High Blood Pressure and Its Correlates among Assistant Physical Education Teachers in Republic of Benin (West Africa)

doi:10.4236/ape.2012.22011

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Advances in Physical Education

2012. Vol.2, No.2, 61-67

Published Online May 2012 in SciRes (http://www.SciRP.org/journal/ape) http://dx.doi.org/10.4236/ape.2012.22011

High Blood Pressure and Its Correlates among Assistant Physical

Education Teachers in Republic of Benin (West Africa)

Polycarpe Gouthon1, Barnabé Akplogan2, Jean-Marie Falola2, Houndjovi Pierre Dansou3,

Hippolyte Agboton4, Solange Adégnika1, Issiako Bio Nigan1

1Laboratory of PSA and Motricity, National Institute of Youth, Physical Education and Sport (INJEPS),

University of Abomey-Calavi (Benin), Porto-Novo, Republic of Benin

2Laboratory of Biomechanics and Performance (LABIOP), National Institute of Youth, Physical Education and

Sport (INJEPS), University of Abomey-Calavi (Benin), Porto-Novo, Republic of Benin

3Laboratory of Exercise Physiology, National Institute of Youth, Physical Education and Sport (INJEPS),

University of Abomey-Calavi (Benin), Porto-Novo, Republic of Benin

4Cardiology Department of the National Universitary Hospital of Cotonou (Benin), Unity of Formation and Research in

Cardiology, Faculty of Health Science, University of Abomey-Calavi (Benin), Porto-Novo, Republic of Benin

Email: [email protected]

Received January 30th, 2012; revised February 28th, 2012; accepted April 30th, 2012

Objective: This cross-sectional study carried out in Republic of Benin, aimed at assessing the relation

between high blood pressure (HBP) and its correlates in an exhaustive sample of 123 Assistant physical

education teachers (APE teachers), enrolled in a two-year in-service training. Methods: These teachers

have been interviewed and clinically tested. The lifestyle, blood pressure, three indexes of adiposity,

blood lipids, white blood cells and neutrophils counts and plasma C-reactive protein were the main study

variables. Results: HBP was present in 34.1% of the teachers. The three main factors associated to HBP,

that had the higher rates were neck circumference (78.3%), the biological index of atherogenicity (72.2%),

and waist circumference (44.2%). Neck circumference was the most relevant modifiable variable to ex-

plaining HBP in this group (OR = 3.14; 95% IC: 1.09 - 9.00; p = 0.033). Conclusions: The teachers stud-

ied must keep on exercising as early as their primary training comes to an end. Doing so, they could avoid

overweight and reduce the risk of hypertension.

Keywords: High Blood Pressure; Physical Education Teacher; Cardiovascular Disease; Inactivity

Introduction

Blood pressure is determined by the interaction of hemody-

namic factors as cardiac output, total peripheral resistance (Daniels

et al., 1996) and non-hemodynamic ones as age, sex, blood

lipids, heredity, etc. The association of these factors induces the

high inter-individual variability of blood pressure values re-

corded in a given population. These pressure values can in-

crease abnormally in a subject, even in a group, so that a light

and temporary high blood pressure (HBP) may appear, that is a

systolic pressure ≥ 140 mm Hg and/or a diastolic pressure ≥ 90

mm Hg (WHO, 1999) and become more often a sustained and

severe disease.

The importance of HBP (or hypertensive) pathology within

the cardiovascular diseases in Africa is well established (Ag-

boton et al., 1987). Indeed, arterial hypertension in black peo-

ples has become during last decades an important problem of

public health, because of its increasing gravity which involves

high prevalence, morbidity and mortality (Aubry, 2003). Ac-

cording to Fourcade et al. (2007), there were 80 million patients

with arterial hypertension in sub-Saharan Africa in 2000 and

they will probably be 150 millions in 2025. In Africa, the non-

controlled arterial hypertension (>80% of the cases), associated

with ageing, obesity, a hyper-salted food weak in potassium

and other atherogenous factors, seems to be the main risk factor

for hemorrhagic-caused cerebrovascular events (Aubry, 2003;

Guenette & Mantha, 2005).

In the therapeutic “arsenal” used against this disease, regular

practice of aerobic exercise (brisk walk, race, cycling, dance,

swimming, etc.) requesting large muscular groups and other

lifestyle rules are often primarily suggested (WHO, 1999).

