Hypertension amonge teenage years 28

Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

HYPERTENSION IN TEENAGE YEARS

Jafar Al-Said. M.B.ChB. MD. FASN. FACP.Chair of Internal Medicine.Nephrology and Internal medicine Consultant.Bahrain Specialist Hospital


SCHEME

• Introduction.

• Magnitude of the problem.

• Definition of Teenage HTN.

• International Data.

• Hypertension and obesity screening among High and middle schools in Bahrain.

• Conclusion.


45%

41%

41%

36%

38%35%

2014 GLOBAL HTN PREVALENCE

HTN GLOBAL PREVALENCE

39%

Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016Jafar Al-Said. Global HTN prevalence during the 21st Century. Poster at ESH 2015. Milano.

The Predicted Increment in Hypertensive Patients During the 21st Century

Assuming a Stable Prevalence of 39% of the Global population


DEFINITION OF TEENAGE

HTN


CLASSIFICATION OF PREHYPERTENSION AND HYPERTENSION IN CHILDREN AND ADOLESCENT

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. May 2005. NIH Publication No. 05-5267. http: / /www.nhlbi.nih.gov/health/prof/heart /hbp/hbp_ped.pdf. Accessed July 27, 2011.

Measure BP at each

office visit for > 3

years age


HYPERTENSION IN ADOLESCENTS.

Undiagnosed:• 75% of the cases of HTN.

• 90% of Prehypertensive

Aglony M, Acevedo M, Ambrosio G - Expert Rev Cardiovasc Ther - December 1, 2009; 7 (12); 1595-603


PREVALENCE OF HTN AMONG PEDIATRIC AGE EDWIN RODRIGUEZ-CRUZ, P SYAMASUNDAR RAO.

• United States Data. Updated July 2015• 2 – 5% of Children has HTN.

• Gender difference: < 6 years similar BP. 6- puberty slightly higher in girls. till puberty. Adolescent males have higher BP.

• Race: No difference in race.

http://emedicine.medscape.com/article/889877-overview


PREVALENCE OF HYPERTENSION AND PRE-HYPERTENSION AMONG ADOLESCENTS

Aim: HTN and PreHTN prevalence in adolescence. school screening population

Results:• Cross sectional. Houston, Texas. • N = 6790.• Age 11-17 years.• Ht., Wt. and BP. (oscillomertric) • Repeated BP twice for abnormal BP in different occasions.

• PreHypertensive 15.7%• HTN 3.2%.

Karen L. McNiece, Timothy S. Poffenbarger, Jennifer L. Turner, Kathy D. Franco, Jonathan M. Sorof, Ronald J. Portman, Prevalence of Hypertension and Pre-Hypertension among Adolescents. The Journal of Pediatrics Volume 150, Issue 6, June 2007, Pages 640–644.e1


PREVALENCE OF HYPERTENSION AND ITS ASSOCIATION WITH OBESITY AMONG SCHOOL CHILDREN AGED 6-15 LIVING IN SAKARYA PROVINCE IN TURKEY.

Aim: determine the prevalence of HTN and obesity among school aged 6-15.

Results:• 12 schools randomly selected. • N = 2166.

• HTN present in 15.15%.• Obesity present in 18%

Factors associated with HTN: •Gender and obesity.

•NOT family history. Önsüz FM, Demir F. Prevalence of hypertension and its association with obesity among school

children aged 6-15 living in Sakarya Province in Turkey. Turk J Med Sci. 2015;45(4):907-12.


DIN-DZIETHAM R, LIU Y, BIELO MV, SHAMSA F

• National Survey data.• Non institutionalized population from 1963 – 2002.• Age 8-17.

Results:• PreHTN increased 2.3% (p= 0.0003)• HTN increased by 1% (NS).• HTN was more among African American and Hispanic.

Din-Dzietham R, Liu Y, Bielo MV, Shamsa F - High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation - September 25, 2007; 116 (13); 1488-96

High blood pressure trends in children and adolescents in nationalsurvey, 1963 to 2002.


TEENS AT RISK FOR PROGRESSION TO HIGH BP. DENISE MANN. AMERICAN SOCIETY OF HTN 2006

Aim: rate of progression of BP.

• 8000 adolescent.• Age 13-15.• Single BP checked Two years apart.

