Pediatrician Adherence to Guidelines for Diagnosis and Management of High Blood Pressure

Rea, Corinna J.; Brady, Tammy M.; Bundy, David G.; Heo, Moonseong; Faro, Elissa Z.; Giuliano, Kimberly; Goilav, Béatrice; Kelly, P. Adam; Orringer, Kelly; Tarini, Beth A.; Twombley, Katherine; Rinke, Michael L.

doi:10.1016/j.jpeds.2021.11.008

Cited by 23 publications

(26 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 19 , 24 Only 5% to 56% of children have appropriate follow-up after elevated BP level measurement. 19 , 24 , 25 , 26 , 27 Less than 25% of children with hypertension are accurately diagnosed, less than half receive lifestyle counseling, and only 6% are prescribed antihypertensive medication. 19 , 25 , 26 , 28 , 29 , 30 Clear challenges and knowledge-practice gaps exist in pediatric hypertension care ( Figure 1 ).…”

Section: Hypertension Prevalencementioning

confidence: 99%

High Blood Pressure in Children and Adolescents: Current Perspectives and Strategies to Improve Future Kidney and Cardiovascular Health

Robinson

Chanchlani

2022

Kidney International Reports

View full text Add to dashboard Cite

Section: Hypertension Prevalencementioning

confidence: 99%

High Blood Pressure in Children and Adolescents: Current Perspectives and Strategies to Improve Future Kidney and Cardiovascular Health

Robinson

Chanchlani

2022

Kidney International Reports

View full text Add to dashboard Cite

“…In fact, a recent multisite study done evaluating the adherence of primary care pediatricians to the 2017 AAP clinical practice guideline for high BP found that compliance to various recommendations was low, ranging from 2% to 46%. 88 Similarly, a separate study had also found low adherence to clinical practice guidelines in the management of type 1 diabetes mellitus, with optimal adherence in only 7.4% person-years. 89 Clearly, in establishing good clinical practices for better patient outcomes, effort has to be made beyond just guideline development, to also include implementation through education and awareness, policy-making, and healthcare budgeting.…”

Section: Discussionmentioning

confidence: 96%

“…Although clinical practice guidelines exist to provide evidence‐based guidance to standardize care for better patient outcomes, its mere existence do not guarantee improved patient care. In fact, a recent multisite study done evaluating the adherence of primary care pediatricians to the 2017 AAP clinical practice guideline for high BP found that compliance to various recommendations was low, ranging from 2% to 46% 88 . Similarly, a separate study had also found low adherence to clinical practice guidelines in the management of type 1 diabetes mellitus, with optimal adherence in only 7.4% person‐years 89 .…”

Section: Discussionmentioning

confidence: 99%

Screening for metabolic complications of childhood and adolescent obesity: A scoping review of national and international guidelines

et al. 2022

View full text Add to dashboard Cite

Summary The rise in prevalence of childhood obesity is paralleled by an increase in obesity‐related metabolic complications, which add significantly to the population burden of cardiovascular morbidity in the long term. Early detection of obesity‐related metabolic complications through appropriate screening strategies forms a crucial aspect of obesity management. We performed a scoping review of international and national guidelines on the management of pediatric obesity to evaluate the recommendations on screening for metabolic complications, namely, hypertension, diabetes, dyslipidemia, and non‐alcoholic fatty liver disease. Thirty guidelines were included, 23 (76.7%) of which had some guidance on screening for metabolic complications. However, there were significant variations in the extent and details of recommendations for screening for these metabolic complications. There has been no consensus on the body mass index (BMI) thresholds, age of onset, frequency, and screening tests recommended for detecting hypertension, diabetes, dyslipidemia, and non‐alcoholic fatty liver disease between guidelines. These variations did not appear to be polarized based on geographical location or population ethnicity. We provide our recommendations on metabolic screening based on the strength of evidence in the guidelines, also incorporating recommendations from key childhood hypertension, diabetes, and lipid guidelines. Appropriate implementation of screening strategies is crucial to improve detection of metabolic complications, to allow for earlier or more intensified interventions for affected children with obesity.

show abstract

“…One reason is that clinic BP data are seldom obtained in the recommended manner prior to referral for ABPM. Rea et al found that only 2% of patients had followed the recommended steps from the 2017 AAP CPG for assessment of clinic BP readings, only 10% had a follow-up appointment, and 2% had recommended lab tests (27). ABPM is generally not available in primary care practice because of cost, poor reimbursement, and the time required for data collection and interpretation.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory blood pressure monitoring in children: A retrospective single-center study

Ahlenius

Koek²,

Yamaguchi³

2023

Front. Pediatr.

View full text Add to dashboard Cite

Objectives(1) Compare 24-hour ambulatory blood pressure monitoring (ABPM) diagnoses in a pediatric population with the new 2022 guidelines to the original diagnoses with the 2014 guidelines. (2) Determine whether findings of hypertension from ABPM could be predicted from prior patient data. (3) Determine whether ABPM readings could predict left ventricular mass index (LVMI) in patients who obtained an echocardiogram (ECHO).Study designSingle-center retrospective study on patients referred to Pediatric Nephrology Clinic for evaluation of elevated blood pressure who underwent ABPM from 2015 to 2018. Predictions of hypertension were obtained using a logistic regression model, and predictions of LVMI were performed using regression models including (a) the wake systolic and diastolic BP indices, or (b) additionally including the standard deviation (SD) of wake SBP and DBP.ResultsWith the change in 2022 to new ABPM guidelines from the AHA, comparing the old and new guidelines led to 70% of previous pre-hypertensive diagnoses now meeting criteria for diagnosis of hypertension, and a rise from 21% of the ABPMs meeting criteria for hypertension to 51% now meeting criteria. In a logistic regression model, prior patient data were not predictive of a diagnosis of hypertension from ABPM (Nagelkerke's R2 = 0.04). Among the individual variables studied, none were statistically significant. For prediction of LVMI, the SD of wake SBP and DBP were significantly associated with increased LVMI, but the wake SBP and DBP indices were not.ConclusionsIn our patient population, the new ABPM guidelines led to a significant increase in diagnoses of hypertension. Prior patient data was not sufficient to predict a diagnosis of hypertension by ABPM, supporting the need for evaluation by ABPM as the gold standard. Our analysis of the relationship between ABPM readings and LVMI supports the hypothesis that BP variability contributes to increased LVMI. These data are consistent with growing evidence in the adult literature that BP variability detected by ABPM is associated with left-ventricular hypertrophy

show abstract

Pediatrician Adherence to Guidelines for Diagnosis and Management of High Blood Pressure

Cited by 23 publications

References 27 publications

High Blood Pressure in Children and Adolescents: Current Perspectives and Strategies to Improve Future Kidney and Cardiovascular Health

High Blood Pressure in Children and Adolescents: Current Perspectives and Strategies to Improve Future Kidney and Cardiovascular Health

Screening for metabolic complications of childhood and adolescent obesity: A scoping review of national and international guidelines

Ambulatory blood pressure monitoring in children: A retrospective single-center study

Contact Info

Product

Resources

About