Prevalence of Hypertension in Minority School –Aged Children in

North-West Arkansas

Mohammad Ilyas, M.D., Eduardo R. Ochoa,M.D., Creshelle R. Nash, M.P.H., M.D., Patricia Minor,

B.S.N., R.N., Hanan M. Givens, B.S., Kathy Powers, R.N., Marianne Neighbors, Ed.D., B.S.N., Kathleen Barta, Ed.D., R.N., Wynona Bryant-Williams, Ph.D.

Outline

• The Arkansas Minority Health Commission• Hypertension in Children • The Springdale Study

– Background– Methods

• The Results• The Conclusion and Implications• Question and Answer

The Arkansas Minority Health Commission

• Formed in 1991• The mission of AMHC: “to assure all minority Arkansans access to health care that is

equal to the care provided to other citizens of the state and to seek ways to provide education, address, treat, and prevent diseases and conditions that are prevalent among minority populations”

The Arkansas Minority Health Commission

• Study issues relating to the delivery of and access to health services to minorities in the state

• Identify any gaps in the health service delivery system

• Make recommendations to the relevant agencies and to the legislature to improve health care delivery

The Arkansas Minority Health Commission

• In 2000 the Arkansas Legislature passed Initiated Act I for the administration of the Targeted State Needs Programs utilizing a portion of Arkansas Tobacco Settlement funds establishing the Minority Health Initiative (MHI) administered by the AMHC.– Increase awareness of hypertension, strokes and

other disorders.– Provide screening or access to screening for

hypertension, strokes and other disorders.– Develop intervention strategies

Percentage of students classified as overweight or at risk for overweight by Arkansas

public school district (Year 3)

Source: ACHI. The Arkansas Assessment of Childhood and Adolescent Obesity—Tracking Progress (Year 3 Fall 2005–Spring 2006). Little Rock, AR: ACHI; September 2006.

The Arkansas Minority Health Commission

• In 2000 the Arkansas Legislature passed Initiated Act I for the administration of the Targeted State Needs Programs utilizing a portion of Arkansas Tobacco Settlement funds establishing the Minority Health Initiative (MHI) administered by the AMHC.– Increase awareness of hypertension, strokes and

other disorders.– Provide screening or access to screening for

hypertension, strokes and other disorders.– Develop intervention strategies

Overweight and Hypertension in Children

Ogden CL et al. JAMA 2002 Sorof JM et al. Pediatrics 2004

Prevalence of Overweight in Children

0%

2%

4%

6%

8%

10%

12%

14%

16%

6 to 11 years 12 to 19 years

Age Group

Prev

alen

ce 1971-19741999-2000

Prevalence of Hypertension in School Children

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

4.50%

5.00%

Year

Prev

alen

ce

19892004

The Third Annual Arkansas Assessment of Childhood and Adolescent Obesity. ACHI. August 2006

Tracking of Blood Pressure

• Bogalusa Heart Study showed 40% individuals with SBP > 80th percentile at baseline had levels above that 15 years later

• DBP tracking seen in 37% individuals• The ability to predict BP levels in adulthood from

measurements in childhood would provide the opportunity to intervene before hypertension is established, thereby reducing the CVD risk. (Lane et al. J Human Hypertension 2004)

Hypertension and Cardiovascular risk

• University of Rochester NY• Patients with primary hypertension (10-18 y)• Matched normotensive controls• All patients had ABPM, Echocardiogram, Carotid

ultrasound• LVMI, and cIMT did not correlate with weight, BMI

but correlated with ABPM parameters

Lande, M. B. et al. Hypertension 2006;48:40-44

Copyright ©2006 American Heart Association

Lande, M. B. et al. Hypertension 2006;48:40-44

Relationship between cIMT and daytime SBP index

Aims

• To investigate the prevalence of hypertension in school aged children in Springdale schools that have a large minority population.

• To determine what percent of these hypertensive children were previously undiagnosed.

• To refer children with high blood pressure for further evaluation and care.

• Education of school nurses and other nurses in the area in proper blood pressure measurement.

