Prevention and Wellness

1. Impact of BMI and BMI Change
on BP Percentile and Change in
BP Percentile in Those Age 3-17
Years
Patrick J. O’Connor MD MA MPH1, Emily D. Parker Ph.D. 1,
Joan Lo MD.2 Alan Sinako MD, Matt Daley MD MPH, Elyse Kharbanda MD MPH,
Nicole K. Trower BS,1, Heather Tavel BS, Malini Chandra Ph.D., Jay R. Desai MPH1 ,
Karen L. Margolis MD MPH1, David J. Magid MD MPH3
1HealthPartnersResearch Foundation, Minneapolis, MN;
2Kaiser Permanente of Northern California, Oakland, CA
3Kaiser Permanente of Colorado, Denver, CO; Division of Research,

2. Duality of Interest: Dr. O’Connor
• No duality of Interest
• Funded by NIH, NHLBI R01 HL093345

3. Significance
• Overweight (BMI 85-95th percentile) and
obesity (BMI >= 95th percentile) are massive
problems in children and adolescents
• BMI increases may be driving increased
prevalence of elevated Bp in these age groups
• EMRs enable surveillance of patterns in BP
and BMI over time

4. Design, Study Sites, Data Sources
• Retrospective Cohort Study
• 3-HMO sites: KP Colorado, KP Northern
California, HealthPartners
• Pediatric Hypertension Superset for Project
• Years of Data: 2007-2011, more coming
• Used about 10 Data Tables: demo, vitals, Dx,
Rx, diagnoses, enrollment, utilization, etc.

5. Study Subjects
• Age 3-17 years
• In 2007-2011, have at least one outpatient
visit with an eligible BP measure
• Eligible BP measure means BP with a height
+/- 90 days of BP (to compute BP percentile)
• About XXX study subjects in analysis
• About XXX person-years of data

6. Blood Pressure Percentile
• BP value is adjusted for gender, age, and
height using a standard CDC equation to
compute BP percentile

7. Existing Hypertension
• Hypertension diagnosis: was there 1+ HT
diagnosis code (401.xx) within first year
• Hypertension treatment: 1+ fills for HT
medication
• Excluded clonidine, used mostly for behavioral
reasons

8. Covariates
• Age
• Sex
• Race
• SES (geocoded)
• Baseline BMI percentile
• Baseline BP percentile

9. Dependent Variables
• BP percentile (cross sectional with baseline
BMI percentile)
• Change in BP percentile (function of baseline
BMI percentile)
• Change in BP percentile (function of change in
BMI percentile over time)

10. Analysis Plan
• Consistency of data across sites
• Distributions of BP and BMI data
• BP percentile (cross sectional with baseline
BMI percentile) (adjusted and unadjusted)
• Change in BP percentile (function of baseline
BMI percentile) (adjusted and unadjusted)
• Change in BP percentile (function of change in
BMI percentile over time)(adjusted and
unadjusted)

11. SBP % over time as function of
baseline BMI %
100
90
80
70
60
SBP percentile
BMI <85th
50
BMI 85th-<95th
40 BMI >=95th
30
20
10
0
0 6 12 24 36 48
months

12. 100
3-5 year olds
90
80
70
60
SBP percentile
50 BMI <85th
BMI 85th-<95th
40
BMI >=95th
30
20
10
0
0 6 12 24 36 48
months

13. 100
6-8 year olds
90
80
70
60
SBP percentile
50 BMI <85th
BMI 85th-<95th
40 BMI >=95th
30
20
10
0
0 6 12 24 36 48
months

14. 100
9-11 year olds
90
80
70
60
SBP percentile
50 BMI <85th
BMI 85th-<95th
40 BMI >=95th
30
20
10
0
0 6 12 24 36 48
months

15. 100
12-14 year olds
90
80
70
60
SBP percentile
50 BMI <85th
BMI 85th-<95th
40 BMI >=95th
30
20
10
0
0 6 12 24 36 48
months

