Chapter 6: A responsive and sustainable service
6.5 Developing and maintaining an advanced nursing workforce
Figure 4 shows the severity of hypertension in the study subjects.
36 35
3 24
20
3 0
5 10 15 20 25 30 35 40
Pre-hypertension Stage 1 hypertension
Stage 2 hypertension Stage of Hypertension
Frequency (No.)
Female Male
Figure 4: Distribution of pre-hypertension and hypertension by gender
As shown in Figure 4 above, 35 (63.6%) of the 55 pupils that had stage 1 hypertension were females and 20 (36.4%) were males. On the other hand, stage 2 hypertension was equally distributed between males and females each having 3 (50%) of 6.
HYPERTENSION AND AGE
The highest frequency of hypertension of 6.7% was found among the 7year old children while the lowest frequency of 2.5% was found among the 10year old children. Overall, the difference in frequency of hypertension between the ages was not statistically significant (χ2 = 6.58, df = 6, p = 0.362). However, the frequency of hypertension appears to drop sharply after 8years before rising again at 11years. Table VI shows the frequency of hypertension in each age.
Table VI: Distribution of hypertension by age
Age Hypertension No. (%)
Normal BP No. (%)
TOTAL No. (%)
6yrs 11 (5.6%) 184 (94.4%) 195 (100%)
7yrs 12 (6.7%) 166 (93.3%) 178 (100%)
8yrs 12 (5.6%) 203 (94.4%) 215 (100%)
9yrs 7 (3%) 224 (97%) 231 (100%)
10yrs 5 (2.5%) 196 (97.5%) 201 (100%)
11yrs 5 (4%) 120 (96%) 125 (100%)
12yrs 9 (5.7%) 148 (94.3%) 157 (100%)
TOTAL (%) 61 (4.7%) 1241 (95.3%) 1302 (100%) χ2 = 6.58, df = 6, p = 0.362
The mean age of 8.83±1.90 years for the normotensive children was found to be higher than the mean age of 8.56±2.05 years for the hypertensive children. This difference observed was not statistically significant. (t = 1.10, df = 1, p = 0.271).
The study subjects were grouped into two almost equal age groups; 6 – 8 years and 9 – 12 years. As shown in table VII, Thirty five (6%) of the 588 children in 6 to 8 year age group had hypertension while 26 (3.6%) of the 714 in the 9 to 12 year age group had hypertension. The observation was not statistically significant (χ2 = 3.85, df = 1, p = 0.05).
Table VII: Distribution of hypertension by age group
Age group Normal BP No. (%)
Hypertension No.(%)
TOTAL No. (%)
6 – 8 years 553(94%) 35(6%) 588
9 – 12 years 688(96.4%) 26(3.6%) 714
TOTAL 1241(95.3%) 61(4.7%) 1302(100%) χ2 = 3.86, df = 1, p = 0.05
Although hypertension was more prevalent in the 6 – 8 year age group, only 1 (2.9%) of the 35 hypertensive children in this age group had stage 2 hypertension compared to 5 (19.5%) of the 26 hypertensive children in the older age group. This difference was not statistically significant (χ2 = 4.44, df = 1, Fisher exact = 0.05).
Table VIII shows the severity of hypertension in the two age groups.
Table VIII: Stage of hypertension in age groups
Age group Stage1 No. (%)
Stage2 No. (%)
TOTAL No. (%)
6 – 8 years 34(97.1%) 1(2.9%) 35
9 – 12 years 21(80.5%) 5(19.5%) 26
TOTAL 55(90.2%) 6(9.8%) 61(100%)
χ2 = 4.44, df = 1, Fisher exact = 0.05
HYPERTENSION AND GENDER
The mean systolic BP was 98.57±10.32mm Hg in females and 97.50±10.05mm Hg in males. Although the mean systolic BP was higher in females than males, no statistically significant difference was observed (t = 1.88, df = 1, p = 0.06). The mean diastolic BP of 62.02±7.83mm Hg in females was also higher than that of 61.62±7.55mm Hg observed in males with no statistically significant difference observed (t = 0.95, df = 1, p = 0.340).
Thirty eight (5.3%) of the 717 females in the study were found to be hypertensive while 23 (3.9%) of the 585 males were hypertensive (Table IX). The difference observed was not statistically significant (χ2 = 1.35, df = 1, p = 0.245).
