Eva amoako atta

Development of blood pressure percentile tables for children from African and Caribbean backgrounds living in the UK

Eva A-Attah (MB BS, MPH)

Institute for Health Research & Policy

12th November 2010

Outline For Presentation

Background Aims & Objectives Method Results Summary of findings Conclusion/Recommendation

BACKGROUND High BP(Hypertension)

– World #1 cause of death.

Hypertension= sustained raised systolic and diastolic BP

High prevalence of Hypertension in UK.

-32% men & 30% women,71%(over 75’s)

Effects of High BP

High BP in Caribbean & African Children

Higher prevalence of hypertension in Caribbean & Africans than Caucasians observed. Obesity predisposes to high BP in children.

Association between adult and childhood BP established.

Childhood BP Monitoring

BP Monitoring - Best way to diagnose hypertension.

Parameters for BP monitoring in children (age, gender & height)

Height impt to avoid misclassification.

CDC-US has developed BP tables for girls and boys.

Objectives

-To develop BP percentile tables for African and Caribbean children for easy monitoring of their BP.

-To identify African and Caribbean children aged 5-18yrs with abnormally high BP.

-To ascertain the BP levels of African and Caribbean children for clinical and research purposes.

Subjects and methods Raw data was obtained from the Health Survey for

England 1991 to 2008.

The data was sorted to obtain a total of 900 African and Caribbean children aged 5 – 18 years.

The Normal Distribution of the data was verified using LMS method which is based on the British 1990 reference data.

Diastolic and systolic blood pressures as well as height, weight and body mass index of the children were retrieved for analysis using SPSS version 17. Out of the total number of children, 99% had valid parameters which could be analysed.

Methods cont. The analysis of the data entailed the sorting out

of the data into various age groups and gender.

For each age group and gender, the 50th, 75th, 90th and 95th height percentile were determined

Then for each height percentile of a particular age group and gender, the respective 50th, 90th, 95th and 99th percentile of both the systolic and diastolic pressures determined.

The results were then tabulated.

