Hidden burden of hypertension in Arab adolescents linked to obesity, dyslipidemia, and vitamin D status

The present study aims to investigate the prevalence of undiagnosed hypertension (HTN) in Saudi adolescents and identify the potential interactions between vitamin D (VD) and dyslipidemia (DLD) in the context of HTN. This cross-sectional study included 4760 apparently healthy adolescents aged 14.4 ± 1.6 years (64% girls). Anthropometrics, fasting glucose, lipid profiles [triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)], and serum 25(OH)D [deficiency < 50 nmol/l (20 ng/mL); sufficient ≥ 50 nmol/l (20 ng/mL)] were measured. Undiagnosed HTN was defined as adolescent who has systolic or diastolic BP ≥ 95th percentile (for age, sex and height) and not received a diagnosis of high BP or HTN from a physician or healthcare professional and who was not on any antihypertensive medication. Results showed high prevalence of undiagnosed HTN (21.1%), VD deficiency (VDD) (84.4%), and DLD (22%) among participants. Abnormal lipids were significant risk factors for HTN in overall participants [low-HDL-C, OR = 1.3, 95%CI: 1.1-1.5, p < 0.001; high-LDL-C, OR = 1.2, 95%CI: 1.0-1.4, p = 0.01], which persisted only in girls [low-HDL-C, OR = 1.4, 95%CI: 1.1-1.6, p = 0.001; high-LDL-C, OR = 1.3, 95%CI: 1.1-1.6, p = 0.008]. Hypertriglyceridemia and VDD were not found to be significant risk factors for HTN. Obesity showed the strongest association with HTN [OR = 1.7, 95%CI: 1.4-2.2, p < 0.001]. VD has significant inverse relationship with SBP in both genders but not with DBP. This study found significant sex differences in the prevalence of lipid abnormalities, where hypertriglyceridemia and low-HDL-C were more common in boys (24.4% vs. 20.7% and 61.8% 51.9%, respectively), while high-LDL-C was more prevalent in girls (60.4% vs. 50.3%). In conclusion, we revealed a critical high prevalence of undiagnosed HTN among Saudi adolescents, with sexual dimorphisms in associated risk factors. Obesity and DLD were exposed as risk factors for adolescent HTN rather than VDD. The lack of significant association between VD and HTN needs further investigation. Our results highlight the necessity for national awareness and intervention programs for the early detection and management of HTN through regular screening and follow-up, which can have crucial long-term benefits.