Hypertension in Teenage years Jafar Al-Said. M.B.ChB. MD. FASN. FACP. Chair of Internal Medicine. Nephrology and Internal medicine Consultant. Bahrain Specialist Hospital Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Scheme Introduction. Magnitude of the problem. Definition of Teenage HTN. International Data. Hypertension and obesity screening among High and middle schools in Bahrain. Conclusion. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

2014 Global HTN prevalence 36% 45% HTN GLOBAL PREVALENCE 39% 41% 38% 35% 41% 36% 45% HTN GLOBAL PREVALENCE 39% Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Assuming a Stable Prevalence of 39% of the Global population The Predicted Increment in Hypertensive Patients During the 21st Century Assuming a Stable Prevalence of 39% of the Global population Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016 Jafar Al-Said. Global HTN prevalence during the 21st Century. Poster at ESH 2015. Milano.

Definition of Teenage HTN Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Measure BP at each office visit for > 3 years age Classification of Prehypertension and Hypertension in children and Adolescent Measure BP at each office visit for > 3 years age National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. May 2005. NIH Publication No. 05-5267. http: / /www.nhlbi.nih.gov/health/prof/heart /hbp/hbp_ped.pdf. Accessed July 27, 2011. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Hypertension in adolescents. Undiagnosed: 75% of the cases of HTN. 90% of Prehypertensive Aglony M, Acevedo M, Ambrosio G - Expert Rev Cardiovasc Ther - December 1, 2009; 7 (12); 1595-603 Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Prevalence of HTN among Pediatric age Edwin Rodriguez-Cruz, P Syamasundar Rao. United States Data. Updated July 2015 2 – 5% of Children has HTN. Gender difference: < 6 years similar BP. 6- puberty slightly higher in girls. till puberty. Adolescent males have higher BP. Race: No difference in race. http://emedicine.medscape.com/article/889877-overview Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Prevalence of Hypertension and Pre-Hypertension among Adolescents Aim: HTN and PreHTN prevalence in adolescence. school screening population Results: Cross sectional. Houston, Texas. N = 6790. Age 11-17 years. Ht., Wt. and BP. (oscillomertric) Repeated BP twice for abnormal BP in different occasions. PreHypertensive 15.7% HTN 3.2%. Karen L. McNiece, Timothy S. Poffenbarger, Jennifer L. Turner, Kathy D. Franco, Jonathan M. Sorof, Ronald J. Portman, Prevalence of Hypertension and Pre-Hypertension among Adolescents. The Journal of Pediatrics Volume 150, Issue 6, June 2007, Pages 640–644.e1 Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Prevalence of hypertension and its association with obesity among school children aged 6-15 living in Sakarya Province in Turkey. Aim: determine the prevalence of HTN and obesity among school aged 6-15. Results: 12 schools randomly selected. N = 2166. HTN present in 15.15%. Obesity present in 18% Factors associated with HTN: Gender and obesity. NOT family history. Önsüz FM, Demir F. Prevalence of hypertension and its association with obesity among school children aged 6-15 living in Sakarya Province in Turkey. Turk J Med Sci. 2015;45(4):907-12. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Din-Dzietham R, Liu Y, Bielo MV, Shamsa F High blood pressure trends in children and adolescents in national survey, 1963 to 2002. Din-Dzietham R, Liu Y, Bielo MV, Shamsa F National Survey data. Non institutionalized population from 1963 – 2002. Age 8-17. Results: PreHTN increased 2.3% (p= 0.0003) HTN increased by 1% (NS). HTN was more among African American and Hispanic. Din-Dzietham R, Liu Y, Bielo MV, Shamsa F - High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation - September 25, 2007; 116 (13); 1488-96 Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Teens At risk for Progression to High BP. Denise Mann Teens At risk for Progression to High BP. Denise Mann. American society of HTn 2006 Aim: rate of progression of BP. 8000 adolescent. Age 13-15. Single BP checked Two years apart. Results: Progression from Prehypertensive to HTN was 7% per year. Predictors of HTN: Wt. in males. Age in females. http://www.webmd.com/heart-disease/news/20060519/high-blood-pressure-teens Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Determinants of BP distribution in School Children. Anisa M Determinants of BP distribution in School Children. Anisa M. Durrani, Wasim Fatima Aim: Determining BP percentile distribution and the association with Anthropometric parameters in Aligrah (India). Results: N = 701. Age group 12-16 years. High BP was present in: 9.36% of Boys 9.46% of girls Anisa M. Durrani, Wasim Fatima, Determination of BP in School children. European Journal of Public Health.22,3,369-373 Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Hypertension and Its Correlates Among School Adolescents in Delhi Aim: Prevalence of HTN among urban adolescent schools. Association with Anthropometric measurements. Methodology: Cross sectional. In Central Delhi. Results: N = 315. Boys 66% (208). Mean Age 14.1 + 0.96. HTN 1.6% systolic, 5.4% diastolic. Prehypertensive 4.1% systolic, 26% diastolic. Tanu Anand, G. K. Ingle, G. S. Meena, Jugal Kishore, and Rajesh Kumar. Hypertension and Its Correlates Among School Adolescents in DelhiInt J Prev Med. 2014 Mar; 5(Suppl 1): S65–S70. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Prevalence of high blood pressure in 122,053 adolescents: a systematic review and meta-regression. Aim: Systematic review of literature for HTN prevalence. Analyze possible factors. Compare the prevalence among developing and developed countries. Methodology: 55 studies. Till Aug. 2013. Results: N 122,053 Prevalence is: Total 11.2%. Boys 13% versus Girls 9.6% P < 0.01 De Moraes AC, Lacerda MB, Moreno LA, Horta BL, Carvalho HBPrevalence of high blood pressure in 122,053 adolescents: a systematic review and meta-regression. Medicine (Baltimore) - December 1, 2014; 93 (27); e232 Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Etiology of HTN in teenagers Primary HTN is now increasingly identified in Children and adolescent. Usually mild form. Associated with: family history. Over wt. Metabolic syndrome. Secondary HTN is more common. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. May 2005. NIH Publication No. 05-5267. http: / /www.nhlbi.nih.gov/health/prof/heart /hbp/hbp_ped.pdf. Accessed July 27, 2011 Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Etiology of Hypertension Renal causes. Endocrinal causes. Coarctation of the aorta. Drug Induced. Obstructive sleep apnea. Connective Tissue disease. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. May 2005. NIH Publication No. 05-5267. http: //www.nhlbi.nih.gov/health/prof/heart /hbp/hbp_ped.pdf. Accessed July 27, 2011. Lurbe E, Cifkova R, Cruickshank JK, et al. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens. 2009;27(9):1719-1742. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Risk for developing HTN in teenager Over wt. & obesity. Family history of HTN and CV. Male gender. Maternal smoking. Lack of physical activity. Smoking. Breast feeding reduce risk of HTN. Race and Ethnicity is not associated with risk. Riley M., Bluham B., High blood pressure in children and adolescents. American Family Physician; Volume 85, Number 7.April 1, 2012 Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

