Prevalence of Elevated Blood Pressure and BMI in US Children and Adolescents OCONNOR

Impact of BMI and BMI Change on BP Percentile and Change in BP Percentile in Those Age 3-17

Years

Patrick J. O’Connor MD MA MPH1, Emily D. Parker Ph.D. 1,

Joan Lo MD.2 Alan Sinako MD, Matt Daley MD MPH, Elyse Kharbanda MD MPH, Nicole K. Trower BS,1, Heather Tavel BS, Malini Chandra Ph.D., Jay R. Desai MPH1 ,

Karen L. Margolis MD MPH1, David J. Magid MD MPH3

1HealthPartners Research Foundation, Minneapolis, MN;2Kaiser Permanente of Northern California, Oakland, CA3Kaiser Permanente of Colorado, Denver, CO; Division of Research,

Duality of Interest: Dr. O’Connor

• No duality of Interest

• Funded by NIH, NHLBI R01 HL093345

Significance

• Overweight (BMI 85-95th percentile) and obesity (BMI >= 95th percentile) are massive problems in children and adolescents

• BMI increases may be driving increased prevalence of elevated Bp in these age groups

• EMRs enable surveillance of patterns in BP and BMI over time

Design, Study Sites, Data Sources

• Retrospective Cohort Study• 3-HMO sites: KP Colorado, KP Northern

California, HealthPartners• Pediatric Hypertension Superset for Project • Years of Data: 2007-2011, more coming• Used about 10 Data Tables: demo, vitals, Dx,

Rx, diagnoses, enrollment, utilization, etc.

Study Subjects

• Age 3-17 years• In 2007-2011, have at least one outpatient

visit with an eligible BP measure• Eligible BP measure means BP with a height

+/- 90 days of BP (to compute BP percentile)• About XXX study subjects in analysis• About XXX person-years of data

Blood Pressure Percentile

• BP value is adjusted for gender, age, and height using a standard CDC equation to compute BP percentile

Existing Hypertension

• Hypertension diagnosis: was there 1+ HT diagnosis code (401.xx) within first year

• Hypertension treatment: 1+ fills for HT medication

• Excluded clonidine, used mostly for behavioral reasons

Covariates

• Age • Sex• Race• SES (geocoded)• Baseline BMI percentile• Baseline BP percentile

Dependent Variables

• BP percentile (cross sectional with baseline BMI percentile)

• Change in BP percentile (function of baseline BMI percentile)

• Change in BP percentile (function of change in BMI percentile over time)

Analysis Plan• Consistency of data across sites• Distributions of BP and BMI data• BP percentile (cross sectional with baseline

BMI percentile) (adjusted and unadjusted)• Change in BP percentile (function of baseline

BMI percentile) (adjusted and unadjusted)• Change in BP percentile (function of change in

BMI percentile over time)(adjusted and unadjusted)

SBP % over time as function of baseline BMI %

0 6 12 24 36 480

10

20

30

40

50

60

70

80

90

100

BMI <85thBMI 85th-<95thBMI >=95thSeries4

months

SBP

perc

entil

e

0 6 12 24 36 480

10

20

30

40

50

60

70

80

90

100

3-5 year olds

BMI <85thBMI 85th-<95thBMI >=95th

months

SBP

perc

entil

e

0 6 12 24 36 480

10

20

30

40

50

60

70

80

90

100

6-8 year olds


months

SBP

perc

entil

e

0 6 12 24 36 480

10

20

30

40

50

60

70

80

90

100

9-11 year olds


months

SBP

perc

entil

e

0 6 12 24 36 480

10

20

30

40

50

60

70

80

90

100

12-14 year olds


months

SBP

perc

entil

e

0 6 12 24 360

10

20

30

40

50

60

70

80

90

100

15-17 year olds


months

SBP

perc

entil

e

0 0.5 1 2 3 40

20

40

60

80

100

120

SBP <90thSBP 90th-<95thSBP 95th-99thSBP >99th

months

BMI p

erce

ntile

BMI % over time as a function of baseline SBP %

0 0.5 1 2 3 40

20

40

60

80

100

120

3-5 year olds


months

BMI p

erce

ntile

0 0.5 1 2 3 40

20

40

60

80

100

120

6-8 year olds


months

BMI p

erce

ntile

0 0.5 1 2 3 40

20

40

60

80

100

120

9-11 year olds


months

BMI p

erce

ntile

0 0.5 1 2 3 40

20

40

60

80

100

120

12-14 year olds


months

BMI p

erce

ntile

0 0.5 1 2 3 40

20

40

60

80

100

120

15-17 year olds


months

BMI p

erce

ntile

Table 1. Data from Two Study Sites

Total N 3-5 years 6-8 years 9-11 years 12-14 years 15-17 years

79838 14919 12301 15703 18018 18897

Normal BP 47843 9658 7563 9634 10595 10393

Pre-HT 30731 5169 4631 5903 7051 7977

HT 1264 92 107 166 372 527

Normal Weight 56289 12228 8810 10438 11979 12834

Overweight 11930 1571 1681 2504 2990 3184

Obese 11619 1120 1810 2761 3049 2879

No Risk factors 37314 8137 5932 7152 7988 8105

One of the 2 risk factors

29504 5612 4509 5768 6598 7017

Both Risk Factors 13020 1170 1860 2783 3432 3775

** Tables 1, 2, 3: Data in these tables came from two study sites. Each subjet counted in the table had at least 3 blood pressure measurements taken (2007-2009). Hypertension is defined by at least 3 or more elevated blood pressures >=95th percentile. Normal weight, overweight and obese were defined by the baseline BMI percentile.

Table 2. Data From Two Sites, Girls

Total N 3-5 years 6-8 years 9-11 years 12-14 years 15-17 years

40900 7052 5748 7663 9238 11199

Normal BP 24578 4651 3524 4752 5721 5930

Pre-HT 15735 2354 2175 2838 3356 5012

HT 587 47 49 73 161 257

Normal Weight 29304 5787 4216 5316 6232 7753

Overweight 6231 764 757 1182 1619 1909

Obese 5365 501 775 1165 1387 1537

No Risk factors 19507 3946 2830 3657 4355 4719


14868 2546 2080 2754 3243 4245

Both Risk Factors

6525 560 838 1252 1640 2235

Table 3. Data From Two Sites, BoysTotal N 3-5 years 6-8 years 9-11 years 12-14 years 15-17 years

38938 7867 6553 8040 8780 7698

Normal BP 23265 5007 4039 4882 4874 4463

Pre-HT 14996 2815 2456 3065 3695 2965

HT 677 45 58 93 211 270

Normal Weight 26985 6441 4594 5122 5747 5081

Overweight 5699 807 924 1322 1371 1275

Obese 6254 619 1035 1596 1662 1342

No Risk factors 17807 4191 3102 3495 3633 3386


14636 3066 2429 3014 3355 2772

Both Risk Factors

6495 610 1022 1531 1792 1540

Conclusions—1

Conclusions—2

Conclusions—3

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Prevalence of Elevated Blood Pressure and BMI in US Children and Adolescents OCONNOR

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