Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Prevalence in Hypertension in Children ADAMS

560 views

Published on

Cardiovascular Disease

  • Be the first to comment

  • Be the first to like this

Prevalence in Hypertension in Children ADAMS

  1. 1. Prevalence of Hypertension inChildren: Comparison Between Task Force Recommendations and Average of Multiple Measurements over 2 or 4 years
  2. 2. Authors Kenneth F. Adams Emily D. Parker Alan R. Sinaiko Louise C Greenspan Joan C. Lo Karen L. Margolis David J. Magid Nancy E. Sherwood Elyse O. Kharbanda Nicole K. Schneider Matthew F. Daley Patrick J. O’Connor2
  3. 3. Institutions  HealthPartners  Kaiser Permanente Colorado  Kaiser Permanente Northern California  University of Minnesota  Funding: NHLBI 1R01HL093345-013
  4. 4. Background: Childhood Hypertension  Hypertension in adults is an asymptomatic physiologic condition that predicts long term adverse conditions  Hypertension may also be a sign of current pathologic conditions (e.g., kidney disease)  Hypertension in children is associated with pre- clinical cardiovascular disease in adulthood (carotid intimal media thickness, left ventricular hypertrophy)  Tracking: Elevated BP in childhood is a risk factor for hypertension in adulthood4
  5. 5. Background: Childhood Hypertension  NHBPEP 4th Working Group prescribed an approach to assessing hypertension  Gender, age, & height-specific BP percentiles based on normative data collected from school studies  Mimics adult hypertension guidelines  Measurement should be repeated on separate occasions (Stage 1)  Various classifications  Pre-HTN, Stage 1, Stage 2  Providers should measure BP at all routine clinic visits  Prospective orientation5
  6. 6. Background: Current clinical environment  Electronic medical records (EMR) allow provider to track blood pressure over time  Several years of retrospective data may be available  Conversion from BP (as mm Hg) to age, gender, and height-specific BP percentiles can be automated  But interpretation of retrospective BP data may not be straight-forward6
  7. 7. Methods  Source population: Children and adolescents (3-17 years); patient at one of 3 sites  Analysis cohort is a subset of the source population  Inclusion: Children having ≥ 3 BP measures (height must be available)  Exclusion: Pregnant at any time during follow-up  Subjects are censored at time of HTN diagnosis or claim for anti-HTN drug7
  8. 8. Results: Prevalence of hypertension and other intermediate categories By Working Group Classification Frequency n % HTN * 3,210 2.63 Pre-HTN and other intermediate categories † 36,285 29.63 Normal: All BP <90th % 82,832 67.74 Total 122,273 100.00 * Includes 3+ consecutive BP measures ≥ 95th % (Stage 1 HTN), or 1+ BP measure >99th % + 5 mm Hg (Stage 2 HTN) † Intermediate categories include BP 90th to 95th % (pre-HTN), 1-2 BP ≥ 95th %, or 3+ non-consecutively elevated BP measures8
  9. 9. Results: Cross-Tabulation of Working Group Definitions with Avg BP ≥ 95th % Average BP Percentile Working Group Classification < 95th * ≥ 95th Total n % % % 3+ consecutive BP measures ≥ 95th % 2,728 1.96 0.27 2.23 1+ BP measure >99th % + 5 mm Hg 477 0.29 0.10 0.39 Not hypertensive 119,068 97.20 0.18 97.38 Total 122,273 99.45 0.55 100.00 * cell percentages9
  10. 10. Results: Hypertension Prevalence By Look-back Duration HTN Prevalence Using 3 Definitions Look-back Time Unique 3+ 1 or more Average Period subjects consecutive BP >99th % BP ≥ 95th BP ≥ 95th % + 5 mm Hg percentile n % % % Up to 4 years 122,273 2.63 1.00 0.55 Most recent 3 years 117,696 2.55 0.99 0.56 Most recent 2 years 98,648 2.45 0.97 0.58 Most recent 1 year 60,773 2.57 1.09 0.7410
  11. 11. Results: Hypertension Prevalence By Number of BP Measures Available HTN Prevalence Using 3 Definitions Number of BP Unique 3+ 1 or more Average Measures Available subjects consecutive BP >99th % BP ≥ 95th BP ≥ 95th % + 5 mm Hg percentile n % % % 3 41,139 1.28 0.18 0.92 4-5 39,648 1.63 0.28 0.49 ≥6 41,486 3.75 0.72 0.24 Total 122,273 2.23 0.39 0.5511
  12. 12. Comments (1)  These preliminary data show  Prevalence of hypertension in overall pediatric population is low by all 3 measures  4th Working Group definitions have only limited correspondence with hypertension defined by average BP percentile ≥ 95th percentile12
  13. 13. Comments (2)  These preliminary data show  Duration of follow-up (1-4 years) is not related to prevalence of any of the 3 BP measures  Prevalence of Stage 1 and Stage 2 hypertension increases with the number of BP measures available  Prevalence of average BP≥ 95th percentile decreases with number of BP measures available13
  14. 14. Comments (3)  Potential significance  Differences in subjects identified by the 3 hypertension definitions suggests lack of persistence and indicates further research is needed  Clinical usefulness of diagnosing hypertension in pediatric patients using these criteria is unclear14

×