Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study

Kaelber, David C.; Liu, Weiwei; Ross, Michelle; Localio, A. Russell; León, Janeen B.; Pace, Wilson D.; Wasserman, Richard C.; Fiks, Alexander G.

doi:10.1542/peds.2016-2195

Cited by 59 publications

(52 citation statements)

References 29 publications

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“…Unlike these other common conditions, however, abnormal BP is commonly unrecognised and untreated by primary care providers. In a large study utilising electronic medical record data, Kaelber and colleagues (7) demonstrated that just 10.2% of children who met criteria for elevated BP and 23.2% of those who met criteria for HTN had that diagnosis documented in their medical record, confirming the results of prior single-centre studies (8,9). Treatment rates in those actually diagnosed with HTN were surprisingly low, with just 5.6% of patients receiving antihypertensive medications (7).…”

Section: Key Notesmentioning

confidence: 76%

“…While the conclusions of the USPSTF have been subject to a great deal of criticism , they provide a context for the data mentioned earlier regarding low rates of recognition and treatment of childhood primary HTN . Since there are no prospective trials linking childhood BP levels and later CV disease, the impetus for treatment is diminished, creating an overall ambivalence regarding HTN in the young.…”

Section: Lack Of Cardiovascular Outcome Data Creates Provider Ambivalmentioning

confidence: 99%

“…The USPSTF found no direct evidence that routine BP measurement accurately identifies children and adolescents who are at increased risk for CV disease in adulthood and inadequate evidence that routine BP measurement accurately identifies children and adolescents who are at increased risk for adult HTN or other intermediate measures of adult CV disease. (18) While the conclusions of the USPSTF have been subject to a great deal of criticism (19)(20)(21), they provide a context for the data mentioned earlier regarding low rates of recognition and treatment of childhood primary HTN (7)(8)(9)(10). Since there are no prospective trials linking childhood BP levels and later CV disease, the impetus for treatment is diminished, creating an overall ambivalence regarding HTN in the young.…”

Section: Lack Of Cardiovascular Outcome Data Creates Provider Ambivalmentioning

confidence: 99%

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High blood pressure in the young: why should we care?

Flynn

2017

Acta Paediatrica

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Section: Key Notesmentioning

confidence: 76%

Section: Lack Of Cardiovascular Outcome Data Creates Provider Ambivalmentioning

confidence: 99%

Section: Lack Of Cardiovascular Outcome Data Creates Provider Ambivalmentioning

confidence: 99%

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High blood pressure in the young: why should we care?

Flynn

2017

Acta Paediatrica

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“…This figure rose to 75% with the inclusion of patients whose BP were rechecked and remained elevated, and again did not receive any intervention or follow-up. Kaelber et al ’s recent retrospective cohort study of 398 079 patients aged 3–18 years also reiterates the infrequency of a diagnosis of paediatric hypertension 58. Only 23% and 10.2% of hypertensive and prehypertensive patients were formally diagnosed as such, and of those with persistent hypertension for 12 months or longer a mere 5.6% were prescribed medication.…”

Section: Screening For High Bpmentioning

confidence: 95%

What’s new in paediatric hypertension?

Lalji

Tullus

2017

Arch Dis Child

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Paediatric hypertension predisposes to hypertension and cardiovascular disease in adult life. Despite clear guidelines, there remains a lack of screening. Diagnosis remains challenging given the high rate of false-positive high blood pressure (BP) readings at a single visit; thus, multiple visits are required to confirm the diagnosis. Depending on the normative data sets used, hypertension in overweight and obese children can be underestimated by up to 20%. Specific BP targets are required for subgroups such as adolescents, children with chronic kidney disease (CKD) and type 1 diabetes. High dietary salt intake is a risk factor for cardiovascular disease. Given the rise in processed food consumption, children in developed nations are likely to benefit from salt restriction at a population-based level.

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“…However, the percentile‐based definition included hundreds of abnormal BP cutoff values, which resulted in a complex and cumbersome decision process. Elevated BP in children and adolescents was frequently undiagnosed in the clinical practice . As a solution for this problem, the American Academy of Pediatrics (AAP) recommended 120/80 mm Hg as thresholds to identify elevated BP in adolescents aged 13‐17 years .…”

Section: Introductionmentioning

confidence: 99%

Validation of recommended definition in identifying elevated blood pressure in adolescents

Fan

Liu

Zhang

2019

J of Clinical Hypertension

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Adult hypertension is an important public health challenge worldwide due to its high prevalence and its risk for cardiovascular disease (CVD). 1,2 Blood pressure (BP) levels in children and adolescents have been increasing alarmingly during the past decades. 3,4 Elevated BP in children and adolescents may result in target organ damage and increase the risks of adult hypertension and consequent subclinical CVD. [5][6][7][8] Consequently, the early detection of elevated BP in children and adolescents is crucial to promote cardiovascular health and reduce the future CVD risk.The US Fourth Report recommended the sex-, age-, and heightspecific 90th BP percentiles to define pediatric elevated BP, which was accepted worldwide. 9 However, the percentile-based definition included hundreds of abnormal BP cutoff values, which resulted in a complex and cumbersome decision process. Elevated BP in children and adolescents was frequently undiagnosed in the clinical practice. 10,11 As a solution for this problem, the American Academy of Pediatrics (AAP) recommended 120/80 mm Hg as thresholds to identify elevated BP in adolescents aged 13-17 years. 12 The new definition of elevated BP in adolescents was consistent with adult hypertension definition released recently by American College of Cardiology/American Heart Association. 12,13 To our best knowledge, data are presently limited to compare the performance of the new definition in identifying elevated BP and concomitant cardiometabolic risks with the revised sex-, age-, and height-specific pediatric BP standard presented in AAP guideline. AbstractRecently, the American Academy of Pediatrics (AAP) recommended 120/80 mm Hg as thresholds for identifying elevated blood pressure (BP) in adolescents aged 13-17 years.The authors aimed to compare the performance of the new definition in identifying elevated BP with traditional percentile-based definition. Data were obtained from the National Health and Nutrition Examination Survey 1999-2014, which included 7485 adolescents aged 13-17 years. Elevated BP was defined using the recommended (≥120/80 mm Hg) and traditional definition (≥90th percentile for sex, age, and height or 120/80 mm Hg) presented in AAP guideline. The prevalence of elevated BP was 15.7% and 17.2% using the recommended and traditional definition, respectively (P < .001). The recommended definition had high sensitivity (90.9%), perfect specificity (100.0%), perfect positive predictive value (100.0%), and very high negative predictive value (98.1%) compared with the traditional definition. The Kappa correlation coefficient between two definitions was 0.94 (P < .001). Similar results can be observed in subgroups across sex, age, and sex-and age-specific height percentile except for both sexes with young age and low height percentile. Generally, our results supported the use of the recommended definition for identifying elevated BP in adolescents. |FAN et Al. by the US National Center for Health Statistics of the Centers for Disease Control and Prevention since 1999 in 2-ye...

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Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study

Abstract: Hypertension and prehypertension were infrequently diagnosed among pediatric patients. Guidelines for diagnosis and initial medication management of abnormal BP in pediatric patients are not routinely followed.

Cited by 59 publications

References 29 publications

High blood pressure in the young: why should we care?

High blood pressure in the young: why should we care?

What’s new in paediatric hypertension?

Validation of recommended definition in identifying elevated blood pressure in adolescents

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