Purpose and Significance: The purpose of this secondary analysis is to explore the incidence of previously undiagnosed hypertension in 5th grade children in a large urban school district, and, further, to determine the relationship of childhood hypertension and BMI, gender, ethnicity.
It highlights the significance of health disparities when comparing White Americans and African Americans
- develop high blood pressure earlier in life
- have higher blood pressures
- have a 1.3-times greater rate of nonfatal stroke,
- have a 1. 8-times greater rate of fatal stroke,
- have a 1.5-times greater rate of death attributable to heart disease
(U. S. Centers for Disease Control)
The significance of this study is based on two factors: 1) the poverty level of the children (Cleveland has the highest child poverty level in the U.S. and 100% of children in the city school district are eligible for free or reduced cost breakfasts and lunches.). 2) the lack of continuity in the health care of the children (the school district estimates that fewer than one half of the students have a medical home and receive much of their health care through emergency rooms and multiple clinics). To highlight the significance of inconsistent healthcare and caregivers, it is estimated that 34-38% of children diagnosed with hypertension, have end organ damage at the time of diagnosis.
Methods:
This is a secondary analysis of data from the project, “Nursing in Cleveland’s schools”. The original study that produced the data for this secondary analysis was a district wide health- screening program over a 7 year period of time. All 5th grade children were screened annually for elevated blood pressures (BPs). BPs were taken 3 times at the screening, averaged and the percentile determine. If the BP was in the 95th percentile or higher, they were taken on two more occasions. If the BP was at the 95th percentile or higher on each of these three occasions, the child was potentially hypertensive and referred on. This secondary analysis explored the correlations between the incidence of hypertension and the variables of gender, BMI and ethnicity.
Results:
- The sample for this analysis was 7398 children, 49.9% female and 51.1% male. The average age was 11.1 years.
- 408 children or 5.5% had BPs at the 95th percentile or higher on three occasions.
- 199 females and 209 males were identified-gender was not significantly associated with elevated blood pressures
- 42-44% of 5th grade children were found to have BMIs in the overweight or obese range each year of the screenings.
- The relationship between hypertensive level BPs and BMIs was significant at the .001 level.
Conclusion:
Hypertension is a chronic condition that is a major contributor to burden of disease for individuals, families and society. This study highlights the hypertensive related health outcomes in African Americans and emphasizes the importance of early detection and treatment to control the effects of hypertension. In addition the data support the issue of obesity as a major contributor to the early development of hypertension.