They help in achieving high physical fitness (Ortlepp et al.,

2003), reducing systolic pressure to an average of 4 to 9 mm

Hg, even if there is no weight loss (Guenette & Mantha, 2005).

Though this practice prevents blood pressure increase, many PE

teachers in Republic of Benin cease any physical activity or

reduce significantly its frequency, a few years after the end of

their initial training. It is well known that stopping physical

activities or exercise training (for long or short duration), re-

ferred to as detraining, causes a regression of the physiological

adaptations acquired while training (Mujika & Padilla, 2001;

Mujika & Padilla, 2000; Nelson et al., 1986). The literature data

also state that detraining induces in high level athletes, an in-

crease in the arterial hypertension risk factors such as over-

weight, increased resting heart rate, dyslipidemia, hyperglyce-

mia (Petibois et al., 2004; Petibois & Deleris, 2003; Oshida et

al., 1991). The phenomenon is the same for the blood pressure

itself which increases gradually, even in teenagers (Hagberg et

al., 1983).

In this context, only a periodic assessment of the hyperten-

sive risk and the associate risk factors, when an approach based

on an absolute cardiovascular risk (Gaziano et al., 2005) may

P. GOUTHON ET AL.

not be used, can help to define the proportion and profile of PE

teachers with HBP in republic of Benin. In case the correlate

factors to HBP may be modifiable ones, counsels addressing

lifestyle changes can be given to the involved teachers.

Such assessment strategies have been implemented in coun-

tries like Sweden, Estonia and Croatia in Europe (Misigoj-

Durakovic et al., 2004; Pihl et al., 2002; Sandmark, 2000), even

the Congo in Africa (Mbemba et al., 2007). They may never-

theless be undertaken in other African populations who may be

(or not be) genetically or environmentally different each from

other (Opie & Yackoob, 2005). This study which contributes to

achieving this issue was undertaken to analyze HBP and its

correlates among a population of APE teachers in Republic of

Benin.

Materials and Methods

Nature of the Study an d Se tt ings

It is a cross-sectional study, carried out in September 2008 at

the National Institute of Youth, Physical Education and Sport of

Porto-Novo (INJEPS), of the Republic of Benin (West Africa).

Study Population a nd Sampling

The population studied is the Assistant PE teachers APE,

surveyed during the first year of a two year in-service training.

A non- probability and exhaustive sample was constituted of all

the teachers satisfying the following inclusion criteria: to be a

male APE teacher exerting in Republic of Benin and regularly

Regis- tered on the official list of the trainees of INJEPS; to be

volun- tary, to have a healthy look or be without any recognised

dis- ease like arterial hypertension. The untreated sick teachers,

those having personal antecedents of cardiovascular events or

untreated diabetes Mellitus, were not integrated into the study

sample.

During a meeting with the INJEPS’ Academic Direction and

the APE teachers, the information related to the study were

presented, in order to get the Institutional approval and the

informed consent of the teachers to take part in the study, with

respect to the convention of Helsinki (1964). Afterwards, 129

teachers out of 144 (89.5%) volunteered to participate in the

study, but six among them were not available for some meas-

ures undertaken in 123 subjects.

Study Desi gn

Anthropometric variables are measured three times succes-

sively, and the average recorded, by trained PE teachers. Height

is measured with a vertical height gauge (sensitivity of 0.5 cm),

weight with a scale (Seca, Germany; sensitivity of 0.5 kg) and

circumferences with a non-extensible tape measure (Butterfly).

Neck circumference is measured (within 1 mm) just under the

top of Adam’s apple (Ben Noun & Laor, 2003) and waist cir-

cumference within 1 mm too, according to the recommenda-

tions of Mac Dougall et al. (1988).

Heart rate monitors (Accurex Plus, Polar, Finland) are used

to measure the resting heart rate and a manual sphygmoma-

nometer is used to measure systolic and diastolic blood pressure,

referring to the Korotkoff I and Korotkoff V sounds. Cardio-

vascular variables are also measured by trained nurses three

times over a period of 30 min, in the left arm of the subjects

when they are seated and the average values are recorded.

