RM=unadjusted ratios of mean BMIs.48 À0.4 1. 3. waist-to-hip ratio (WHR) and mean difference in blood pressure by sex and ethnic group—studies ranked on size of the ethnic minority children sample First author surname and date of publication Age group studied (years) Ethnic group No.03) 12.8 (0.1) Not given Not given Not given À6.17 1.2 (9.63 33.2 À1.8 À1.1 2.7 Boys and girls combined 35.8 12.14 À0.3* 2.6 À5.5 À3.824 (0.44c 32.1 (10. wPo0. *Po0.99c combined À0.80 129.70 (0.5 À4.6 À2.05. b RC=Regression coefficient.1 c Boys Height 132.65c 131.18c Not 32.4 À3.6 2.87 1.7 À2.8 17.0 32.4 0. À1.87 À1.1 18. Values in parentheses are (SD’s)7 and (SE’s).8 (11.6 0 a WHR Not given SBP RC 0 b DBP RCb 0 0.9 À2.96 1 WHR Weight RC 0 a Height RC 130.009) Figures not given but stated that black boys and girls were heavier than white boys and girls.89c c 3.42 1.66c 137.8) 60.43 1.63c Boys and girls 0.2 Weight RC 0 a Anthropometric data Mean difference (ethnic minority—European descent) Girls Boys BMI 18. height (meters).6 À2.1 (8.00c 131.6 (11.1) 140.8 18.6 À1. comparing ethnic groups.009) 18.9 36.0 30.38 À2.14 131.7 2.27c 0.22 1.1 RC 0 a Girls DBP SBP RC b BMI 17.8 17.7 À0.4 17.816 (0.1 17.2 18.781 (0.59c c 132.88c 1.3) 58.8 0. Boys Nazroo et al (2001)9 5–15 Gen. equivalent to absolute difference in mean SBP and DBP standardised for age and height.68 Variations in blood pressures C Agyemang et al 1.27c 2.

These observations imply that the comparatively high BP in African origin populations in the UK is a controllable problem with appropriate interventions. for it is hard to image genetic factors where the effect is delayed to later adult life. The loss of the protecJournal of Human Hypertension . having a quicker rise at middle age compared to the white population in the UK.16–20 In some of these USA studies. unlike in adults.and height-standardised mean SBP and DBP in boys compared to the white subjects.13. It may be that young people of African origin can be protected from the high risks of stroke their older counterparts have. height. the differences being significant in one study. In Cruickshanks et al’s22 study. found higher BP in African-American children than in white children. the mean SBP and DBP were marginally lower in Afro-Caribbeans than in the white subjects in those under 30 years of age.9 yet the rest of the studies combined them as one homogeneous group. Alternatively. Pakistani and Bangladeshi girls had a higher ageand height-standardised mean SBP and DBP than Indian girls. It is estimated that white-coat hypertension ranges from 44 to 88% in children depending on the population studied and definition used.17 The UK result is still more unexpected in the face of a comparatively high BMI in African descent children.7 showed lower mean BP levels. overall. These findings and the contrasts between adults and children highlight the importance of studying South Asian subgroups separately rather than mixing them as one homogeneous group. which may make other studies misleading. Overall. These variations imply that between-study differences are not interpretable and focus attention on within-study differences. They also favour environmental rather than genetic causation.15 Most studies in the US have Higher DBP in South Asian boys is consistent with the higher DBP levels in South Asian adults reported by Agyemang and Bhopal.14 It is hard to account for the effect of white-coat hypertension in each study.9 Limitations of the review The interpretation of the results is not straightforward due to the small number of studies. Bangladeshi adults. Pakistanis and Bangladeshis) in the samples. the younger black group had lower.1 Lack of consistent results in mean SBP and DBP in South Asian children also mirrors the findings of the UK adult studies. This question requires a cohort study that tracks changes from early life through to late middle age. in Primatesta et al’s21 study. In Lane et al’s23 study. ethnic differences in BP were still present after adjusting for age. and differences in methods between studies. These findings suggest that BP levels change differently with African groups.2 Ethnic differences in body size and shape further complicates interpretation of these studies. The importance of heterogeneity among people of African descent11 and South Asian subgroups12 has been stressed but is often ignored. but the older black group had higher. For example.2 For instance.7 while the most recent study9 showed a similar age.Variations in blood pressures C Agyemang et al Discussion Key findings 235 Few studies provided BP comparisons by ethnic group in children in the UK and only one study reported on Chinese children. the children’s BPs were measured in different locations with different techniques.24 Children of South Asian descent Discussion of the key findings Children of African descent The similar BP levels reported in children from African descent are in contrast with the higher BP levels among older adults2 and African-American children in the US. despite their low BP. BP levels compared to the white group.1 Bangladeshi children have this high BP despite having a comparatively low BMI. weight. It is also not clear whether the effect of white-coat hypertension differs in different ethnic groups.16. have much lower SBP and DBP compared to other ethnic groups in the UK. the two earlier studies6.9 Pakistani and Bangladeshi boys had a higher ageand height-standardised SBP than Indian boys. incomplete description of the samples. the different mixes of Afro-Caribbeans and West Africans and South Asian subgroups (Indians. A higher mean BP level in Bangladeshi children compared to the white children is very surprising given that the Bangladeshi adult population. the younger black group aged 15–24 years had a lower BP than the white group. Chinese boys and girls had a significantly higher age.and height-standardised mean DBP than boys and girls in the general population. Most studies reported similar mean BP levels in children from South Asian descent compared to their white counterparts. there are major generational changes. and BMI. The readings analysed varied. The data show a lower SBP but a higher DBP in girls of African descent compared to white girls. In children of African descent. ethnic variations were small. This finding of similar BP in children of African descent is consistent with the findings of similar BP levels in the younger African groups in the UK’s adult studies. have extremely high rates of stroke and coronary heart disease. The Health Survey for England ‘99 data show important differences between South Asian subgroups. Variations in methods of measurement of BP limit the capacity to combine the data.1 The Health Survey for England ‘99 is the only study that examined South Asian subgroups.

