prevalence of hypertension in minority school –aged children in north-west arkansas mohammad...
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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????