16. 100
15-17 year olds
90
80
70
60
SBP percentile
50 BMI <85th
BMI 85th-<95th
40 BMI >=95th
30
20
10
0
0 6 12 24 36
months

17. BMI % over time as a function of
120
baseline SBP %
100
80
BMI percentile
SBP <90th
60
SBP 90th-<95th
SBP 95th-99th
SBP >99th
40
20
0
0 0.5 1 2 3 4
months

18. 120
3-5 year olds
100
80
BMI percentile
SBP <90th
60
SBP 90th-<95th
SBP 95th-99th
SBP >99th
40
20
0
0 0.5 1 2 3 4
months

19. 120
6-8 year olds
100
80
BMI percentile
SBP <90th
60
SBP 90th-<95th
SBP 95th-99th
SBP >99th
40
20
0
0 0.5 1 2 3 4
months

20. 120
9-11 year olds
100
80
BMI percentile
SBP <90th
60
SBP 90th-<95th
SBP 95th-99th
SBP >99th
40
20
0
0 0.5 1 2 3 4
months

21. 120
12-14 year olds
100
80
BMI percentile
SBP <90th
60
SBP 90th-<95th
SBP 95th-99th
SBP >99th
40
20
0
0 0.5 1 2 3 4
months

22. 120
15-17 year olds
100
80
BMI percentile
SBP <90th
60
SBP 90th-<95th
SBP 95th-99th
SBP >99th
40
20
0
0 0.5 1 2 3 4
months

23. Table 1. Data from Two Study Sites
Total N 3-5 years 6-8 years 9-11 years 12-14 years 15-17 years
79838 14919 12301 15703 18018 18897
Normal BP 47843 9658 7563 9634 10595 10393
Pre-HT 30731 5169 4631 5903 7051 7977
HT 1264 92 107 166 372 527
Normal Weight 56289 12228 8810 10438 11979 12834
Overweight 11930 1571 1681 2504 2990 3184
Obese 11619 1120 1810 2761 3049 2879
No Risk factors 37314 8137 5932 7152 7988 8105
One of the 2 risk 29504 5612 4509 5768 6598 7017
factors
Both Risk Factors 13020 1170 1860 2783 3432 3775
** Tables 1, 2, 3: Data in these tables came from two study sites. Each subjet counted in the table had at least 3
blood pressure measurements taken (2007-2009). Hypertension is defined by at least 3 or more elevated blood
pressures >=95th percentile. Normal weight, overweight and obese were defined by the baseline BMI percentile.

24. Table 2. Data From Two Sites, Girls
Total N 3-5 years 6-8 years 9-11 years 12-14 years 15-17 years
40900 7052 5748 7663 9238 11199
Normal BP 24578 4651 3524 4752 5721 5930
Pre-HT 15735 2354 2175 2838 3356 5012
HT 587 47 49 73 161 257
Normal Weight 29304 5787 4216 5316 6232 7753
Overweight 6231 764 757 1182 1619 1909
Obese 5365 501 775 1165 1387 1537
No Risk factors 19507 3946 2830 3657 4355 4719
One of the 2 14868 2546 2080 2754 3243 4245
risk factors
Both Risk 6525 560 838 1252 1640 2235
Factors

25. Table 3. Data From Two Sites, Boys
Total N 3-5 years 6-8 years 9-11 years 12-14 years 15-17 years
38938 7867 6553 8040 8780 7698
Normal BP 23265 5007 4039 4882 4874 4463
Pre-HT 14996 2815 2456 3065 3695 2965
HT 677 45 58 93 211 270
Normal Weight 26985 6441 4594 5122 5747 5081
Overweight 5699 807 924 1322 1371 1275
Obese 6254 619 1035 1596 1662 1342
No Risk factors 17807 4191 3102 3495 3633 3386
One of the 2 risk 14636 3066 2429 3014 3355 2772
factors
Both Risk 6495 610 1022 1531 1792 1540
Factors

26. Conclusions—1

27. Conclusions—2

28. Conclusions—3

29. More Information?
Please Contact:
Patrick.j.oconnor@healthpartners.com