Blood lipids are assayed by the enzymatic and colorimetric

method, using a UNISPEC 22D spectrophotometer. C-reactive

protein (CRP) is assayed by semi-quantitative method, with the

CRP Latex® kit (Reactivos LPG, Spain), by successive dilu-

tions from 1/2 to 1/16. White blood cell (WBC) and neutrophil

(NEU) counts are assessed on the whole blood, using an auto-

mat Medonic CA620/530 (Boule Medical, Sweden). Blood

samples (10 mL) are drawn by venipuncture into EDTA tubes,

early in the morning (before 8 am), at the antecubital fold of the

left elbow, after a 12-hour fasting and a 24 hour-resting, e.g.

without intense physical activity.

The other personal data are collected on individual question-

naire forms completed by each PE teacher.

Study Variables

Two groups of variables are selected: in one hand, high blood

pressure (HBP) considered as the dependent variable, and in the

other hand, anthropometric, biological and sociodemographic

parameters, considered as correlates or independent variables.

The Dependent Variable

In this study, it is high blood pressure (HBP) defined as an

occasional systolic and/or diastolic blood pressure ≥ 140/90

mm Hg (WHO, 1999). A subject with a systolic pressure (SBP)

< 140 mm Hg and a diastolic pressure (DBP) < 90 mm Hg is

considered to have a normal blood pressure (NBP).

The HBP Correlates or Independent Vari ables

Adiposity indexes

They are body mass index (BMI), neck and waist circumfer-

ences (NC and WC). BMI is calculated according to the for-

mula BMI (kg/m2) = Weight/Height2, with weight measured in

kg and height in meter. Values of BMI > 30 kg·m2, NC > 37 cm

(Ben-Noun & Laor, 2003) and WC > 94 cm (Pouliot et al.,

1994), are considered as abnormal.

Blood lipids

The following blood lipids, total cholesterol (TC), HDL-

cholesterol (HDL-C), LDL-cholesterol (LDL-C), are assessed.

Although triglycerides (TG) are considered as a metabolic syn-

drome marker, they are also assessed, since TG/low HDL-C has

been found to be correlated to ischemic heart disease (Jeppesen

et al. 2003). The biological index of atherogenicity (BIA) is

calculated, according to the formula reported by Akplogan et al.

(1985) in which BIA = TC – HDL-C/HDL-C.

Values of TC > 2 g/L, LDL-C > 1.6 g/L, HDL-C < 0.40 g/L,

TG > 2 g/L (Boreham et al., 1993), BIA > 2 (Akplogan et al.,

1985) are also recorded as abnormal.

Emerging risk markers of cardiovascular disease

Other variables considered as emerging risk markers of car-

diovascular disease which are blood C-reactive protein (CRP),

white blood cell count (WBC) and neutrophil count (NEU) are

also measured. Abnormal values are CRP > 6 mg/L, WBC >

8000 × 109 cells/L, NEU > 5000 × 109 cells/L (Orakzai et al.,

2006; Horne et al., 2005).

Sociodemographic and lifestyle variables

The following categorical variables with their respective

modalities are surveyed through questionnaire addressed to

each participant: age (≥50 years or <50 years); seniority in the

teaching profession (≥10 years or <10 years); alcohol drinking

(often, sometimes, never) and current tobacco consumption (yes

or no). Given the difficulty of assessing objectively salt consump-

P. GOUTHON ET AL.

tion in the conditions of this study, a subjective way is used to

know if each teacher is conscious of salt overconsumption or

not, by their response (yes or no) to the question. Personal ex-

perience of disease apart from hypertension was informed on

by answering “yes” or “no” to the question. As none of the

surveyed teachers affirmed they had leisure and competitive

physical activity, daily average walking time (occupational and

other opportunities) and movement on bicycle (≥30 min or <30

min) are evaluated as indicators of physical activity.

Data Analysis

The data collected are processed with Statistica (Stat Soft Inc.,

version 5.5) and SPSS (version 11.5) softwares. Quantitative

data are presented as mean value (m) ± standard deviation. We

transformed the quantitative variables used as HBP correlates

into qualitative ones. The frequencies of HBP and each of its

correlate in the study sample are then calculated and we under-

take a bivariate analysis (X2 test) between them. NC alone then

associated with age and the three correlates which are signify-

cant at p < 0.10 for the X2 test are used to achieve a step by step

logistic regression. The level of significance of all statistical

tests is set at p < 0.05.

Results

Demographics and Lifestyle of the Subjects

As descriptive statistics of Table 1 shows the studied APE

teachers are on average 48.2 ± 4.61 years old, with a seniority

of 20.61 ± 4.62 years in the profession and a mean BMI of 25.7

± 3.71 kg/m2.