Ground Work• Schools

– Springdale High– Bayyari Elementary

• Meeting with School District– Dr. Rollins– Sharla Brackett– Barbra Ludwig, Kathy Launder

• Involvement of School nurses and Nursing Educators in the area– Dr. Marianne Neighbors, RN– Dr. Kathleen Barta, RN

• Passive Consent

The Partnership

• Arkansas Minority Health Commission• Arkansas Children’s Hospital • University of Arkansas for Medical Sciences• Eleanor Mann School of Nursing • Springdale School District

Blood Pressure Measurement Training

• Interactive BP measurement training– Selection of proper BP

cuff– MAC– BP charts, definitions– Apparatus– Proper BP measurement

in children

Screening Day

Blood Pressure Screening

• Information– Name (to be kept at school)– Subject unique ID number – Date of birth and age – Gender– Ethnicity – Race– Ht. Wt. Heart rate– Mid arm circumference– Size of BP cuff used

– 3 sets of BP measurements

Height & Weight

Assent

Students seated , MAC

Choose proper cuff

Students fromClasses

5 min rest, 3 oscillatory BP readings, 1 min interval

Omron HEM 907

Definitions

• Normal– SBP and DBP <90th percentiles for gender, age, and

height• Pre-hypertension

– Average SBP or DBP between 90th and 95th percentiles or > 120/80 mm Hg

• Hypertension– Average SBP and/or DBP > 95th for gender, age,

and height on more than 3 occasions

Fourth Report on BP. Pediatrics August 2004

Height & Weight

Assent

Students seated , MAC

Choose proper cuff

Auscultatory BP

Students fromClasses

5 min rest, 3 oscillatory BP readings, 1 min interval

Height & Weight

Assent

Students seated , MAC

Choose proper cuff

Auscultatory BP

Students fromClasses

5 min rest, 3 oscillatory BP readings, 1 min interval

Information to SNFor follow up

2 more BP if need(2 week apart)

Referral to PCPFollow up

The Study PopulationN= 475

Gender Male 243 (51.2%)Female 232 (48.8%)

Grade 4th 85 (17.9%)10th 390 (82.1%)

Race Black 15 (3.2%)White 256 (53.9%)Asian/PI 37 (7.8%)Native American 2 (0.4%)

Ethnicity Hispanic 244 (51.4%)Non-Hispanic 231 (48.6%)

The Results: Over-Weight or At Risk of Over-Weight

4th Grade 56.6%

10th Grade 46.1%

*BMI greater than 85 percentile for Age

86%

14%

94%

6%

32%

68%

33%

67%

98%

2%

96%

4%

First screening : N= 475

65/475 27/475

17/25 17/473

7/127/469

Second screening : N= 25

Third screening : N= 12

Estimated Prevalence

School Blood Pressure Screening

Authors Age Number Method Prevalence

Year

Moore et al 5-19 747 Oscillatory HEM 907

18.4%, 5.1%, 2.8%

2006

Chiolero et al 12-13 5207 Oscillatory 11.4%, 3.8%, 2.2%

2007

Genovesi et al

6-11 2416 Auscultatory mercury

8.8%, 4.2% 2005

Jago et al 12-14 1740 Oscillatory HEM 907

13.8% 2005

Sorof et al 10-19 5102 Oscillometry Spacelabs

19%, 9.5%, 4.5%

2002

The Results:Prevalence of Increased Blood Pressure

Number Percent

1st Screening

Oscillatory 4th 410th 61

4.7%15%

Ascultatory 4th 110th 26

1.2%6.6%

2nd Screening 4th 110th 16

1.1%4%

3rd Screening 4th 110th 6

1.1%1.5%

Conclusion

• A high percentage of school children in studied population are overweight or at risk of being overweight

• A large percentage of school children had elevated blood pressure( 14%) at first screening

• Study identified 7 newly diagnosed hypertensive children. One did not have PCP– 2 Asian/PI, 3 Hispanic and 2 Caucasian

The Implications

• What is the policy?• Other Consequences

• Effective Partnerships• Health Professional Education• Opportunities for Community-Based Research and

health improvement • Individual Mentoring

Questions????