Prevalence of Hypertension inChildren: Comparison Between Task Force Recommendations and Average of Multiple ...
Authors Kenneth F. Adams Emily D. Parker Alan R. Sinaiko Louise C Greenspan Joan C. Lo Karen L...
Institutions  HealthPartners  Kaiser Permanente Colorado  Kaiser Permanente Northern California  Universit...
Background: Childhood Hypertension  Hypertension in adults is an asymptomatic physiologic condition that predicts...
Background: Childhood Hypertension  NHBPEP 4th Working Group prescribed an approach to assessing hypertension ...
Background: Current clinical environment  Electronic medical records (EMR) allow provider to track blood press...
Methods  Source population: Children and adolescents (3-17 years); patient at one of 3 sites  Analysis cohort...
Results: Prevalence of hypertension and other intermediate categories By Working Group Classification ...
Results: Cross-Tabulation of Working Group Definitions with Avg BP ≥ 95th % ...
Results: Hypertension Prevalence By Look-back Duration HTN Prevalence Using 3 Definit...
Results: Hypertension Prevalence By Number of BP Measures Available HTN Prevalence Usi...
Comments (1)  These preliminary data show  Prevalence of hypertension in overall pediatric population is low by...
Comments (2)  These preliminary data show  Duration of follow-up (1-4 years) is not related to prevalence of an...
Comments (3)  Potential significance  Differences in subjects identified by the 3 hypertension definitions sug...
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Prevalence in Hypertension in Children ADAMS

Cardiovascular Disease
Published on: Mar 4, 2016
Source: www.slideshare.net


Transcripts - Prevalence in Hypertension in Children ADAMS

  • 1. Prevalence of Hypertension inChildren: Comparison Between Task Force Recommendations and Average of Multiple Measurements over 2 or 4 years
  • 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. Institutions  HealthPartners  Kaiser Permanente Colorado  Kaiser Permanente Northern California  University of Minnesota  Funding: NHLBI 1R01HL093345-013
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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

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