Results: • Progression from Prehypertensive to HTN was 7% per year.

• Predictors of HTN:• Wt. in males.• Age in females.

http://www.webmd.com/heart-disease/news/20060519/high-blood-pressure-teens


DETERMINANTS OF BP DISTRIBUTION IN SCHOOL CHILDREN. ANISA M. DURRANI, WASIM FATIMA

Aim: Determining BP percentile distribution and the association with Anthropometric parameters in Aligrah (India).

Results:

• N = 701.

• Age group 12-16 years.

• High BP was present in:• 9.36% of Boys

• 9.46% of girlsAnisa M. Durrani, Wasim Fatima, Determination of BP in School children. European Journal of Public Health.22,3,369-373


HYPERTENSION AND ITS CORRELATES AMONG SCHOOL ADOLESCENTS IN DELHI

Aim: Prevalence of HTN among urban adolescent schools.Association with Anthropometric measurements.

Methodology:Cross sectional. In Central Delhi.

Results:N = 315.Boys 66% (208).Mean Age 14.1 + 0.96.

HTN 1.6% systolic, 5.4% diastolic.Prehypertensive 4.1% systolic, 26% diastolic. Tanu Anand, G. K. Ingle, G. S. Meena, Jugal Kishore, and Rajesh Kumar. Hypertension and Its Correlates

Among School Adolescents in DelhiInt J Prev Med. 2014 Mar; 5(Suppl 1): S65–S70.


PREVALENCE OF HIGH BLOOD PRESSURE IN 122,053 ADOLESCENTS: A SYSTEMATIC REVIEW AND META-REGRESSION.

Aim:1. Systematic review of literature for HTN prevalence.2. Analyze possible factors. 3. Compare the prevalence among developing and developed countries.

Methodology: 55 studies.Till Aug. 2013.

Results:N 122,053Prevalence is:

Total 11.2%.Boys 13% versus Girls 9.6% P < 0.01

De Moraes AC, Lacerda MB, Moreno LA, Horta BL, Carvalho HBPrevalence of high blood pressure in 122,053 adolescents: a systematic review and meta-regression. Medicine (Baltimore) - December 1, 2014; 93 (27); e232


ETIOLOGY OF HTN IN TEENAGERS

• Primary HTN is now increasingly identified in Children and adolescent. • Usually mild form.

• Associated with:• family history.• Over wt.• Metabolic syndrome.

• Secondary HTN is more common.

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. May 2005. NIH Publication No. 05-5267. http: / /www.nhlbi.nih.gov/health/prof/heart /hbp/hbp_ped.pdf. Accessed July 27, 2011


ETIOLOGY OF HYPERTENSION• Renal causes.

• Endocrinal causes.

• Coarctation of the aorta.

• Drug Induced.

• Obstructive sleep apnea.

• Connective Tissue disease.National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. May 2005. NIH Publication No. 05-5267. http: //www.nhlbi.nih.gov/health/prof/heart /hbp/hbp_ped.pdf. Accessed July 27, 2011.

Lurbe E, Cifkova R, Cruickshank JK, et al. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens. 2009;27(9):1719-1742.


RISK FOR DEVELOPING HTN IN TEENAGER• Over wt. & obesity.

• Family history of HTN and CV.

• Male gender.

• Maternal smoking.

• Lack of physical activity.

• Smoking.

Breast feeding reduce risk of HTN.

Race and Ethnicity is not associated with risk.

Riley M., Bluham B., High blood pressure in children and adolescents. American Family Physician; Volume 85, Number 7.April 1, 2012


HISTORY• Birth, growth and development history.

• Screening for:• Urological and renal abnormalities. • Cardiac.• Endocrinal. • Neurological.

•Drugs.

•Sleep pattern.


BP CUFF SIZE

Measuring BP:• Auscultation.• Confirm the Oscillometric

with Auscultation ( > 90%)

• Rt. Arm supported.• Arm at heart level. • Proper size cuff.• Site quite for 5 min.• Chair with back support.• Feet on the ground.


BLOOD PRESSURE ANTHROPOMETRIC CHARTS

FOR BOYS.


BLOOD PRESSURE ANTHROPOMETRIC CHARTS FOR Girls.


PHYSICAL EXAM• BMI.

• Growth.

• Difference between the limbs.

• Abdominal Bruits.

