Patient-, Provider-, and Clinic-Level Predictors of Unrecognized Elevated Blood Pressure in Children

Brady, Tammy M.; Solomon, Barry S.; Neu, Alicia M.; Siberry, George K.; Parekh, Rulan S.

doi:10.1542/peds.2009-0555

Cited by 121 publications

(131 citation statements)

References 10 publications

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“…Although our findings are consistent with previous observations that hypertension is often unrecognized in childhood, 3,4 factors other than underrecognition may also contribute to the lack of follow-up. Providers may recognize an elevated BP but dismiss it as measurement error or a consequence of the child being upset or anxious.…”

Section: Timing Of Repeat Bp Measurementsupporting

confidence: 92%

“…2 Despite these long-standing recommendations, hypertension often goes unrecognized in children. 3,4 Screening for hypertension in asymptomatic children and adolescents occurs during routine clinical care. When a screening blood pressure is elevated in the hypertensive range (blood pressure $95th percentile for age, gender, and height percentile), a repeat measurement within 1 to 2 weeks is recommended.…”

Section: Articlementioning

confidence: 99%

“…1,2 Whereas several previous epidemiologic studies have examined pediatric hypertension, these investigations have typically used cross-sectional data or data from nonclinical settings [5][6][7][8][9] ; fewer studies have examined hypertension screening in routine clinical settings. 3,4,10 In particular, little is known about how frequently children and adolescents have elevated BP readings during outpatient care, how soon elevated BP measurements are typically remeasured, and how well a single elevated BP predicts persistent elevation.…”

Section: Articlementioning

confidence: 99%

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Patterns of Care and Persistence After Incident Elevated Blood Pressure

2013

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Screening for hypertension in asymptomatic children and adolescents occurs during routine care. For those with elevated blood pressure, a repeat measurement within 1 to 2 weeks is recommended. However, little is known about patterns of care after an incident elevated blood pressure. WHAT THIS STUDY ADDS:In a population of 72 625 children and adolescents, 6108 (8.4%) had an incident elevated blood pressure. Among these, 1275 (20.9%) had their blood pressure measurement repeated within 1 month. However, few individuals with an incident elevated blood pressure subsequently developed hypertension.abstract BACKGROUND AND OBJECTIVE: Screening for hypertension in children occurs during routine care. When blood pressure (BP) is elevated in the hypertensive range, a repeat measurement within 1 to 2 weeks is recommended. The objective was to assess patterns of care after an incident elevated BP, including timing of repeat BP measurement and likelihood of persistently elevated BP. METHODS:This retrospective study was conducted in 3 health care organizations. All children aged 3 through 17 years with an incident elevated BP at an outpatient visit during 2007 through 2010 were identified. Within this group, we assessed the proportion who had a repeat BP measured within 1 month of their incident elevated BP and the proportion who subsequently met the definition of hypertension. Multivariate analyses were used to identify factors associated with follow-up BP within 1 month of initial elevated BP.RESULTS: Among 72 625 children and adolescents in the population, 6108 (8.4%) had an incident elevated BP during the study period. Among 6108 with an incident elevated BP, 20.9% had a repeat BP measured within 1 month. In multivariate analyses, having a followup BP within 1 month was not significantly more likely among individuals with obesity or stage 2 systolic elevation. Among 6108 individuals with an incident elevated BP, 84 (1.4%) had a second and third consecutive elevated BP within 12 months. CONCLUSIONS:Whereas .8% of children and adolescents had an incident elevated BP, the great majority of BPs were not repeated within 1 month. However, relatively few individuals subsequently met the definition of hypertension. Pediatrics 2013;132:e349-e355 AUTHORS:

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Section: Timing Of Repeat Bp Measurementsupporting

confidence: 92%

Section: Articlementioning

confidence: 99%

Section: Articlementioning

confidence: 99%

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Patterns of Care and Persistence After Incident Elevated Blood Pressure

2013

PEDIATRICS

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“…Unfortunately, nearly 40 years later, the diagnosis of hypertension is missed in the majority of cases, and familiarity with pediatric hypertension among clinicians is extremely poor. [4][5][6] Barriers to optimal recognition include not only poor knowledge, but also a failure to abstract National guidelines for the diagnosis and management of hypertension in children have been available for nearly 40 years. Unfortunately, knowledge and recognition of the problem by clinicians remain poor.…”

mentioning

confidence: 99%

Diagnosis, Epidemiology, and Management of Hypertension in Children

Rao

2016

Pediatrics

132

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National guidelines for the diagnosis and management of hypertension in children have been available for nearly 40 years. Unfortunately, knowledge and recognition of the problem by clinicians remain poor. Prevalence estimates are highly variable because of differing standards, populations, and blood pressure (BP) measurement techniques. Estimates in the United States range from 0.3% to 4.5%. Risk factors for primary hypertension include overweight and obesity, male sex, older age, high sodium intake, and African American or Latino ancestry. Data relating hypertension in childhood to later cardiovascular events is currently lacking. It is known that BP in childhood is highly predictive of BP in adulthood. Compelling data about target organ damage is available, including the association of hypertension with left ventricular hypertrophy, carotid-intima media thickness, and microalbuminuria. Guidelines from both the United States and Europe include detailed recommendations for diagnosis and management. Diagnostic standards are based on clinic readings, ambulatory BP monitoring is useful in confirming diagnosis of hypertension and identifying white-coat hypertension, masked hypertension, and secondary hypertension, as well as monitoring response to therapy. Research priorities include the need for reliable prevalence estimates based on diverse populations and data about the long-term impact of childhood hypertension on cardiovascular morbidity and mortality. Priorities to improve clinical practice include more education among clinicians about diagnosis and management, clinical decision support to aid in diagnosis, and routine use of ambulatory BP monitoring to aid in diagnosis and to monitor response to treatment.

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“…In another study of 1,143 children, 6% were shown to have a measured BP >99th percentile +5 mmHg (thus showing marked hypertension), but still only 26% of these had high BP documented as a concern in their notes [4]. Another study showed that as many as 87% of children with elevated BP recordings did not have this recognized by their health provider [5].…”

mentioning

confidence: 99%