 |
|
Underdiagnosis of Hypertension in Children and Adolescents
Matthew L. Hansen, MD;
Paul W. Gunn, BS;
David C. Kaelber, MD, PhD
JAMA. 2007;298(8):874-879.
Context Pediatric hypertension is increasing in prevalence with the pediatric obesity epidemic. Diagnosis of hypertension in children is complicated because normal and abnormal blood pressure values vary with age, sex, and height and are therefore difficult to remember.
Objectives To determine the frequency of undiagnosed hypertension and prehypertension and to identify patient factors associated with this underdiagnosis.
Design, Setting, and Participants A cohort study of 14 187 children and adolescents aged 3 to 18 years who were observed at least 3 times for well-child care between June 1999 and September 2006 in the outpatient clinics in a large academic urban medical system in northeast Ohio. For children and adolescents who met criteria for hypertension or prehypertension at 3 or more well-child care visits, the proportion with a hypertension-related International Classification of Diseases, Ninth Revision code in the diagnoses list, problem list, or past medical history list of any visit was determined.
Main Outcome Measures Proportion of children and adolescents with 3 or more elevated age-adjusted and height-adjusted blood pressure measurements at well-child care visits and with a diagnosis of hypertension or prehypertension documented in the electronic medical record. Multivariate logistic regression identified patient factors associated with a correct diagnosis.
Results Of 507 children and adolescents (3.6%) who had hypertension, 131 (26%) had a diagnosis of hypertension or elevated blood pressure documented in the electronic medical record. Patient factors that increased the adjusted odds of a correct diagnosis were a 1-year increase in age over age 3 (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.03-1.16), number of elevated blood pressure readings beyond 3 (OR, 1.77; 95% CI, 1.21-2.57), increase of 1% in height-for-age percentile (OR, 1.02; 95% CI, 1.01-1.03), having an obesity-related diagnosis (OR, 2.61; 95% CI, 1.49-4.55), and number of blood pressure readings in the stage 2 hypertension range (OR, 1.68; 95% CI, 1.29-2.19). Of 485 children and adolescents (3.4%) who had prehypertension, 55 (11%) had an appropriate diagnosis documented in the electronic medical record. Patient factors that increased the adjusted odds of being diagnosed with prehypertension included a 1-year increase in age over age 3 (OR, 1.21; 95% CI, 1.09-1.34) and number of elevated blood pressure readings beyond 3 (OR, 3.07; 95% CI, 2.20-4.28).
Conclusions Hypertension and prehypertension were frequently undiagnosed in this pediatric population. Patient age, height, obesity-related diagnoses, and magnitude and frequency of abnormal blood pressure readings all increased the odds of diagnosis.
Author Affiliations: School of Medicine, Case Western Reserve University, Cleveland, Ohio (Drs Hansen and Kaelber and Mr Gunn); Department of Emergency Medicine, Oregon Health and Science University School of Medicine, Portland (Dr Hansen); and the Departments of Internal Medicine and Pediatrics, MetroHealth Medical Center, Cleveland, Ohio, and the Center for Information Technology Leadership, Partners Healthcare, and the Departments of Internal Medicine and Pediatrics, Harvard Medical School, Boston Children's Hospital, Brigham and Women's Hospital, and Massachusetts General Hospital, Boston, Massachusetts (Dr Kaelber).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED LETTER
Diagnosing Hypertension in Children and Adolescents
Johan M. van Schalkwyk and Martin J. Turner
JAMA. 2008;299(2):168.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
The association of continuity of care on the diagnosis of hypertension in children and adolescents
Benson et al.
J Child Health Care 2009;13:361-369.
ABSTRACT
Blood Pressure Differences by Ethnic Group Among United States Children and Adolescents
Rosner et al.
Hypertension 2009;54:502-508.
ABSTRACT
| FULL TEXT
Hypertension in Pediatric Long-term Hemodialysis Patients in the United States
Chavers et al.
CJASN 2009;4:1363-1369.
ABSTRACT
| FULL TEXT
Simple Table to Identify Children and Adolescents Needing Further Evaluation of Blood Pressure
Kaelber and Pickett
Pediatrics 2009;123:e972-e974.
ABSTRACT
| FULL TEXT
Refining the Blood Pressure Phenotype in Children: When Does Target Organ Damage Begin?
Falkner and DeLoach
Hypertension 2009;53:905-906.
FULL TEXT
Prevalence of Antihypertensive, Antidiabetic, and Dyslipidemic Prescription Medication Use Among Children and Adolescents
Liberman et al.
Arch Pediatr Adolesc Med 2009;163:357-364.
ABSTRACT
| FULL TEXT
Sympathoexcitation by Oxidative Stress in the Brain Mediates Arterial Pressure Elevation in Obesity-Induced Hypertension
Nagae et al.
Circulation 2009;119:978-986.
ABSTRACT
| FULL TEXT
Pediatric Stroke in the United States and the Impact of Risk Factors
Lo et al.
J Child Neurol 2009;24:194-203.
ABSTRACT
Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
WRITING GROUP MEMBERS et al.
Circulation 2009;119:e21-e181.
FULL TEXT
Evaluation and Treatment of Hypertension in General Pediatric Practice
Boneparth and Flynn
CLIN PEDIATR 2009;48:44-49.
ABSTRACT
Trends in the Diagnosis of Overweight and Obesity in Children and Adolescents: 1999-2007
Benson et al.
Pediatrics 2009;123:e153-e158.
ABSTRACT
| FULL TEXT
Intracranial Hemorrhage in Children: An Evolving Spectrum
Lo et al.
Arch Neurol 2008;65:1629-1633.
ABSTRACT
| FULL TEXT
Elevated Blood Pressure in Relation to Overweight and Obesity Among Children in a Rural Canadian Community
Salvadori et al.
Pediatrics 2008;122:e821-e827.
ABSTRACT
| FULL TEXT
Candesartan Cilexetil Effectively Reduces Blood Pressure in Hypertensive Children
Franks et al.
The Annals of Pharmacotherapy 2008;42:1388-1395.
ABSTRACT
| FULL TEXT
Blood Pressure Variability and Classification of Prehypertension and Hypertension in Adolescence
Falkner et al.
Pediatrics 2008;122:238-242.
ABSTRACT
| FULL TEXT
Are Children Doomed by What They Eat and Drink?
Weinberger
Hypertension 2008;51:615-616.
FULL TEXT
Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Writing Group Members et al.
Circulation 2008;117:e25-e146.
FULL TEXT
Diagnosing Hypertension in Children and Adolescents
van Schalkwyk and Turner
JAMA 2008;299:168-168.
FULL TEXT
Review: The role of noninvasive hemodynamic monitoring in the evaluation and treatment of hypertension
Ferrario et al.
Ther Adv Cardiovasc Dis 2007;1:113-118.
ABSTRACT
Diagnosing Pediatric Hypertension: Missed Opportunities
JWatch Pediatrics 2007;2007:1-1.
FULL TEXT
Hypertension Often Undiagnosed in Children
JWatch General 2007;2007:2-2.
FULL TEXT
|