History Birth, growth and development history. Screening for: Urological and renal abnormalities. Cardiac. Endocrinal. Neurological. Drugs. Sleep pattern. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

BP Cuff size Measuring BP: Auscultation. Confirm the Oscillometric with Auscultation ( > 90%) Rt. Arm supported. Arm at heart level. Proper size cuff. Site quite for 5 min. Chair with back support. Feet on the ground. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

BLOOD PRESSURE ANTHROPOMETRIC CHARTS FOR BOYS. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

BLOOD PRESSURE ANTHROPOMETRIC CHARTS FOR Girls. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Physical Exam BMI. Growth. Difference between the limbs. Abdominal Bruits. Ambiguous genitalia. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. May 2005. NIH Publication No. 05-5267. http: / /www.nhlbi.nih.gov/health/prof/heart /hbp/hbp_ped.pdf. Accessed July 27, 2011 Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Investigation for Confirmed Hypertensive Children CBC. Chemistry 6. Urine Analysis & Cx. FBS. Lipids. Ultrasound for the kidneys. Echocardiography. If suspected: Polysomnography. Drug screening. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. May 2005. NIH Publication No. 05-5267. http: / /www.nhlbi.nih.gov/health/prof/heart /hbp/hbp_ped.pdf. Accessed July 27, 2011. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Target Organ damage LVH is preset in 34-38% of children with mild HTN. (64-66) Echo is recommended in all HTN children. Increased Carotid intimal thickness. (60) Reversible retinopathy reported in 50% of HTN children. (69) Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

ABPM in Teens Confirm border line BP. Discrepancy between home and office. White coat HTN “present in 53% of teens” Lurbe E, Sorof JM, Daniels SR. Clinical and research aspects of ambulatory blood pressure monitoring in children. J Pediatr. 2004;144(1):7-16. Sorof JM, Portman RJ. White coat hypertension in children with elevated casual blood pressure. J Pediatr. 2000;137(4):493-497. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Systolic and diastolic ambulatory blood pressure (systolic/diastolic) values for clinical use Lurbe et al. Management of high blood pressure in children and adolescents: recommendations of the European Society of HypertensionJournal of Hypertension 2009, Vol 27 No 9. 1719-1742 Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Management of BP Target BP. No target organ damage < 95th centile. With Target organ Damage <90th centile. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. May 2005. NIH Publication No. 05-5267. http: / /www.nhlbi.nih.gov/health/prof/heart /hbp/hbp_ped.pdf. Accessed July 27, 2011. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

1- Lifestyle. 2- Medications. Management of BP Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Lifestyle Management Wt. Reduction. Daily Na. intake: 1.2gm/day 4-8 years 1.5gm > 8 years Regular Exercise. Healthy Diet. Avoid Tobacco and Alcohol. Family counseling for diet and physical activities. U.S. Preventive Services Task Force. Screening for obesity in children and adolescents. January 2010. http://www.uspreventiveservicestaskforce. org/uspstf/uspschobes.htm. Accessed January 20, 2011. Klatsky AL, Friedman GD, Siegelaub AB, Gérard MJ. Alcohol consumption and blood pressure Kaiser-Permanente Multiphasic Health Examination data. N Engl J Med. 1977;296(21):1194-1200. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Indication for Antihypertensive Drugs Symptomatic HTN. Secondary HTN. Target organ damage. DM I & II. Persistent HTN despite lifestyle. NIH Publication No. 05-5267. Revised May 2005 Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Recommended initial doses for selected antihypertensive agents for the management of hypertension in children and adolescents Lurbe et al. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. Journal of Hypertension 2009, Vol 27 No 9. 1719-1742 Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Medical Therapy National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. May 2005. NIH Publication No. 05-5267. http: / /www.nhlbi.nih.gov/health/prof/heart /hbp/hbp_ped.pdf. Accessed July 27, 2011. Lurbe E, Cifkova R, Cruickshank JK, et al. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens. 2009;27(9):1719-1742. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

N = 2594 Boys 1268 Girls 1326 Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Conclusion Hypertension has a high Global Burden. Shifting the resources and efforts towards prevention is recommended. One third of the screened school sample had abnormal BP. Males have higher BP. The independent variables correlated with BP were: Age. Gender BMI. Pulse. The nationality and school correlation with BP needs further studies. Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016

BRITISH SCHOOL BAHRAIN Jafar Al-said. Second Gulf Hypertension Conference 27-28/Jan. 2016