A simplified table improves the recognition of paediatric hypertension.
ABSTRACT Unrecognised and untreated hypertension can lead to significant morbidity and mortality over time. In a 2003 chart review, we found that our providers only recognised 15% of hypertensive blood pressure (BP). Our objective was to determine whether a simplified BP table improves the recognition of elevated BP in children.
We developed a simplified BP table for children 3-18 years and posted it in provider work areas beginning August 2006. We reviewed a retrospective sample of well visits for children aged 3-18 years, with equal numbers by sex and year of age, presenting at a university-based paediatric clinic between January and August 2007. Visit notes for all children with elevated BP values ≥ 90th percentile were reviewed to identify whether the provider recognised that the BP was elevated.
In 493 well visits, 85 (17.2%) children had pre-hypertensive (90th to < 95th percentile) and 100 (20.3%) had hypertensive (≥ 95th percentile) BP values. Providers recognised elevations in 34 (40%) pre-hypertensive and 77 (77%) hypertensive measurements. Recognition was significantly more common for those in the hypertensive than the pre-hypertensive range (χ² = 24.9, degrees of freedom= 1, P < 0.001). Compared with our 2003 data, recognition of hypertensive BP values was significantly greater (77% vs. 15%) (t = 14.479, degrees of freedom = 98, P <0.001) after introduction of the simplified BP table.
Use of a simplified BP table can lead to significantly improved recognition of elevated BP in children.
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ABSTRACT: Key Clinical Points Elevated Blood Pressure in a Child or Adolescent The prevalence of elevated blood pressure among children and adolescents has increased in concert with the marked increase in obesity among the young. Blood-pressure norms (and associated cutoff points for prehypertension and hypertension) for children and adolescents vary according to percentiles for age and height. The evaluation of elevated blood pressure in children and adolescents is designed to detect secondary hypertension, which may be curable. Management generally starts with nonpharmacologic therapy, followed by pharmacotherapy if the former approach is not successful; however, pharmacotherapy is initiated early if hypertension is severe or if there are concomitant conditions such as diabetes mellitus. Sustained hypertension in the young may be associated with end-organ damage. Available data suggest that therapy to lower blood pressure can reverse end-organ damage.New England Journal of Medicine 06/2014; 370(24):2316-2325. · 54.42 Impact Factor
- Paediatrics & child health 02/2013; 18(2):63-4. · 1.55 Impact Factor
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ABSTRACT: To elucidate why pediatricians fail to diagnose childhood hypertension, with special emphasis on the use of blood pressure (BP) reference data. We hypothesized that pediatricians frequently omit BP measurements and do not routinely relate BP measurements to reference data. We conducted a multicenter survey on BP measurement among 197 participants. Respondents were asked to estimate BP percentiles and classify BP readings in 12 example cases. Questionnaires were completed onsite in the presence of the researchers, without access to BP reference data. We found that 71% of physicians measure BP during ambulatory visits only if the child has risk factors for hypertension. After measuring BP, 65% compare the reading with reference data only if they suspect that it is elevated. Their ability to rate a reading at its true value is limited, however; 47% of the physicians classified 1 or more of the prehypertensive or hypertensive cases as normal. Most pediatricians do not screen for hypertension, contrary to recommendations. After obtaining a BP measurement, the majority do not compare the reading with reference standards; however, without the use of reference data, they commonly underestimate the BP percentile and potentially miss cases of childhood hypertension.The Journal of pediatrics 10/2013; · 4.02 Impact Factor