In the study sample, 128 teachers (99.20%) usually move on

motorcycle or in car and 22 among them (17.1%) use to walk

less than 30 minutes per day, including movements during the

physical education (PE) courses. In this group, 63 teachers

(48.8%) affirmed to have personal antecedents of diseases (ar-

terial hypertension not included), like malaria, joint pains, res-

piratory tract diseases, etc.

Table 1.

Mean values ± SD of blood pressure, demographics and HBP correlates

among assistant PE teachers APE in Republic of Benin.

Variables N M ± SD

Demographics

Age (years) 123 48.25 ± 4.61

Seniority in the profession (years) 123 20.61 ± 4.62

Height (cm) 123 173.30 ± 6.92

Weight (kg) 123 77.63 ± 13.81

Blood pressure

Systolic blood pressure (mm Hg) 123 133.51 ± 18.92

Diastolic blood pressure (mm Hg) 123 79.75 ± 12.19

HBP correlates

Body mass index (kg/m2) 123 25.73 ± 3.71

Waist circumference (cm) 123 91.79 ± 10.70

Neck circumference (cm) 123 38.23 ± 2.46

Resting heart rate (bpm) 123 69.88 ± 6.36

Total cholesterol (g/L) 115 2.02 ± 0.35

HDL-cholesterol (g/L) 115 0.48 ± 0.19

LDL-cholesterol (g/L) 115 1.36 ± 0.36

Triglycerides (g/L) 115 0.84 ± 0.41

White blood cell count (109 × cells/L) 115 4.53 ± 1.69

Neutrophil cell count (109 × cells/L) 115 2.39 ± 1.18

Note: M: mean value; SD: standard deviation; N: sample size; HBP: high blood

pressure; PE: physical education.

Frequencies of HBP and Its Correlates

HBP is present in 43 teachers among 123, i.e. 35% of them

(Figure 1), with the distribution presented in Table 2. The five

correlates of HBP which have the highest frequencies of ab-

normal values in this group are: NC (78.3%), BIA (72.9%),

WC (44.2%), LDL-C (22.5%), and BMI (14%). The percent-

ages of the subjects who show high values of WBC, NEU, and

CRP are low (respectively 3.9%, 3.9% and 4.7%), but that of

TG is null.

Results of the X2 Test

The results of the univariate analysis (X2 test) are presented

in Tables 3( a) and (b). The way they were evaluated showed that

the variables related to lifestyle (tobacco, alcohol, salt, daily time of

walk), blood lipids and the emergent risk factors do not signifi-

cantly correlate to HBP in the studied group (p > 0.05). How-

ever, the percentage of subjects with HBP having a NC ≥ 37 cm

Note: HR: heart rate; AHT: arterial hypertension; BMI: body mass index; WC:

waist circumference; NC: neck circumference; TC: total cholesterol; LDL-C:

LDL-cholesterol; HDL-C: HDL-cholesterol; TG: triglycerides; BIA: biologic

index of atherogenicity; WBC: white blood cell count; NEU: neutrophil cell count;

CRP: C-reactive protein.

Figure 1.

Frequencies of HBP and that of its correlates’ abnormal values among

assistant PE teachers in Republic of Benin.

Table 2.

Stratification of blood pressure values among Assistant PE teachers in

Republic of Benin (N = 123).

Blood pressur e val ue s

Systolic blood pressure

Frequencies

(%)

Normal blood pressure (NBP)<140 mm Hg 81 (65.8)

High blood pressure (HBP)≥140 mm Hg 42 (34.1)

<160 mm Hg - ≥140 mm Hg29 (23)

<180 mm Hg - ≥160 mm Hg9 (7.3) Stratification of HBP

≥180 mm Hg 4 (3.2)

Diastolic blood pressure

Normal blood pressure (NBP)<90 mm Hg 94 (76.4)

High blood pressure (HBP)≥90 mm Hg 29 (23.6)

<100 mm Hg - ≥90 mm Hg 18 (14.6)

<110 mm Hg - ≥100 mm Hg7 (5.7) Stratification of HBP

≥110 mm Hg 4 (3.3)

P. GOUTHON ET AL.

Table 3(a).

Results of the X2 test between HBP and its correlates among Assistant

PE teachers in Republic of Benin (N = 123).

