1. Prevalence of Hypertension in Minority School –Aged Children in North-West Arkansas Mohammad Ilyas, M.D., Eduardo R. Ochoa,M.D., Creshelle R. Nash, M.P.H., M.D., Patricia Minor, B.S.N., R.N., Hanan M. Givens, B.S., Kathy Powers, R.N., Marianne Neighbors, Ed.D., B.S.N., Kathleen Barta, Ed.D., R.N., Wynona Bryant-Williams, Ph.D.

2. Outline The Arkansas Minority Health Commission Hypertension in Children The Springdale Study – Background – Methods The Results The Conclusion and Implications Question and Answer

3. The Arkansas Minority Health Commission Formed in 1991 The mission of AMHC: “to assure all minority Arkansans access to health care that is equal to the care provided to other citizens of the state and to seek ways to provide education, address, treat, and prevent diseases and conditions that are prevalent among minority populations”

4. The Arkansas Minority Health Commission Study issues relating to the delivery of and access to health services to minorities in the state Identify any gaps in the health service delivery system Make recommendations to the relevant agencies and to the legislature to improve health care delivery

5. The Arkansas Minority Health Commission In 2000 the Arkansas Legislature passed Initiated Act I for the administration of the Targeted State Needs Programs utilizing a portion of Arkansas Tobacco Settlement funds establishing the Minority Health Initiative (MHI) administered by the AMHC. – Increase awareness of hypertension, strokes and other disorders. – Provide screening or access to screening for hypertension, strokes and other disorders. – Develop intervention strategies

6. Percentage of students classified as overweight or at risk for overweight by Arkansas public school district (Year 3) Source: ACHI. The Arkansas Assessment of Childhood and Adolescent Obesity—Tracking Progress (Year 3 Fall 2005–Spring 2006). Little Rock, AR: ACHI; September 2006.

7. The Arkansas Minority Health Commission In 2000 the Arkansas Legislature passed Initiated Act I for the administration of the Targeted State Needs Programs utilizing a portion of Arkansas Tobacco Settlement funds establishing the Minority Health Initiative (MHI) administered by the AMHC. – Increase awareness of hypertension, strokes and other disorders. – Provide screening or access to screening for hypertension, strokes and other disorders. – Develop intervention strategies

8. Overweight and Hypertension in Children Ogden CL et al. JAMA 2002Sorof JM et al. Pediatrics 2004

9. The Third Annual Arkansas Assessment of Childhood and Adolescent Obesity. ACHI. August 2006

10. Percent at risk for overweight & overweight by grade and ethnicity Source: Thompson et al, Morbidity and Mortality Weekly Reports January 2006; 55(1):5-8.

11. Tracking of Blood Pressure Bogalusa Heart Study showed 40% individuals with SBP > 80 th percentile at baseline had levels above that 15 years later DBP tracking seen in 37% individuals The ability to predict BP levels in adulthood from measurements in childhood would provide the opportunity to intervene before hypertension is established, thereby reducing the CVD risk. (Lane et al. J Human Hypertension 2004)

12. Hypertension and Cardiovascular risk University of Rochester NY Patients with primary hypertension (10-18 y) Matched normotensive controls All patients had ABPM, Echocardiogram, Carotid ultrasound LVMI, and cIMT did not correlate with weight, BMI but correlated with ABPM parameters Lande, M. B. et al. Hypertension 2006;48:40-44

13. Copyright ©2006 American Heart Association Lande, M. B. et al. Hypertension 2006;48:40-44 Relationship between cIMT and daytime SBP index

14. Obesity in Children Act 1220 and the BMI initiative Findings relevant to AMHC concerns Marianna Pilot Increasing diversity across the state and particularly in NW corridor Addressing obesity and HTN in high risk populations

15. Aims To investigate the prevalence of hypertension in school aged children in Springdale schools that have a large minority population. To determine what percent of these hypertensive children were previously undiagnosed. To refer children with high blood pressure for further evaluation and care. Education of school nurses and other nurses in the area in proper blood pressure measurement.

