PREVALENCE OF HYPERTENSION AND ITS ASSOCIATED RISK FACTORS AMONG SCHOOL AGE CHILDREN

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1 PREVALENCE OF HYPERTENSION AND ITS ASSOCIATED RISK FACTORS AMONG SCHOOL AGE CHILDREN DR.AZAD ABDUL JABAR HALEEM AL-MEZORI- Dohuk Medical school/ University of Duhok-Kurdistan- Iraq Prof. Dr. AbbasAl-Rabaty-HawlerMedical University-Iraq Prof. Dr. Lekhraj Rampal- University of Putra Malaysia

2 INTRODUCTION Hypertensionforms a major public health problem all over the world. A growing body of evidence has documented increased prevalence and risk factors of chronic conditions in children including obesity and hypertension.

3 Various factors influence blood pressure, including age, sex, weight, race, nutrition profile and environmental factors. There is evidence that childhoodhypertension can lead to adult hypertension.

4 Aims of the study Socio-demographic factors Age Gender Lifestyle related factors Smoking BMI Prevalence of Hypertension Family history Family history of Hypertension Family history of obesity/overweight Family history of smoking

5 Patients and Methods study location Duhok and Erbil in Iraq. Study Design A cross-sectional study Study duration 5 th February 2012 to 10 th July Study Population School age children, their age 10 to 17 years from both genders.

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

7 Sample Technique Patients and Methods

8 Instruments & Data Collection

9 Anthropometric measurements Height and Weightwere measured BMI were calculated by ratio of weight (kg) to height (m) squared (kg/m 2 ). CDC were used to establish BMI percentiles.

10 Children were classified based on these percentiles as follows: < 5th percentile underweight, 5th to < 85th percentile Healthy weight, 85th to < 95th percentile overweightand 95 th obese. Anthropometric measurements

11 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. Patients and Methods

12 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. PrehypertensionBP 90th percentile but <95th percentile. HypertensionBP 95 th percentile at all 3 visits. Patients and Methods

13 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

14 RESULTS AND DISCUSSIONS

15 Mean Blood Pressure The overall mean systolicand diastolicwere mmHg and 63.71mmHg, respectively. There was a statistically significant ( P < 0.05)

16 Prevalence of hypertension prehypertension was 5.5 % hypertension was 3.7% RESULTS AND DISCUSSIONS

17 Prevalence of hypertension by the Age The mean age was 13.7years (10-17) years. BP significantlyincreasing 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. ( %) (9.1%) 177 (97.3%) 5 (2.7%) 0 (0%) (9.6%) 184 (95.3%) 8 (4.1%) 1 (0.5%) (16.5%) 309 (93.1%) 12 (3.6%) 11 (3.3%) (12.9%) 234 (90.3%) 17 (6.6%) 8 (3.1%) (13.3) 238 (89.1%) 19 (7.1%) 10 (3.7%) (7.8%) 141 (89.8%) 8 (5.1%) 8 (5.1%) (18.9%) 330 (87.1%) 29 (7.7%) 20 (5.3%) (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

18 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 notsignificant

19 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 Discussion

20 Hypertension and BMI Prevalence of Over weight was 15.2% While the prevalence of Obesity was 12.1%. 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

21 There are many causes behind increase blood pressure in obesity such as; Sympathetic nervous system imbalance. Impairment of the physiological mechanism of pressure natriuresis. Hyperinsulinemia. and early vascular changes. Effect of Leptin. Discussion

22 Hypertension and smoking Variables No. ( %) Smoking Normal Pre hypertension Hypertension No. ( %) No. ( %) No. ( %) 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

23 The cigarette smoking causes sympathetic activation, oxidative stress, and stiffening arteries. acute vasopressor effects that are associated with increased markers of inflammation which are linked with hypertension. PLEASE let us to work hardly to move the world to a smoking free state. Discussion

24 Hypertension and Physical Activity Variables No. ( %) Physical activity Normal Pre hypertension Hypertension No. ( %) No. ( %) No. ( %) 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

25 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. Increase endothelium-dependent vasodilatation through production of nitric oxide. Discussion

26 Hypertension and family history 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 = The impact of parental hypertension is most likely the result of shared genes, learned behaviors, shared environmentsor various combinations.

27 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

28 Hypertension and family history of smoking Variable No. ( %) Family history of smoking NORMAL PRE HYPERTENSION HYPERTENSION No. ( %) No. ( %) No. ( %) 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 The study's results suggest that promoting smoke-free homes may protect cardiovascular health in children as well as adults.

29 Limitation of study First, there is an association between hypertensionand obesitybut since this is a cross sectional study, direction of causality cannot be definitely stated. A longitudinalstudy would be desirable in the future. Second, the trustworthiness and accuracy of the provided information by questionnaire (physical activity, smoking ) may present underestimated or overestimated values, since they reflect socially desirable and undesirable behaviors.

30 Recommendations It is recommended that weight, heightand blood pressure should be assessed regularly in children and adolescents to identify individuals at risk. Prevention of cardiovascular risk factors in early childhood may be an important step in preventing noncommunicable diseases.

31 THANKS

Depok-Indonesia STEPS Survey 2003

Depok-Indonesia STEPS Survey 2003 The STEPS survey of chronic disease risk factors in Indonesia/Depok was carried out from February 2003 to March 2003. Indonesia/Depok carried out Step 1, Step 2 and Step 3. Socio demographic and behavioural