Table IX: Distribution of hypertension by gender
χ2 = 1.35, df = 1, p = 0.245 Gender Normal BP
No. (%)
Hypertension No. (%)
Total No. (%)
Female 679 (94.7%) 38 (5.3%) 717 (100%)
Male 562 (96.1%) 23 (3.9%) 585 (100%)
Total 1241 (95.3%) 61 (4.7%) 1302 (100%)
Hypertension and body mass index(BMI)
The weight of the study subjects ranged from 15.00 to 88.50kg with a mean of 31.57±8.84kg while the height ranged from 1.07 to 1.77m with a mean of 1.37±0.12m. The BMI of the study subjects ranged from 11.07 to 36.37kg/m2 with a mean of 16.44±2.67kg/m2.
The mean BMI of 16.68±2.69kg/m2 for females was higher than the mean BMI of 16.16±2.63 kg/m2 for males. This difference was statistically significant. (t = 3.50, df
= 1, p < 0.001). One hundred and one (17.2%) of the younger children aged 6 – 8years had a high BMI while 51 (7.1%) of the older children aged 9 – 12 years had a high BMI >85th percentile for age. This difference was statistically significant. (χ2
= 31.48, df = 1, p < 0.001).
One hundred and fifty two (11.7%) of the study subjects were underweight, a larger proportion of 998 (76.7%) were normal weight, 75 (5.8%) were overweight and 77 (5.9%) were obese (Figure 5).
11.7%
76.7%
5.8% 5.9%
Underweight Normal weight Overweight Obese
Figure 5: BMI classes of the study subjects
One (0.7%) of the underweight children had hypertension. Forty three (4.3%) of the normal weight children, 4 (5.3%) of the overweight children and 13 (16.9%) of the obese children had hypertension as shown in Table X. The highest frequency of hypertension was found among the obese children, followed by the overweight children, normal weight children and the least in the underweight children. This observed trend was statistically significant (χ2 for trend = 27.20, p < 0.001).
Table X: Distribution of hypertension by BMI classification
BMI Normal BP
No. (%)
Hypertension No. (%)
Total No.
Underweight 151 (99.3%) 1 (0.7%) 152
Normal weight 955 (95.7%) 43 (4.3%) 998
Overweight 71 (94.7%) 4 (5.3%) 75
Obese 64 (83.1%) 13 (16.9%) 77
Total 1241 (95.3%) 61 (4.7%) 1302 χ2 for trend = 27.20, p < 0.001
The median BMI of hypertensive children was 16.8kg/m2 and that of normotensive children was 15.82kg/m2. There was a statistically significant difference between them (μ'=49203, μ=26498, two sided p<0.001).
Table XI shows the frequency of hypertension in children that had a high BMI greater than the 85th percentile (overweight and obese children) and those that had a low or normal BMI less than or equal to the 85th percentile (underweight and normal weight children) of the BMI-for-age. Seventeen (11.2%) of the 152 children with a high BMI had hypertension as compared to 44 (3.8%) of the 1150 children with a low or normal BMI. This observation was statistically significant (χ2 = 16.28, df = 1, p < 0.001).
Table XI: Distribution of hypertension by BMI percentile
BMI percentile Normal BP No. (%)
Hypertension No. (%)
TOTAL No.
Low or normal BMI
(≤85th percentile) 1106(96.2%) 44(3.8%) 1150
High BMI
(>85th percentile) 135(88.8%) 17(11.2%) 152
TOTAL 1241(95.3%) 61(4.7%) 1302(100%) χ2 = 16.28, df = 1, p < 0.001
On excluding the hypertensive children, 16 (11.9%) of the 135 children with a high BMI had pre-hypertension, while 44 (4%) of the 1106 children with a low or normal BMI had pre-hypertension. The observation was also statistically significant (χ2 = 16.2107, df = 1, p <0.001).
HYPERTENSION AND SOCIO-ECONOMIC CLASS
The frequency of hypertension decreased with reducing social class from 18 (6.4%) in respondents from social class I to 0 (0%) in respondents from social class V as shown in Table XII. This observed trend was not statistically significant. (χ2 for trend = 1.864, p = 0.172).
