Prevalence of hypertension and its associated risk factors among school age children

2. INTRODUCTION
• Hypertension forms a major public health problem.
• the is an increased prevalence of chronic conditions in
children including obesity and hypertension.
• Globally the prevalence of hypertension is increasing
and more than 1 billion people are hypertensive, and
the increasing trends are witnessed more in low-
income and middle-income countries.
• A cumulative incidence of pediatric HTN in China and
India is 50 % and 23% respectively, is quite disturbing.

3. • Various factors age, sex, weight,
race, nutrition profile and environmental
factors.
• Childhood hypertension adult
hypertension.
INTRODUCTION

4. • Over the past four decades, 22,200 scientific
reports regarding “Pediatric Hypertension”
(HTN)have been produced since 1950 and, more
importantly of which, 21,200 in the last 20 years.
• This revealed an increased both clinical and
scientific interest about pediatric hypertension,
since the release of the first guidelines of the
Fourth Report of National Blood Pressure
Education Program Working Group on High Blood
Pressure in Children and Adolescents (IV Report)
2004.
INTRODUCTION

5. New Guidelines
• Following the publication of the new Clinical Practice Guidelines (CPG)
released by the American Academy of Pediatrics in 2017, pediatric HTN
has been aroused a renewed interest.The main novelties were:
o Novel percentiles based on cut-off obtained from the original database of
the IV Report after exclusion of both overweight and obese individuals;
o Use of “elevated BP” instead of “pre-hypertension”;
o Simplified table;
o A diversified definition in subjects according to the age as reported in the
table. In children aged < 13 years, it is recommended to use as cut-off the
BP levels 95th percentile for age, sex, and height, while in those aged 13
years a fixed cut-o 130/80 mmHg independent of age, sex, and height.

6. Prevalence of
Hypertension
Socio-demographic factors
Age
Gender
Family history
Family history of Hypertension
Family history of D.M
Family history of chronic renal disease
Family history of obesity/overweight
Family history of smoking
Lifestyle related factors
Smoking
BMI
Physical activity
Salt and fat intake
Aims of the study

7. Patients and Methods
• study location
• Duhok and Erbil in Iraq.
• Study Design
• A cross-sectional study
• Study duration
• 5th February 2012 to 10th July 2012.

8. • Sample Size:
• Epi-Info software program, prevalence of
hypertension 4%.
• at 95% C.I = 1475 students.
• The larger the sample size were enrolled 2009.
Patients and Methods

9. Patients and Methods
Sample Technique

10. • Sample Criteria:
• All school aged 10 to 17 years.
• Exclusion criteria:
• Students who were on leave at the time of
study or refuse to share in study.
• Student with hypertension.
• Chronic disease .
• Drugs .
Patients and Methods

11. Instruments & Data Collection

12. Anthropometric measurements
• Height was measured without shoes using a portable
stadiometer
• Weight was measured in light clothing using a digital
Heine portable scale.
• BMI was calculated for children and parents as the
ratio of weight (kg) to height (m) squared (kg/m2).
• The most current anthropometric data from CDC were
used to establish BMI percentiles.

13. • Children were classified based on these
percentiles as follows:
• < 5th percentile underweight,
• 5th to < 85th percentile Healthy weight,
• 85th to < 95th percentile overweight and
• ≥ 95th obese.
• For adults 20 years (children parents)
• if BMI 18.5 to < 25 normal, 25 to < 30
Overweight and ≥ 30 Obese.

14. Blood Pressure Measurement
• BP standardized mercury sphygmomanometer
with manually inflated cuff of suitable size and a
stethoscope.
• It was measured on the right arm after the child
was sitting for 5 minutes.
• back supported, feet on the floor, right arm
supported, and cubital fossa at heart level .
Patients and Methods

15. • When the BP ≥ 90th percentile BP was repeated
twice at the same visit, and average were used.
• Other two BP measurements were carried out
within a period of two weeks.
• Prehypertension BP ≥ 90th percentile but <95th
percentile.
• Hypertension BP ≥ 95th percentile at all 3 visits.
Patients and Methods

16. Data Analysis
• SPSS (statistical package for the social
sciences) for windows version 19.
• A P-value of less than 0.05 was considered to
be statistically significant.
Patients and Methods

17. RESULTS AND DISCUSSIONS

18. Mean Blood Pressure
• The overall mean systolic and diastolic were 106.75 mmHg
and 63.71 mmHg, respectively.
• There was a statistically significant ( P > 0.05)