Correlates of HBP Subjects with NBP

Frequencies (%)

Subjects with HBP

Frequencies (%)p

Age (years)

≥50

<50

33 (57.8)

45 (68.2)

24 (42.2)

21 (31.8)

0.16

Salt overconsumption

Yes

76 (64.4)

2 (40.0)

42 (35.6)

3 (60.0)

0.25

Current tobacco consumption

Yes

5 (45.5)

73 (65.2)

6 (54.5)

39 (34.8)

0.16

Daily time of walk (min)

<30

>30

15 (71.4)

63 (61.8)

6 (28.6)

39 (38.2)

0.28

Personal history of disease

Yes

34 (63.4)

44 (67.7)

24 (36.6)

21 (32.3)

0.29

Body mass index (kg/m²)

>30

<30

8 (44.4)

70 (66.7)

10 (55.6)

35 (33.3)

0.06

Waist circumference (cm)

≥94

<94

31 (55.4)

47 (70.1)

25 (44.6)

20 (29.9)

0.06

Neck circumference (cm)

≥37

<37

56 (58.3)

22 (81.5)

40 (41.7)

5 (18.5)

0.02

Note: Daily time of walk: the average time the subject used to walk every day;

NBP: normal blood pressure; HBP: high blood pressure.

Table 3(b).

Results of the X2 test between HBP and its correlates among Assistant

PE teachers in Republic of Benin (N = 123).

Correlates of HBP Subjects with NBP

Frequencies (%)

Subjects with HBP

Frequencies (%) p

Total cholesterol (g/L)

≥2

34 (58.6)

39 (68.4)

24 (41.4)

18 (31.6)

0.18

HDL-cholesterol (g/L)

≤0,4

>0,4

27 (57.4 )

45 (67.2 )

20 (42.0)

22 (32.8)

0.19

LDL-cholesterol (g/L)

≥0,6

<0,6

15 (51.7)

57 (67.1)

14 (48.3)

28 (32.9)

0.10

Triglycerides (g/L)

≥2

BIA

≥2

56 (60.6)

16 (76.2)

37 (39.4)

5 (23.8)

0.13

White blood cell count

≥8 × 109 cells/L

<8 × 109 cells/L

4 (80.0)

68 (62.4)

1 (20.0)

41 (37.6)

0.39

Neutrophil cell count

≥5 × 109 cells/L

<5 × 109 cells/L

4 (80)

68 (62.4)

1 (20.0)

41 (37.6)

0.39

CRP (mg/L)

≥6

3 (50.0)

69 (63.9)

3 (50.0)

39 (36.1)

0.38

Note: CRP: C-reactive protein; BIA: biologic index of atherogenicity; NBP:

normal blood pressure; HBP: high blood pressure.

is higher than that of the ones whose NC values are <37 cm

(41.7% against 18.5%, p = 0.02). An increased NC can conse-

quently be considered correlated to HBP in this group.

Results of the Logistic Regression

When NC is introduced alone into the logistic regression, the

results indicate that it contributes independently and to a sig-

nificant degree, to explaining HBP occurring in the studied

group, with an Odds Ratio (OR) = 3.14 (95% CI: 1.09 - 9.00; p

= 0.033). Thus, a subject whose NC is > 37 cm, is 3.14 times

likely to have HBP than the one whose NC is < 37 cm. After

adjusting for age as a quantitative continuous variable, both NC

and age contribute significantly, with respective OR = 1.12

(95% CI: 1.02 - 1.23; p = 0.012) for age and OR = 3.02 (95%

CI: 1.03 - 8.85; p = 0.044) for NC. After adjusting for age, BMI,

and WC, age and NC remain in the final model of the regres-

sion (Table 4, stage 3), the two correlates which contribute to a

significant degree to explaining the occurrence of HBP in the

studied group, with respective OR = 1.12 (95% CI: 1.02 - 1.23,

p = 0.012) and OR = 3.02 (95% CI: 1.03 - 8.85, p = 0.044).

Table 4.

Synthesis of the logistic regression between HBP and its correlates among

Assistant PE teachers in Republic of Benin (N = 123).