16. Ground Work Schools – Springdale High – Bayyari Elementary Meeting with School District – Dr. Rollins – Sharla Brackett – Barbra Ludwig, Kathy Launder Involvement of School nurses and Nursing Educators in the area – Dr. Marianne Neighbors, RN – Dr. Kathleen Barta, RN Passive Consent

17. The Partnership Arkansas Minority Health Commission Arkansas Children’s Hospital University of Arkansas for Medical Sciences Eleanor Mann School of Nursing Springdale School District

18. Blood Pressure Measurement Training Interactive BP measurement training – Selection of proper BP cuff – MAC – BP charts, definitions – Apparatus – Proper BP measurement in children

19. Screening Day

20. Blood Pressure Screening Information – Name (to be kept at school) – Subject unique ID number – Date of birth and age – Gender – Ethnicity – Race – Ht. Wt. Heart rate – Mid arm circumference – Size of BP cuff used – 3 sets of BP measurements

21. Height & Weight Assent Students seated, MAC Choose proper cuff Students from Classes 5 min rest, 3 oscillatory BP readings, 1 min interval Omron HEM 907

22. Definitions Normal – SBP and DBP <90 th percentiles for gender, age, and height Pre-hypertension – Average SBP or DBP between 90 th and 95 th percentiles or > 120/80 mm Hg Hypertension – Average SBP and/or DBP > 95 th for gender, age, and height on more than 3 occasions Fourth Report on BP. Pediatrics August 2004

23. Height & Weight Assent Students seated, MAC Choose proper cuff Auscultatory BP Students from Classes 5 min rest, 3 oscillatory BP readings, 1 min interval

24. Height & Weight Assent Students seated, MAC Choose proper cuff Auscultatory BP Students from Classes 5 min rest, 3 oscillatory BP readings, 1 min interval Information to SN For follow up 2 more BP if need (2 week apart) Referral to PCP Follow up

25. The Study Population N= 475 GenderMale 243 (51.2%) Female 232 (48.8%) Grade4 th 85 (17.9%) 10 th 390 (82.1%) RaceBlack 15 (3.2%) White 256 (53.9%) Asian/PI 37 (7.8%) Native American 2 (0.4%) EthnicityHispanic 244 (51.4%) Non-Hispanic 231 (48.6%)

26. The Results: Over-Weight or At Risk of Over-Weight 4 th Grade56.6% 10 th Grade46.1% *BMI greater than 85 percentile for Age

27. First screening : N= 475 65/475 27/475 17/2517/473 7/12 7/469 Second screening : N= 25 Third screening : N= 12 Estimated Prevalence

28. School Blood Pressure Screening Authors AgeNumberMethodPrevalenc e Year Moore et al5-19747Oscillatory HEM 907 18.4%, 5.1%, 2.8% 2006 Chiolero et al12-135207Oscillatory11.4%, 3.8%, 2.2% 2007 Genovesi et al 6-112416Auscultatory mercury 8.8%, 4.2%2005 Jago et al12-141740Oscillatory HEM 907 13.8%2005 Sorof et al10-195102Oscillometry Spacelabs 19%, 9.5%, 4.5% 2002

29. The Results: Prevalence of Increased Blood Pressure NumberPercent 1 st Screening Oscillatory4 th 4 10 th 61 4.7% 15% Ascultatory4 th 1 10 th 26 1.2% 6.6% 2 nd Screening4 th 1 10 th 16 1.1% 4% 3 rd Screening4 th 1 10 th 6 1.1% 1.5%

30. Conclusion A high percentage of school children in studied population are overweight or at risk of being overweight A large percentage of school children had elevated blood pressure( 14%) at first screening Study identified 7 newly diagnosed hypertensive children. One did not have PCP – 2 Asian/PI, 3 Hispanic and 2 Caucasian

31. The Implications What is the policy? Other Consequences Effective Partnerships Health Professional Education Opportunities for Community-Based Research and health improvement Individual Mentoring

32. Questions????