19. Prevalence of hypertension
• prehypertension was 5.5 %
• hypertension was 3.7%
RESULTS AND DISCUSSIONS

20. Prevalence of hypertension by the Age
• The mean age was 13.7 years (10-17) years .
• BP significantly increasing with advancing age, in a way that
highest prevalence of hypertension was recorded in 17 years.
Age No. (%)
Normal Pre hypertension Hypertension
No. ( %) No. ( %) No. ( %)
10 182 (9.1%) 177 (97.3%) 5 (2.7%) 0 (0%)
11 193 (9.6%) 184 (95.3%) 8 (4.1%) 1 (0.5%)
12 332 (16.5%) 309 (93.1%) 12 (3.6%) 11 (3.3%)
13 259 (12.9%) 234 (90.3%) 17 (6.6%) 8 (3.1%)
14 267 (13.3) 238 (89.1%) 19 (7.1%) 10 (3.7%)
15 157 (7.8%) 141 (89.8%) 8 (5.1%) 8 (5.1%)
16 379 (18.9%) 330 (87.1%) 29 (7.7%) 20 (5.3%)
17 240 (11.9%) 211 (87.9%) 13 (5.4%) 16 (6.7%)
Total 2009 (100%) 1824 (90.8%) 111 (5.5%) 74 (3.7%)
X2 =26.9 df =1 P>0.001

21. Prevalence of hypertension by Genders
• (49.3%) were male and (50.7%) were females.
• Hypertension was more in male than female
3.9% and 3.4%, respectively.
• prevalence by gender is not significant

22. • In general this study showed that both SBP
and DBP were positively associated with age
in both genders.
• These findings are supportive to the
recommendations of the updated fourth
report from the National High Blood Pressure
Education Program (NHBPEP) Working Group
on Children and Adolescents 2004.
Discussion

23. • A sex-preferential susceptibility of males to
hypertension in adolescents was established
in most of the literatures,
• this is may be related to differential sex
steroid effects on the vasculature.
Discussion

24. Association between hypertension and BMI
• In the present study, the prevalence of Over weight
was 15.2%
• While the prevalence of Obesity was 12.1% .

25. Obesity and hypertension
• The odds HPT increased by 1.5 times if the
persons were overweight and obese.
Variables No. (%)
Normal Pre hypertension Hypertension
No. ( %) No. ( %) No. ( %)
Body mass index
Under weight 83 (4.1%) 78 (94%) 4 (4.8%) 1 (1.2%)
Normal 1376 (68.5%) 1264 (91.9%) 69 (5%) 43 (3.1%)
Over weight 306 (15.2%) 281 (91.8%) 15 (4.9%) 10 (3.3%)
Obese 244 (12.1%) 201 (82.4%) 23 (9.4%) 20 (8.2%)
X2 = 19.3 df = 1 P>0.001 Odd Ratio = 1.48

26. There are many causes behind increase blood
pressure in obesity such as;
• leptin, a protein hormone which is involved in
body weight regulation and metabolism.
• Sympathetic nervous system imbalance.
• Impairment of the physiological mechanism of
pressure natriuresis.
• Hyperinsulinemia.
• and early vascular changes.
Discussion

27. Hypertension and smoking
• There was a strong and significant Association between
hypertension and smoking.
• The respondents with history of smoking were 5.6 times more
likely to have hypertension compared to non smokers.
Variables No. ( %) Normal Pre
hypertension Hypertension
No. ( %) No. ( %) No. ( %)
Smoking
YES 79 (3.9%) 54 (68.4%) 7 (8.9%) 18 (22.8%)
NO 1930 (96.1%) 1770 (917%) 104 (5.4%) 56 (2.9%)
X2 = 76.2 df = 1 P>0.001 Odd Ratio = 5.66

28. The cigarette smoking causes
• sympathetic activation,
• oxidative stress, and
• acute vasopressor effects that are associated
with increased markers of inflammation which
are linked with hypertension.
• Cigarette smoking also increases blood
pressure through stiffening arteries, with
particular effects on chronic smokers.
• PLEASE let us to work hardly to move the
world to a smoking free state.
Discussion

29. Hypertension and Physical Activity
• Statistically significant association between
physical inactivity and hypertension.
Variables No. ( %)
Normal Pre
hypertension Hypertension
No. ( %) No. ( %) No. ( %)
Physical activity
YES 525 (26.1%) 485 (92.4%) 17 (3.2%) 23 (4.4%)
NO 1484 (73.9%) 1339 (90.2%) 94 (6.3%) 51 (3.4%)
X2 = 7.85 df = 1 P =0.02

