Pediatric Hypertension: Provider Perspectives

Abstract

Pediatric hypertension is a risk for adult cardiovascular disease, making early detection important. The prevalence of pediatric essential hypertension is rising due to the increased prevalence of obesity. Though guidelines for screening, diagnosis, evaluation, and management are available, there are barriers to accurate diagnosis of pediatric hypertension, including lack of knowledge and complexity of blood pressure standards. We aimed to gain insights into reasons for low rates of diagnosis and treatment from primary care providers. As part of a multisite randomized controlled trial, we interviewed 8 providers in a community health center network. We used a grounded theoretical approach to analyze transcripts. Providers reflected on numerous barriers to diagnosis, management, and follow-up; recommendations for educational content; and how community health center systems can be improved. Findings informed development of a multifaceted intervention. Despite lack of training on essential hypertension, providers were comfortable recommending lifestyle changes to promote healthier weight and reduced blood pressure.

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

“…Similar results were seen in an earlier multicentre study that used insurance claim data . While some studies that have examined the management of hypertensive children in primary care cite provider's unfamiliarity and/or discomfort in treating childhood HTN , another explanation could be provider ambivalence related to underappreciation of the significance of abnormal BP in the paediatric age group.…”

Are Body Composition Parameters Better than Conventional Anthropometric Measures in Predicting Pediatric Hypertension?

“…Moreover, pediatric hypertension is associated with target organ damage, including left ventricular hypertrophy, increased carotid-intima media thickness and microalbuminuria [2,3]. Nevertheless, several studies have suggested that knowledge, screening, diagnosis, and management for pediatric hypertension is profoundly insufficient among most physicians [4,5].…”

Pediatric Hypertension: Parent Perspectives

“…Parents, even those whose children have received a diagnosis, may be confused about the diagnosis simply because clinicians are confused about the diagnosis. 5 , 14 , 18 , 19 Medical providers need to engage parents and children in the diagnostic process better. For example, parents could be informed that BP values can vary a lot, which is why an average across 3 appointments is needed.…”