Tracking of blood pressure in children and adolescents in Germany in the context of risk factors for hypertension

Transcription

1 Tracking of blood pressure in children and adolescents in Germany in the context of risk factors for hypertension G. Sarganas, A. Schaffrath Rosario, C. Albrecht, A. Woll, H. Neuhauser

2 Study population Motorische Leistungsfähigkeit und körperlich-sportliche Aktivität to 17- year-olds 9- to 24- year-olds n =

3 Statistical Analysis Stability of the ranking (the relative position of an individual compared to others) over time Spearman s Rank Correlation Coefficient (0-1) Systolic Percentile at t 0 Child_A 98 Child_B 95 Child_C 89 Child_D 75 Systolic Percentile at t 1 Child_B 96 Child_A 92 Child_D 90 Child_C 76 Proportion of study participants with hypertensive BP at t 0 and t 1 persistent normal, persistent elevated, resolution, incident Prediction of future values from baseline values Predictive value Logistic regression models were used to predict t 1 -BP above the hypertension threshold, with t 0 -BP as well as baseline and follow-up hypertension risk factors 3

4 Stability of the ranking over time Baseline age n Spearman s rank correlation coefficients (all p-values <0.001) SBP DBP 3-6 years All Male Female years All Male Female years All Male Female years All Male Female

5 Proportion of 3-10 year-old-study-participants at baseline ( ) and at follow-up ( ) according to the BP measures (n=2016) Hypertensive BP: SBP or DBP 95 th percentile or 140/90 mmhg Baseline 3- to 10-year-olds Hypertensive BP 7.9% 3.1% Follow-up 9- to 17-year-olds Hypertensive BP 14.7% Normal BP 92.1% 80.6% Normal BP 85.3% 5

6 Proportion of year-old-study-participants at baseline ( ) and at follow-up ( ) according to the BP measures (n= 526) Hypertensive BP at t 0 : SBP or DBP 95th percentile or 140/90 mmhg Hypertensive BP at t 1 ( 18 year olds): 140/90 mmhg Baseline (t 0 ) 11- to 17-year-olds Hypertensive BP 11.2% 3.8% Follow-up (t 1 ) 18- to 24-year-olds Hypertensive BP 15.4% Normal BP 88.8% 77.2% Normal BP 84.6% 6

7 Probability of having hypertensive BP at six-year follow-up according to baseline BP percentiles 3- to 10-year-olds at baseline 11- to 17-year-olds at baseline DGEpi

8 Positive (PPV) and negative predictive value (NPV) of hypertensive BP * at sixyear follow-up in children and adolescents with risk factors in Germany n Proportion at t 0 % (95% CI) PPV % (95% CI) NPV % (95% CI) Baseline age 3 to 10 years Hypertensive BP at t ( ) 39 (32-46) 87 (87-88) Overweight or obesity at t (11-14) 27 (22-32) 87 (86-88) Obesity at t ( ) 36 (23-50) 86 (85-86) Parental hypertension (27-31) 18 (15-20) 87 (86-88) Hypertensive BP and overweight or obesity at t ( ) 48 (33-62) 86 (86-86) Hypertensive BP and obesity at t ( ) 53 (30-76) 86 (85-86) Hypertensive BP at t 0 and parental hypertension ( ) 51 (38-64) 86 (86-87) Baseline age 11 to 17 years Hypertensive BP at t (8.8-14) 34 (24-45) 87 (85-88) Overweight or obesity at t (14-20) 24 (17-33) 87 (85-88) Obesity at t ( ) 50 (27-74) 86 (85-87) Parental hypertension (28-36) 21 (16-26) 87 (85-89) Hypertensive BP and overweight or obesity at t ( ) 35 (17-59) 85 (85-86) Hypertensive BP and obesity at t ( ) 85 (85-85) Hypertensive BP at t 0 and parental hypertension ( ) 48 (30-67) 86 (85-87) n=<10 subjects *Hypertensive BP: SBP or DBP 95th age-, sex- and height-specific percentile or 140/90 mmhg for children and adolescents under 18 years and for adults aged 18 or older 140/90 mmhg. 8

9 Predictors of hypertensive BP at six-year follow-up in children and adolescents in Germany 3- to 10-year-olds at baseline 11- to 17-year-olds at baseline Female Age Baseline BP hypertensive Overweight or obesity resolution persistent incident Sports 1-2 times/week 3 times/week Parental hypertension Low birthweight (<2500g) Female Age Baseline BP hypertensive Overweight or obesity resolution persistent incident Physical activity 2-5 hours/week >5 hours/week Parental hypertension Low birthweight (<2500g)

10 Discussion Strenghts Large national population database Coverage of a wide age-range (3 to 17 years) Six-years follow-up Standardized BP measurements according to the same protocol at baseline and follow-up Limitations Environment and expectation of an extensive motor testing like in the MoMo study could have an influence on BP at follow-up, leading to somewhat higher BP Only two-time-points for our tracking; however, the KiGGS study just completed its second wave, allowing a 10-year follow-up and an analysis of BP trajectories ICHCA Valencia 2018 Tracking of blood pressure in children G. Sarganas 10

11 Summary One in three children and adolescents aged 3 to 17 years with hypertensive BP at baseline had hypertensive BP six-years later Throughout various metrics for assessing tracking (correlation coefficients, PPV, and multivariable predictive modelling): Six-years BP tracking from childhood to adolescence and young adulthood was moderate Among several moderate or weak predictors, BP in childhood and adolescence was the strongest predictor of future BP ICHCA Valencia 2018 Tracking of blood pressure in children G. Sarganas 11

12 THANK YOU FOR YOUR ATTENTION ICHCA Valencia 2018 Tracking of blood pressure in children G. Sarganas 12