30. • Several studies support that regular physical
activity reduces the risk of cardiovascular disease
morbidity, mortality, lower BP and prevent the
development of HTN.
• The mechanisms may involve:
• reduced activity of sympathetic nervous
• reduced activity of renin–angiotensin–
aldosterone systems.
• Moderate-intensity aerobic exercise has also
been shown to augment endothelium-dependent
vasodilatation through the increased production
of nitric oxide.
Discussion

31. Hypertension and dietary habits
• No statistically significant association between
Hypertension and dietary habits.
• The difficulty in obtaining accurate data on eating
habits in the present study was documented;
• the used questionnaire was limited to rise data
on the cultural basis and an individual family
sense,
• did not take inconsideration the food types,
cooking manner or the amount taken.

32. • There is substantial evidence that a reduction
in salt intake lowers BP and can prevent HTN
and adverse cardiovascular outcomes.
Discussion

33. Hypertension and family history of hypertension
• Strong and significant association between
childhood hypertension and family history of
hypertension.
• The odds increased by 2 times FH of hypertension.
Variables No. ( %)
NORMAL PREHYPERTENSION HYPERTENSION
No. ( %) No. ( %) No. ( %)
Family history of hypertension
YES 563 (28%) 484 (86%) 32 (5.7%) 47 (8.3%)
NO 1446 (72%) 1340 (92.7%) 79 (5.5%) 27 (1.9%)
X2 = 37.8 df = 1 P>0.001 Odd Ratio = 2.01

34. • The impact of parental hypertension is most
likely the result of shared genes, learned
behaviors, shared environments or various
combinations.
Discussion

35. Hypertension and parental
overweight & obesity
• Significant association between Hypertension
and parental overweight &obesity.
Variables No. ( %)
NORMAL PREHYPERTENSION HYPERTENSION
No. ( %) No. ( %) No. ( %)
Parental overweight &obesity
YES 705 (35.1%) 623 (88.4%) 45 (6.4%) 37 (5.2%)
NO 1304 (64.9%) 1201 (92.1%) 66 (5.1%) 37 (2.8%)
X2 = 9.28 df = 1 P =0.02

36. Hypertension and family history of smoking
• Strong and significant association between
hypertension and family history of smoking
• FH smoking were 1.4 times more likely to have
hypertension.
Variable No. ( %)
NORMAL
PRE
HYPERTENSION HYPERTENSION
No. ( %) No. ( %) No. ( %)
Family history of smoking
YES 751 (37.4%) 662 (88.1%) 38 (5.1%) 51 (6.8%)
NO 1258 (62.6%) 1162 (92.4%) 73 (5.8%) 23 (1.8%)
X2 =21.3 df = 1 P>0.001 Odd Ratio = 1.43

37. • The study's results suggest that promoting
smoke-free homes may protect cardiovascular
health in children as well as adults.
Discussion

38. Hypertension and family history of DM &
Chronic Renal Disease
• No significant between those with
hypertension and FH D.M.
• Not significant in those with Hypertension
and FH renal diseases.

39. • Most childhood hypertension, particularly in
preadolescents is secondary to an underlying
disorder, renal parenchymal disease is the
most common (60% - 70% ) .
• These data direct us to exclude renal
etiologies for any cases of hypertension in the
person level and search for the genetic effect
on the family background.
Discussion

40. Recommendations
• Based on the study results, the prevalence of
obesity is high and there is a direct
relationship between obesity and
hypertension in school aged children,
• It is recommended that weight, height and
blood pressure should be assessed regularly in
children and adolescents to identify
individuals at risk.

41. • Prevention of cardiovascular risk factors in
early childhood may be an important step in
preventing noncommunicable diseases, this
may be implemented in programs and policies
to:
• limit sedentary behaviors
• promote physical activity,
• advice healthy nutrition and
• prevent smoking among children.

42. PREVALENCE OF HYPERTENSION AND ITS
ASSOCIATED RISK FACTORS AMONG SCHOOL
AGE CHILDREN IN DUHOK AND ERBIL CITY
By
Ph.D student: Ayoub Abid Abdulmajeed
M.Sc. of pediatric nursing
Supervised by
A.PROF. DR. AZAD ABDUL JABAR HALEEM AL-MEZORI
M.BCh.B, DCH, FIBMS.MRCPCH
study location
The study will carry out in the secondary schools in Duhok city/ Kurdistan region/Iraq.
Study duration
500 school adolescents were enrolled from 15th November 2021.

43. THANKS