Stages Correlate

variables Coefficients

of regression Odds

ratio Confiden ce

interval [CI]p

Age

Neck circumference

Body mass index

Waist circumference

0.11

0.99

0.62

0.06

1.12

2.69

1.87

1.06

0.02 - 1.23

0.85 - 8.46

0.58 - 6.00

0.42 - 2.65

0.016

0.090

0.293

0.888

Age

Neck circumference

Body mass index

0.11

1.01

0.66

1.12

2.76

1.93

0.02 - 1.23

0.93 - 8.19

0.67 - 5.56

0.016

0.06

0.218

3 Age

Neck circumference

0.12

1.10

1.12

3.02 1.02 - 1.23

1.03 - 8.85

0.012

0.044

Note: [CI]: confidence interval [95%]; p: statistical p value.

Discussion

Association between HBP and Its Correlates

Many studies showed that among the main factors associated

with high blood pressure (HBP), obesity, overconsumption of

salt, low consumption of potassium, psychological stress,

physical inactivity, alcohol abuse, etc. are triggers, particularly

in black African peoples (Opie & Yackoob, 2005; WGPPH,

1993; Elliot, 1991). Our results confirm the obvious relations

between HBP and a type of obesity (upper body) but not those

with factors related to lifestyle or category of age. Thus, the cut

off value used (i.e. 50 years) for transforming age into qualita-

tive variable does not appear reliable, since introducing age into

the logistic regression as a continuous variable, shows that it

contributes significantly to the occurrence of HBP. If obesity

constitutes a factor associated with HBP, the seniority in the

profession seems to potentiate this relation (Soteriados et al.,

2005; Rotimi et al., 1995), but it is not the case in our series. It

is known that the environmental factors which a cohort is sub-

jected to at a given moment, influence in a substantial way the

distribution and the degree of obesity in this cohort (O’Donovan et

al., 2005). Since the majority of the PE teachers of this study

usually move in car or on motorcycle and no longer have regu-

lar physical activities, it is reasonable to think that the preva-

lence of HBP and obesity recorded are strongly associated to

their inactivity. They would thus have involved in sedentary

practices, coupled with high consumption of saturated fat and

salt, reducing the positive effects of their working conditions

P. GOUTHON ET AL.

(Misigoj-Durakovic et al., 2004). Since the individuals who

exercise have a better physical fitness than the non-active and a

more favorable cardiovascular risk profile (Francischetti &

Genelhu, 2007), it is suggestible that the overweight and obese

subjects of our sample resume exercises, while reducing satu-

rated fat, salt, tobacco and alcohol consumption. HBP indeed

has a specific pathogenic support in blacks, since: 1) endothelin

has been found at higher concentration in black subjects with

arterial hypertension; 2) the genome contributes in this patho-

genesis, by the means of the genes M-235T coding angiotensi-

nogen and that located on the chromosome 10p, which is im-

plied in the end-stage renal failure; 3) this pathogenesis is espe-

cially related to the increased sensitivity of black peoples to

sodium load, a defect of urinary sodium excretion and a low

plasma renin activity (Aubry, 2003).

In a study carried out in Estonia, Pihl et al., (2002) noted that

59.3% of the PE teachers do exercise regularly during their

leisure time and that the risk of obesity (OR = 0.63; 95% CI:

0.21 - 0.94) and hypertension (OR = 0.52; 95% CI: 0.29 - 0.94)

was lower than that of the non-teachers enrolled as controls.

Sandmark (2000) also reported that when they were 25 years

old, the Swedish PE teachers had on average a BMI higher than

that of the non-teachers, but at a more advanced age, the BMI

of the teachers were on average lower. According to the author,

this report is related to the fact that the subjects who pursue

sporting practice are more numerous in the group of teachers.

In Croatia, the PE teachers have on average a level of sporting

practice or leisure physical activity higher than that of the other

employees of the country. That had a positive impact on the

prevalence of cardiovascular risk factors like overweight, obe-

sity, systolic high pressure and high level of plasma cholesterol

(Misigoj-Durakovic et al., 2004). More recently, Mbemba et al.

(2007) observed in Congo a prevalence of 21% of stage I of

hypertension in PE teachers with a reduced physical activity,

against 1.56% in the group of subjects with a high level of

physical activity. Our results tend to corroborate this previous

finding.

The lifestyle change recommended by Francischetti and

Genelhu (2007) can also offer other benefits to the PE teachers

of this study: 1) it can enable them to become aware and to

better counsel the youngsters for the adoption of favourable

behaviour towards cardiovascular health (O’Loughlin et al.,

1996); 2) while becoming more physically active, the PE

teachers will be more fit and, as it was shown in Israeli PE fe-

male teachers, their behaviour in ageing periods could become

more positive (Netz & Raviv, 2002).

