A simplified table improves the recognition of paediatric hypertension

Department of Internal Medicine, University of Louisville, School of Medicine, Louisville, Kentucky 40202, USA.
Journal of Paediatrics and Child Health (Impact Factor: 1.15). 10/2010; 47(1-2):22-6. DOI: 10.1111/j.1440-1754.2010.01885.x
Source: PubMed


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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    • "Several electronic mobile applications now allow direct BP entry to calculate child specific percentiles without resorting to complex tables[14]. In a busy practice, educating nursing staff responsible for patient intake, and employing a simplified approach for BP evaluation may improve the recognition of pediatric hypertension[15]. For example, a nurse may start by having the child rest in the seated position while the caregiver is answering intake questions. "

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