Table XII: Distribution of hypertension by social class
Social Class Normal BP No. (%)
Hypertension No. (%)
TOTAL No.
I 262 (93.6%) 18 (6.4%) 280
II 463 (95.7%) 21(4.3%) 484
III 349 (95.9%) 15 (4.1%) 364
IV 141 (95.9%) 6 (4.1%) 147
V 9 (100%) 0 (0%) 9
TOTAL 1224 (95.3%) 60 (4.7%) 1284
χ2 for trend = 1.864, p = 0.172
The 5 social classes were further grouped into the upper group (class I & II), middle group (class III) and lower group (class IV & V). One hundred and thirty eight (18.1%) of the 764 from the upper social group had BMI >85th percentile for age while 13 (2.5%) of the 520 from the middle and lower social groups had BMI >85th percentile for age. This difference was statistically significant (χ2 = 72.22, df = 1, p
< 0.001).
Of the 764 pupils from the upper social group, 39 (5.1%) had hypertension while 21 (4%) of the 520 from the middle and lower social groups had hypertension (Table XIII). No statistically significant difference was observed (χ2 = 0.79, df = 1, p = 0.374).
Table XIII: Distribution of hypertension by social group
Social group Normal No. (%)
Hypertension No. (%)
TOTAL No.
Upper 725(94.9%) 39(5.1%) 764
Middle & Lower 499(96%) 21(4%) 520
TOTAL 1224(95.3%) 60(4.7%) 1284(100%) χ2 = 0.79, df = 1, p = 0.374
HYPERTENSION AND FAMILY HISTORY
All respondents that had either parent as hypertensive or a maternal and or paternal family history of hypertension were considered to have a family history of hypertension. Of the 1302 pupils, 316 (24.3%) had a family history of hypertension.
The mean systolic blood pressure of 100.11±10.97mm Hg for children with a family history of hypertension was significantly higher than 97.44±9.87mm Hg for those with no family history of hypertension (t = 4.07, df = 1, p < 0.001). The mean diastolic blood pressure of 62.30±8.33mm Hg for children with a family history of hypertension was also higher than that of 61.69±7.49mm Hg for those with no family history of hypertension. There was however no statistically significant difference (t = 1.23, df = 1, p = 0.220).
Of the 316 pupils that had a family history of hypertension, 24 (7.6%) had hypertension while 37 (3.8%) of the 949 that did not have a family history (or were unaware of any family history) had hypertension (Table XIV). There was a statistically significant difference observed (χ2 = 7.91, df = 1, p = 0.005).
Table XIV: Relationship between hypertension and family history of hypertension
Family history of hypertension
Normal BP No. (%)
Hypertension No. (%)
TOTAL No.
Yes 292(92.4%) 24(7.6%) 316
No or Unknown 949(96.2%) 37(3.8%) 986
TOTAL 1241(95.3%) 61(4.7%) 1302(100%)
χ2 = 7.91, df = 1, p = 0.005
RELATIONSHIP OF STAGE OF HYPERTENSION AND OTHER VARIABLES Stage 2 hypertension was found in 6 (9.8%) of the 61 hypertensive children. Stage 2 hypertension was found to be more prevalent in younger children aged 6 – 8 years (19.2%), males (13%), the upper social class (15.4%), those that had a low or normal BMI (11.4%) and those with no family history of hypertension (13.5%) (Table XV). None of the observations were statistically significant.
Table XV: Relationship between stage of hypertension other variables
Variables
Stage of hypertension Stage 1
No = 55
Stage 2
No = 6 χ2 Fisher’s exact test (p value equivalent)
Age No (%) No (%)
6 – 8 years 34 (97.1) 1 (2.9) 4.51 0.05
9 – 12 years 21 (80.8) 5 (19.2) Gender
Female 35 (92.1) 3 (7.9) 0.43 0.406
Male 20 (87) 3 (13)
Social class
Upper 33 (84.6) 6 (15.4) 3.75 0.153
Middle &
Lower 21 (100) 0 (0)
BMI
Low or Normal
BMI 39 (88.6) 5 (11.4) 0.42 0.460
High BMI 16 (94.1) 1 (5.9) Family history of
hypertension
Yes 23 (95.8) 1 (4.2) 1.43 0.230
No or unknown 32 (86.5) 5 (13.5)