In our cohort, the WBC and neutrophil (NEU) counts do not

appear associated with arterial hypertension. Studies like that of

Horne et al. (2005) however, highlighted the strong relation

between increased WBC count, NEU, NEU/WBC ratio and an

increased risk of cardiovascular disease. Recently, Orakzai et al.

(2006) noted in white men that the WBC count is associated

with high SBP values of about 130 - 139 mm Hg (OR = 1.5;

95% CI: 1.15 - 1.92, p < 0.05). This aspect of our results must

be deepened and on this assumption, the relations between the

emergent risk factors (homocystein, fibrinogen, (Lpa) lipopro-

tein, CRP, WBC and NEU counts) and arterial hypertension

may be evaluated in the various parts of the population in sub-

Saharan Africa.

Multivariate Anal ysi s

In this study, neck circumference (NC) is the only modifiable

variable associated with HBP for p < 0.05, and a subject whose

NC is high, is 3.02 times more likely to have HBP than another

one whose NC is below the borderline value. Ben-Noun et al.

(2001) showed that NC constitutes the most reliable index of

body fat mass distribution in the upper body. Ben Noun and

Laor (2003) even showed that a high value of NC can increase

the risk of coronary disease. Considering his finding, this study

seems to corroborate with regard to HBP. If however one raises

the level of significance of the X2 test up to p < 0.10, the per-

centages of the two groups of teachers with HBP also present

significant differences for BMI (p = 0.06) and WC (p = 0.06)

subgroups. That means we could think that for a higher p value,

these two adiposity indexes of which one (BMI) accounts for

the total adiposity of the body and the other (WC), accounts for

obesity in the upper body, are also associated to HBP. However,

it does not seem to be the case among our PE teachers, since in

the logistic model, these two adiposity indexes do not contrib-

ute to a significant degree to explain HBP occurring.

In this context, the type of HBP recorded in the current study

can be compared to that reported recently under the name of

hypertension associated with obesity, by Francischetti and

Genelhu (2007). It would be the leptin, a protein secreted by

and in the adipocytes, which binds obesity to HBP/hypertension

and an increase in the sympathetic activity of the nervous sys-

tem. The potential mechanisms involved in this hypertension

associated with obesity are: hypoadiponectinemy, a high con-

centration of circulating free fatty acids and an increased pro-

duction of endothelin-1 (ET-1) (Francischetti & Genelhu, 2007)

which we could not unfortunately assess. It is the same case for

glycaemia, blood potassium and salt intake that we could not

assess in the conditions the study was carried out. Problems of

participants and material availability were so critical issues that

we decided to collect data although study limits attached to this

choice. Once more, this study raised the reality of research

carrying out in Developing Countries, in particular those of

sub-Saharan Africa in which sociocultural factors often add to

material unavailability to weaken research designs initiated by

natives.

Conclusion

The results of this study revealed that the APE teachers stud-

ied have a lifestyle favourable to weight gain and increased

blood pressure. The frequencies of high blood pressure and its

correlates related to upper body obesity are high among them.

The multivariate analysis showed that in this particular sample

of APE teachers, neck circumference, a reliable indicator of

upper body obesity, may be considered as one of the most rele-

vant variable explaining high values of blood pressure.

These results suggest that the APE teachers and all the PE

teachers in general, must keep on exercising as early as their

initial training comes to an end. They also have to avoid over-

consumption of salt, alcoholic drinks and saturated lipids. Do-

ing so, they could avoid overweight and reduce the risk of hy-

pertension. We agree with Gaziano et al. (2005) that the use of

quantitative risk based guidelines for treatment of hypertension

could free up major resources for other pressing needs, espe-

cially in developing countries. However, it can be suggested

that for the moment, a periodic measurement of blood pressure

for early detection and care for the PE teachers at risk of HBP

may be integrated into the national programmes of non-tran-

smissible disease prevention.

P. GOUTHON ET AL.

Acknowledgements

The authors are grateful to Mr. Chogninka Roland, which

accepted to undertake blood tests in his Laboratory, and con-

ceded a substantial financial reduction on the real fees. We

thank all the APE teachers who took part in this study, for their

availability. We are also indebted to the managers of the Centre

of Muscular and Cardiovascular Maintenance VITAFORME of

Porto-Novo, for their technical support during data processing

and analysis.

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