8 Foetal and early life growth patterns may be shaping these ethnic variations in BP in ways that we do not understand. 3 Harland JO et al. Dr Kennedy Cruickshank for his advice on the literature search and valuable comments. at least in part. higher observed mean SBP and DBP in black Caribbean and Indian children. References 1 Agyemang C. and body shape and weight Journal of Human Hypertension . In: Erens B.2 However. Prior G (eds). 51: 636–642. Bhopal RS. South Asian refers to people originating from the Indian subcontinent (ie India. they do not clearly explain higher BP levels in Chinese children. Pakistan. 2001. Acknowledgements We thank Professor Peter Whincup for supplying unpublished data and his useful comments. J Hum Hypertens 2002. McMum A.2 It may be that environmental risk factors are more important than body shape and weight in childhood.Variations in blood pressures C Agyemang et al 236 tive effect of low BP in Bangladeshi children does not augur well for the future. Horatio Wan’s recent study revealed that Chinese men and women in Manchester had a higher mean SBP and DBP compared to their counterparts in mainland China. It is clear. and in Pakistani boys in Nazroo et al’s study.9 The finding of higher body weight and BMI in children of African descent is consistent with the finding in adult studies in the UK. Future research must acknowledge the various subgroups of South Asian and African children and should be designed in such a way that data can be synthesised more easily for systematic reviews. Afro-Caribbean refers to people. In the adults. despite lower BMI. Bhopal RS. White refers to people with European ancestral origin. 17: 523– 534. 2 Agyemang C.24%) in this survey on Chinese descent in the UK is a cause for concern. and their offspring. Glossary of ethnicity-related terms Ethnicity refers to the group individuals belong to as a result of their culture. Chinese men and women had lower agestandardised ratios of mean BP than for men and women in the general population. We also thank the anonymous referees. Blood pressure. diet and ancestry.5 This corresponds with comparatively high risk of stroke in Chinese men and women in the UK. Bangladesh. J Epidemiol Community Health 1997. There is a strong case for large-scale epidemiological research in ethnic minority children to examine BP levels and the change in this pattern with increasing age. mean SBP and DBP were lower in Chinese men but higher in Chinese women compared to the white subjects. 4 Karlsen S.24 Anthropometry and ethnic minority children also possibly confound findings. however. religion. Is blood pressure of South Asian adults in the UK higher or lower than that in European white adults? A review of cross-sectional data.4 In Harland et al’s3 study. and Kabita Asray and Hazel King for secretarial support.29%) and women (39. While body shapes and weights may explain. Health Survey for England—The Health of Minority Ethnic Groups ‘99 London. 16: 739–751. The Stationary Office. pp 175–197. Black refers to people with African ancestral origin. Some of the inconsistent results in the UK studies could be explained by the classifications of ethnic minority children and differences in methods of measurement of BP. J Hum Hypertens 2003. London.1. with African ancestral origin but migrating to Britain via the Caribbean islands.7 and vice versa in Bangladeshi children8 is very difficult to explain and in direct contrast with the adult studies. Chapter 7. respectively. sex. variations in BP patterns in ethnic minority children differ from those corresponding adult populations in the UK.24 Children of Chinese descent Higher BP levels reported in Chinese children in Health Survey for England ‘99. For example. which includes language. Drs James Nazroo. Clark et al’s8 study found an association between reduced pregnancy weight gain and higher BP in the 11-year-old offspring of women who were malnourished in early pregnancy. Prevalence of hypertension among Manchester Chinese men (38. that the younger generation of ethnic minority groups have different BP patterns than the previous generation. Variations in age. Bangladeshi children. differ from those of the adults in the same survey. a higher body weight but a lower BP in children from African descent6. who provided comments that helped improve an earlier version of this paper. We thank Ank de Jonge for advice and useful comments. Low levels of cardiovascular risk factors and coronary heart disease in a UK Chinese population. Lisa Riste and Seeromanie Harding for their advice and reassurance on the literature search. Ethnic minority group refers to minority nonEuropean non-white populations. Primatesta P. Is the blood pressure of people from African origin adults in the UK higher or lower than that in European origin whites? A review of cross-sectional data. Conclusion In conclusion. Primatesta P. and Sri Lanka).

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