• Ambiguous genitalia.

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. May 2005. NIH Publication No. 05-5267. http: / /www.nhlbi.nih.gov/health/prof/heart /hbp/hbp_ped.pdf. Accessed July 27, 2011


INVESTIGATION FOR CONFIRMED HYPERTENSIVE CHILDREN

• CBC.• Chemistry 6.• Urine Analysis & Cx. • FBS.• Lipids.• Ultrasound for the kidneys. • Echocardiography.

If suspected: • Polysomnography. • Drug screening.

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. May 2005. NIH Publication No. 05-5267. http: / /www.nhlbi.nih.gov/health/prof/heart /hbp/hbp_ped.pdf. Accessed July 27, 2011.


TARGET ORGAN DAMAGE

• LVH is preset in 34-38% of children with mild HTN. (64-66)

• Echo is recommended in all HTN children.

• Increased Carotid intimal thickness. (60)

• Reversible retinopathy reported in 50% of HTN children. (69)


ABPM IN TEENS

• Confirm border line BP.

• Discrepancy between home and office.

• White coat HTN “present in 53% of teens”Lurbe E, Sorof JM, Daniels SR. Clinical and research aspects of ambulatory blood pressure monitoring in children. J Pediatr. 2004;144(1):7-16.

Sorof JM, Portman RJ. White coat hypertension in children with elevated casual blood pressure. J Pediatr. 2000;137(4):493-497.


SYSTOLIC AND DIASTOLIC AMBULATORY BLOOD PRESSURE (SYSTOLIC/DIASTOLIC) VALUES FOR CLINICAL USE

Lurbe et al. Management of high blood pressure in children and adolescents: recommendations of the European Society of HypertensionJournal of Hypertension 2009, Vol 27 No 9. 1719-1742


MANAGEMENT OF BP

Target BP.

• No target organ damage < 95th centile.

• With Target organ Damage <90th centile.

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. May 2005. NIH Publication No. 05-5267. http: / /www.nhlbi.nih.gov/health/prof/heart /hbp/hbp_ped.pdf. Accessed July 27, 2011.


MANAGEMENT OF BP

1- Lifestyle.

2- Medications.


LIFESTYLE MANAGEMENT• Wt. Reduction.

• Daily Na. intake: 1.2gm/day 4-8 years 1.5gm > 8 years

• Regular Exercise.

• Healthy Diet.

• Avoid Tobacco and Alcohol.

• Family counseling for diet and physical activities. U.S. Preventive Services Task Force. Screening for obesity in children and adolescents. January 2010. http://www.uspreventiveservicestaskforce. org/uspstf/uspschobes.htm. Accessed January 20, 2011.

Klatsky AL, Friedman GD, Siegelaub AB, Gérard MJ. Alcohol consumption and blood pressure Kaiser-Permanente Multiphasic Health Examination data. N Engl J Med. 1977;296(21):1194-1200.


INDICATION FOR ANTIHYPERTENSIVE DRUGS

• Symptomatic HTN.

• Secondary HTN.

• Target organ damage.

• DM I & II.

• Persistent HTN despite lifestyle.

NIH Publication No. 05-5267. Revised May 2005


RECOMMENDED INITIAL DOSES FOR SELECTED ANTIHYPERTENSIVE AGENTS FOR THE MANAGEMENT OF HYPERTENSION IN CHILDREN AND ADOLESCENTS

Lurbe et al. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. Journal of Hypertension 2009, Vol 27 No 9. 1719-1742


• National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. May 2005. NIH Publication No. 05-5267. http: / /www.nhlbi.nih.gov/health/prof/heart /hbp/hbp_ped.pdf. Accessed July 27, 2011.

• Lurbe E, Cifkova R, Cruickshank JK, et al. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens. 2009;27(9):1719-1742.

Medical Therapy


N = 2594Boys 1268Girls 1326


CONCLUSION • Hypertension has a high Global Burden.

• Shifting the resources and efforts towards prevention is recommended.

• One third of the screened school sample had abnormal BP.

• Males have higher BP.

• The independent variables correlated with BP were:• Age.• Gender• BMI.• Pulse.

• The nationality and school correlation with BP needs further studies.


BRITISH SCHOOL BAHRAIN

Hypertension amonge teenage years 28

Health & Medicine

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