RESULTSTABLE FOR BP LEVELS FOR AFRICAN-CARIBBEAN CHILDREN AGED 5-8 YEARS

MALES

Age BP Percentile

SBP, mmHg DBP, mmHg

Percentile of Height Percentile of Height

50th 75th 90th 95th 50th 75th 90th 95th

5

50th 99 102 101 102 52 52 53 55

90th 104 104 105 105 68 67 66 68

95th 104 104 107 107 68 68 68 72

99th 104 104 107 107 68 68 68 72

6

50th 101 102 102 102 59 59 59 59

90th 128 126 125 125 74 74 73 72

95th 128 128 128 128 74 76 75 75

99th 128 128 128 128 74 78 78 78

7

50th 106 106 108 108 60 58 58 58

90th 120 122 122 122 72 72 73 73

95th 120 126 124 124 73 73 74 74

99th 120 130 130 130 73 74 75 75

8

50th 107 107 107 108 62 60 61 62

90th 120 116 120 122 81 76 74 73

95th 120 120 122 138 81 81 81 81

99th 120 120 122 138 81 81 81 81

RESULTS TABLE FOR BP LEVELS FOR AFRICAN-CARIBBEAN CHILDREN AGED 9-12 YEARS

MALES

Age BP Percentile

SBP, mmHg DBP, mmHg



9

50th 111 111 111 111 61 61 61 60

90th 115 116 118 120 71 75 74 73

95th 119 118 120 123 78 78 78 78

99th 119 119 120 123 78 79 79 79

10

50th 108 112 109 110 62 61 59 59

90th 132 131 127 126 76 73 70 70

95th 137 134 132 132 81 78 77 76

99th 137 137 137 137 82 82 82 82

11

50th 108 110 109 110 56 58 57 57

90th 127 121 120 122 65 71 69 68

95th 134 132 129 128 66 72 72 72

99th 134 134 134 134 66 72 72 72

12

50th 114 114 111 113 58 58 57 58

90th 123 127 124 123 71 76 73 72

95th 128 128 128 128 77 82 82 82

99th 128 128 128 128 77 82 82 82

RESULTS

TABLE FOR BP LEVELS FOR AFRICAN-CARIBBEAN CHILDREN AGED 13-15 YEARS

MALES

Age BP Percentile

SBP, mmHg DBP, mmHg



13

50th 116 119 120 120 62 62 62 61

90th 138 138 138 138 65 67 68 68

95th 138 139 138 138 67 69 69 69

99th 138 139 139 139 67 69 70 70

14

50th 115 118 118 119 55 55 55 56

90th 128 131 130 131 75 75 75 75

95th 137 150 146 144 76 85 83 81

99th 137 156 156 156 76 90 90 90

15

50th 112 114 114 112 55 55 53 54

90th 126 126 126 126 64 63 63 63

95th 126 132 131 130 64 64 64 64

99th 126 133 133 133 64 64 64 64

RESULTS


MALES

Age BP Percentile

SBP, mmHg DBP, mmHg



16

50th 116 117 117 116 53 53 53 53

90th 130 131 129 128 72 70 69 69

95th 134 133 133 133 79 77 76 76

99th 134 134 134 134 79 79 79 79

17

50th 119 118 118 118 57 60 61 61

90th 133 133 133 133 82 76 75 77

95th 136 135 135 140 87 85 84 84

99th 136 136 136 143 87 87 87 87

18

50th 119 120 120 120 73 66 62 64

90th 133 138 136 143 76 75 75 75

95th 133 139 139 146 76 76 76 76

99th 133 139 139 146 76 76 76 76


FEMALES

Age BP Percentile

SBP, mmHg DBP, mmHg



5

50th 105 104 104 104 57 56 56 56

90th 118 110 106 106 80 71 68 68

95th 121 121 121 121 84 84 84 84

99th 121 121 121 121 84 84 84 84

6

50th 106 103 104 103 58 57 57 57

90th 113 113 113 113 67 67 67 67

95th 117 116 117 117 67 70 70 70

99th 117 117 117 117 67 72 72 72

7

50th 106 106 107 106 61 61 61 61

90th 110 112 113 113 76 76 76 76

95th 112 113 118 118 76 76 77 77

99th 112 113 118 118 76 76 81 81

8

50th 104 104 104 104 61 62 63 63

90th 115 116 116 116 74 70 69 72

95th 116 119 119 119 76 76 76 76

99th 116 119 119 119 76 76 76 76


FEMALES

Age BP Percentile

SBP, mmHg DBP, mmHg



9

50th 104 104 104 105 56 56 55 56

90th 119 119 119 119 65 63 65 66

95th 120 119 119 128 66 65 66 66

99th 120 120 120 128 66 66 66 66

10

50th 106 109 109 110 57 57 59 58

90th 120 120 120 120 72 69 72 71

95th 120 122 122 122 77 74 74 73

99th 120 122 122 122 77 77 77 77

11

50th 114 110 110 109 60 60 60 60

90th 125 122 127 126 70 67 70 70

95th 129 129 131 130 76 71 74 74

99th 129 129 131 131 78 78 78 78

12

50th 109 110 110 111 54 56 54 56

90th 127 127 128 127 65 77 75 74

95th 127 128 128 128 73 80 80 80

99th 127 128 128 128 73 80 80 80

RESULTS


FEMALES

Age BP Percentile

SBP, mmHg DBP, mmHg



13

50th 108 110 111 113 59 59 59 59

90th 119 124 124 123 74 70 68 68

95th 122 124 124 124 76 76 76 75

99th 122 124 124 124 76 76 76 76

14

50th 112 116 118 118 59 59 59 60

90th 139 132 131 130 65 66 69 68

95th 140 140 140 140 67 69 82 82

99th 140 140 140 140 68 73 82 82

15

50th 114 114 114 115 59 59 59 59

90th 127 127 127 127 63 69 70 70

95th 127 127 127 127 67 71 79 76

99th 127 127 127 127 67 71 91 91

RESULTS


FEMALES

Age BP Percentile

SBP, mmHg DBP, mmHg



16

50th 115 116 116 117 54 59 63 63

90th 128 128 129 128 76 74 74 74

95th 128 132 135 133 77 77 77 77

99th 128 132 151 151 77 77 77 77

17

50th 116 117 114 115 56 56 56 58

90th 128 135 135 133 74 72 71 71

95th 139 137 137 136 78 76 76 75

99th 139 139 139 139 78 78 78 78

18

50th 116 118 117 118 64 64 64 63

90th 129 134 131 134 71 75 75 75

95th 132 143 143 143 77 81 79 78

99th 132 143 143 143 77 83 83 83

Summary of findings

BP increased with age. No significant difference with gender. BP did not consistently increase with height -

compared to US data. Body weight is the major factor influencing

BP.

Conclusions

BP percentiles tables & charts for African and Caribbean children can be produced.

Potential to develop BP reference tables based on gender and age.

Sample size was too small to detect variation in BP in the African and Caribbean children.

Recommendation

The persisting high rates of cardiovascular diseases and hypertension epidemic calls for continuing research to focus attention on blood pressure tracking from childhood to adulthood.

Eva amoako atta

Education

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