Age at menarche and its association with blood pressure in adult women of developing countries: a systematic review and meta-analysis

Figures & data

Figure 1. Flow chart of study screening.

Table 1. Summary characteristics of eligible studies for age at menarche and blood pressure.

First author, year	Country	Number		Average menarche (years)^a	Year at enrolment (years)	Menarche versus		Methods and testers of blood pressure (BP) assessment	Definitions of hypertension	Age at blood pressure assessment (years)^a
		Cases	Subjects			Late	reference
Liu et al. 2021	China	3187	7518	16.00^b	2013–2014	≥18	≤12	BP was taken as the average of the 3 measurements, using an electronic sphygmomanometer (HEM-770A Fuzzy; Omron, Kyoto, Japan) by well-trained staff.	SBp ≥ 140 mmHg or DBp ≥ 90 mmHg or current use of antihypertension medication.	56.00^b
Hu et al. 2021	China	86207	121431	15.38 ± 2.00	2011–2012	>17	14–17	BP was taken as the average of the 3 measurements, using an automated electronic device (OMRON Model HEM-752 FUZZY) by well-trained staff.	Bp ≥ 120/80 mmHg /treated.	56.96 ± 9.14
Chen et al. 2021	China	59852	234867	14.80± (−)	2012–2016	≥17	15	BP was taken as the average of the 3 measurements, using an OMRON HBP-1300 Professional Portable Blood Pressure Monitor (OMRON, Kyoto, Japan) by well-trained staff.	SBp ≥ 140 mmHg, and/or DBp ≥ 90 mmHg, and/or use of antihypertensive medication within 2 weeks.	46.1 ± 18.90
Zhang et al. 2020	China	6429	15361	16.10 ± 2.20	2015–2017	≥18	16	BP was taken as the average of the 3 measurements, using an electronic sphygmomanometer (HEM-770AFuzzy; Omron, Kyoto, Japan) by well-trained staff.	SBp ≥ 140 mmHg and/or DBp ≥ 90 mmHg, or a previously diagnosed hypertension and use of antihypertensive medication in the previous 2 weeks.	61.5 ± 7.70
Zhou et al. 2019	China	1495	5102	15.50 ± 2.10	2013–2014	≥18	≤15	BP was taken as the average of the 3 measurements, using an electronic BP monitor (Omron HBP-1300; OMRON, Kyoto, Japan) by well-trained staff.	Previously diagnosed hypertension with or without current treatment or the average SBp ≥ 140 mmHg and/or DBp ≥ 90 mmHg at physical examinations.	52.6 ± 17.70
Wei et al. 2019	China	11147	30895	15.64 ± 1.92	2004–2008	≥17	≤12	BP was taken as the average of the 2 measurements, UA-779 digital BP monitor by well-trained staff.	—	51.31 ± 10.36
Shen et al. 2019	China	3268	7893	16.00 ± 2.00	2011–2012	18.6	13.3	BP was taken as the average of the 3 measurements, using an Automatic Upper Arm Blood Pressure Monitor (Omron HEM-7200) by well-trained staff.	Currently taking antihypertensive medicine, SBp ≥ 140 mmHg or DBp ≥ 90 mmHg.	58.00 ± 10.00
Petersohn et al. 2019	Mexico	5349	30626	13.00± (−)	1999–2000	>14	≤12	BP was measured using a mercury column sphygmomanometer, model TXJ-10 by well-trained staff.	SBp > 140 mmHg or DBp > 90 mmHg.	<55
Jansen et al. 2019	Mexico	8116	54921	12.50 ± 1.50	2008–2010	≥17	13	Self-reported.	Self-reported if they have ever been diagnosed by a physician.	42.10 ± 7.60
Farahmand et al. 2019	Iran	—	5344	13.27 ± 1.50	1999–2000	17–19	13–14	BP was taken as the average of the 2 measurements, using a mercury sphygmomanometer and the Korotkoff sound technique	SBp ≥ 130 mmHg, DBp ≥ 85 mmHg, or antihypertensive drug treatment.	13.00–50.00^c
Yang et al. 2018	China	3496	6252	16.15 ± 3.46	2013–2015	≥18	≤13	BP was taken as the average of the 3 measurements, using a mercury sphygmomanometer (Yutu Brand, Yutu, Shanghai Medical Instruments Co., Ltd., Shanghai, China) and oscillometric BP monitors (Omron HBP-1300, Kyoto, Japan) by well- trained staff.	SBp ⩾140 mmHg and/or DBp ≥ 90 mmHg and/or a diagnosis of hypertension.	63.75 ± 9.10
