30th Annual Meeting of the Society for Medical Decision Making (October 19-22, 2008): EFFECTIVENESS OF BLOOD PRESSURE SCREENING AMONG ADOLESCENTS ON REDUCING FUTURE BURDEN OF CORONARY HEART DISEASE

Tuesday, October 21, 2008: 3:15 PM

Grand Ballroom A (Hyatt Regency Penns Landing)

Y. Claire Wang, MD, ScD, Mailman School of Public Health, New York, NY, Angela M. Cheung, MD, PhD, FRCP(C), Osteoporosis Program, University Health Network, Toronto, ON, Canada, Kirsten Bibbins-Domingo, PhD, MD, University of California, San Francisco, San Francisco, CA, Lisa A. Prosser, PhD, Henry Ford Health System, Detroit, MI, Nancy R. Cook, Brigham and Women's Hospital, Boston, MA, Stacy A. Trent, University of Illinois Chicago, Chicago, IL, Lee Goldman, MD, MPH, Columbia University Medical Center, New York, NY and Matthew Gillman, MD, SM, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA

Introduction Hypertension is a major cause of morbidity and mortality in the US. Pediatric guidelines recommend universal blood pressure (BP) screening for all children and adolescents, but the long-term effectiveness of this strategy is unknown. We evaluated the impacts of BP screening for a cohort of 4,017,821 (2000 census) 15-year-old US adolescents.

Method We estimated prevalences of elevated BP and of obesity among adolescents from the National Health and Nutrition Examination Survey 1999-2004, after accounting for inter-visit BP variability. We used tracking correlation coefficients from two longitudinal cohorts to predict BP distribution change from age 15 until age 35. From age 35 to death, we used the Coronary Heart Disease (CHD) Policy Model, which simulates the morbidity, mortality and costs from fatal and non-fatal CHD events. We evaluated two screening strategies: (1) universal BP screening and behavioral intervention if the adolescent is hypertensive, and (2) targeted screening for obese adolescents (body mass index ≥95^th percentile). We compared three behavioral interventions: weight loss among the obese, exercise, and sodium reduction. We estimated BP reduction by each intervention from meta-analyses of published studies: weight loss 5.2 mmHg, exercise 4.8 mmHg, and sodium reduction 1.3 mmHg.
Results A one-time universal BP screening program would diagnose 2% of boys and 2.3% of girls (approximately 85,000 15-year-olds) with hypertension. The universal BP screening would be the most effective—preventing up to 411 (male) and 30 (female) lifetime CHD events. This reduction translates into a savings of 7,600 life-years, 8,400 QALYs, and a lifetime undiscounted medical expenditures of $167 million. At the recent obesity prevalence (17% in boys, 15% in girls), the targeted screening strategy would identify approximately 37,500 hypertensive 15-year-olds for intervention. This strategy could result in a reduction of 107 (male) and 10 (female) lifetime CHD events and savings of 2,069 life-years, 2,293 QALYs, and $42 million in medical expenditures. As a comparison, if population-wide sodium reduction is achieved from food content regulation, the expected benefit would be 57,047 life-years and 63,098 QALYs gained and $1.3 billion in medical costs avoided.

Conclusion Hypertension screening in adolescence could provide modest reduction in future CD burden, especially in boys. Population-wide strategies to reduce BP may be more effective.

See more of: Concurrent Session Abstracts I: Children's Health

See more of: 30th Annual Meeting of the Society for Medical Decision Making (October 19-22, 2008)

I-4 EFFECTIVENESS OF BLOOD PRESSURE SCREENING AMONG ADOLESCENTS ON REDUCING FUTURE BURDEN OF CORONARY HEART DISEASE