Elevated blood pressure and hypertension in South Asian children: A mixed-methods analysis exploring associated factors and behavioural influences

The overarching objective of this PhD thesis was to develop a better understanding of how broad-based (physiological, lifestyle, social and cultural) factors, influence blood pressure (BP) in South Asian children in Canada. This was done using a mixed-methods approach that included: a systematic review which informed the direction of the study; multivariate regression analyses to estimate the correlates of BP and hypertension in South Asian children; receiver operating characteristics curve analysis to estimate the validity of adiposity metrics in estimating adverse risk of hypertension in South Asian children, including the appropriate risk thresholds; and semi-structured qualitative interviews to explore attitudes towards healthy behaviours in South Asian children and their parents. From the systematic review, I identified a range of physiological, social and lifestyle factors that were associated with elevated BP and hypertension in children. These variables were subsequently investigated in a sample of 762 South Asian children in Canada. The results suggested that for these children, physiological variables provided better explanatory capacity regarding the risk of elevated BP and hypertension than social or lifestyle factors. Age, sex, BMI z-score, heart rate and weight accounted for 30% of the variance of sBP z-score, while age, BMI z-score, heart rate and daily fast food intake accounted for 23% of the dBP z-score variance. The prevalence of hypertension was found to be high at 12%. The area under the curve (AUC) values for the adiposity measures for boys and girls ranged from 0.74–0.80, suggesting that the adiposity measures were fair in their ability to estimate hypertension risk. Yet, sex-stratified cut-offs associated with adverse risk of hypertension for South Asian boys and girls suggested that these children might be at high risk of hypertension at levels of adiposity considered normal. Last, my interview findings documented the range of influences on healthy behaviour in South Asian children and their parents including school, peer, social media and cultural dynamics. Taken as a whole, my thesis provides vital information for healthcare practitioners in identifying and treating at-risk South Asian children, and for public health practitioners and policymakers in informing the development of effective intervention strategies aimed at preventing hypertension and CVD risk in this population.