Liu et al. 2018	China	1633	7119	15.40 ± 2.00	2012-2014	≥18	14-15	BP was taken as the average of the 3 measurements, using an electronic sphygmomanometer (Omron HEM-7052, Dalian, China) by well-trained staff.	Previously diagnosed hypertension with or without current treatment, or the average SBP ≥140 mmHg and/or DBP ≥90 mmHg at physical examination.	44.70 ± 19.70
Guo et al. 2018	China	1798	60135	14.00^b	2014–2015	≥16	14	BP was taken as the average of the 2 measurements, using an automated device (HBP-9021 J, Omron, Japan) by well-trained staff.	History of diagnosed hypertension, use of blood pressure medication or SBp ≥ 140 mmHg and/or DBp ≥ 90 mmHg.	29.00 ± 4.12
Zheng et al. 2016	China	1401	12654	14.70 ± 1.90	2009–2013	≥17	≤12	Self-reported	Self-reported physician diagnosis of hypertension or self-reported medication use at baseline.	47.68 ± 8.90
Liu et al. 2016	China	1021	1251	15.35 ± 1.96	2009–2010	≥17	≤14	BP was taken as the average of the 2 measurements, using a standard mercury sphygmomanometer by well-trained staff.	SBp ≥ 130 mmHg and/or DBp ≥ 85 mmHg, antihypertensive drug treatment in a patient with a history of hypertension.	70.39 ± 6.21
Chang et al. 2016	China	1606	3292	13.90 ± 1.69	2004–2008	>14	<12	BP was measured using an electronic device (COLIN, VP-1000, Japan) by well-trained staff.	SBp ≥ 140 mmHg, and/or DBp ≥ 90 mmHg, and/or hypertension history and on ant-hypertensive drug treatment.	<55
Cao et al. 2016	China	—	1625	—	2011–2014	16–20	11–13	BP was measured with a mercury manometer in the seated position after a 5-min rest by well-trained staff.	SBp ≥ 130/DBp ≥ 85 mmHg or current use of antihypertensive medications.	60.45 ± 8.19
Qiu et al. 2013	China	937	3304	16.00^b	2011–2012	≥18	16	BP was taken as the average of the 3 measurements, using an automatic-sphygmomanometers by well-trained staff.	History of hypertension.	>55
Akter et al. 2012	Bangladesh	—	1423	—	2009–2010	>13	<12	BP was taken as the average of the 2 measurements, using the standard mercury manometer by well-trained staff.	SBp ≥ 130/DBp ≥ 85 mmHg or subjects diagnosed with hypertension.	<55
Heys et al. 2007	China	—	7349	15.40 ± 2.10	2003–2004	≥14.5	<12.5	BP was taken as the average of the last 2 of 3 measurements, using the Omron 705CP sphygmomanometer (Omron Corporation, Kyoto, Japan) by well- trained staff.	SBp ≥ 130 or DBp ≥ 85 mmHg or treatment of previously diagnosed hypertension.	64.00 ± 6.00

^aMean ± SD apart from some other indication; ^bmedian of age; ^c range of age.

Abbreviations: Blood pressure (BP); systolic blood pressure (SBP); diastolic blood pressure (DBP)

Figure 2. Forest plots of the association between late menarche and hypertension stratified by participants’ mean age at blood pressure assessment. (A) Studies without adjustment for confounders. (B) Studies with adjustment for confounders excluding adiposity. (C) Studies with adjustment confounders including adiposity. Squares represent the relative risk compared with the middle or early menarche group (reference). The size of each square represents the weight (%) assigned to each study. Weights are from the random-effects analysis. RR: relative risk; CI: confidence interval.

Figure 3. Forest plots of the association between late menarche and SBP/DBP stratified by participants’ mean age at blood pressure assessment. (A) Late menarche and SBP. (B) Late menarche and DBP. Squares represent the mean difference of SBP compared with the middle or early menarche group (reference). The size of each square represents the weight (%) assigned to each study. Weights are from the random-effects analysis. MD: mean difference; CI: confidence interval; SBP: systolic blood pressure; DBP: diastolic blood pressure.

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