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
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.
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.
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
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 2012. Study Population School age children, their age 10 to 17 years from both genders.
Sample Size: Epi-Info software program, prevalence of hypertension 4%. at 95% C.I = 1475students. The larger the sample size were enrolled 2009. Patients and Methods
Sample Technique Patients and Methods
Instruments & Data Collection
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.
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
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
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
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
RESULTS AND DISCUSSIONS
Mean Blood Pressure The overall mean systolicand diastolicwere 106.75mmHg and 63.71mmHg, respectively. There was a statistically significant ( P < 0.05)
Prevalence of hypertension prehypertension was 5.5 % hypertension was 3.7% RESULTS AND DISCUSSIONS
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. ( %) 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
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
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
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
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
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
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
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
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
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 = 2.01 -The impact of parental hypertension is most likely the result of shared genes, learned behaviors, shared environmentsor various combinations.
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
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.
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.
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.
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