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Twenty-three percent of children with hypertension and 10% of those with prehypertension were diagnosed by clinicians, based on data from a retrospective study of more than 398,000 children in the United States.
In addition, only 6% of children who met criteria for hypertension received treatment within a year of their diagnosis.
The researchers reviewed data from 398,079 children and adolescents aged 3-18 years who were part of the Comparative Effectiveness Research Through Collaborative Electronic Reporting Consortium. The patients had at least three visits with blood pressure and height measured.
The final study population included 12,138 children with hypertension at 44 sites and 38,874 children with prehypertension at 77 sites. Of the children with hypertension, 23% had hypertension or abnormal blood pressure diagnosis in their electronic health record (EHR). In addition, 32% of 4,996 children with stage 2 hypertension had an EHR diagnosis. A diagnosis was more likely in children who were male, taller, older, heavier, had at least one blood pressure measurement in the stage 2 range, or who had additional measurements beyond the three needed for a diagnosis.
Of the children with prehypertension, 10% had a diagnosis of hypertension or abnormal blood pressure in their EHRs. Diagnosis was more common among males and those who were older, heavier, taller, had more than one blood pressure measurement in the stage 2 range or had additional readings beyond those needed for diagnosis, the investigators said.
Of 2,813 pediatric patients who met criteria for hypertension and continued to have high blood pressure readings, only 6% were prescribed medication within 12 months of diagnosis. The average age for medication initiation was almost 14 years, and the most commonly prescribed medications were angiotensin-converting-enzyme inhibitors or angiotensin-II-receptor blockers for 35% of children, diuretics for 22%, calcium channel blockers for 17%, and beta blockers for 10%, Dr. Kaelber and his associates reported.
The study results were limited by several factors, among them the reliance on ICD-9 codes for identification of abnormal blood pressure and inclusion of all reasons (preventive care and nonpreventive care) for visits to primary care pediatric providers. The findings, however, suggest that “intervention is needed to help pediatric primary care clinicians recognize and treat hypertension and prehypertension,” they wrote.
Funding was provided by U.S. Department of Health & Human Services grants and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The researchers had no relevant financial disclosures.
“Childhood hypertension is associated with increased carotid intima media thickness, increased left ventricular mass, and increased arterial stiffness, all precursors to adverse cardiovascular outcomes in adulthood,” wrote Kevin D. Hill, MD, and Jennifer S. Li., MD, in an accompanying editorial (Pediatrics 2016 Nov 22;138:e20162857. doi: 10.1542/peds.2016-2857).
Although some may question the study findings, “there are compelling reasons to believe the results,” in part because the study’s definition of hypertension and reported 3.3% hypertension rate are consistent with current guidelines and previous studies, they noted.
“Hypertension is indeed more challenging to diagnose in children because of age, sex, and height-related variability in blood pressure norms,” they said. Evaluation of blood pressure percentiles, however, should be routine in pediatric practice.
More research is needed, including head-to-head comparisons of drugs and assessments of lifestyle interventions, the editorialists said. However, “it is clear that childhood hypertension is a major public health concern. The clinical manifestations may be silent during childhood, but this should not deter early diagnosis and treatment.”
Dr. Hill and Dr. Li are with Duke University in Durham, N.C. They had no financial conflicts to disclose. Their work was supported in part by the National Institutes of Health.
“Childhood hypertension is associated with increased carotid intima media thickness, increased left ventricular mass, and increased arterial stiffness, all precursors to adverse cardiovascular outcomes in adulthood,” wrote Kevin D. Hill, MD, and Jennifer S. Li., MD, in an accompanying editorial (Pediatrics 2016 Nov 22;138:e20162857. doi: 10.1542/peds.2016-2857).
Although some may question the study findings, “there are compelling reasons to believe the results,” in part because the study’s definition of hypertension and reported 3.3% hypertension rate are consistent with current guidelines and previous studies, they noted.
“Hypertension is indeed more challenging to diagnose in children because of age, sex, and height-related variability in blood pressure norms,” they said. Evaluation of blood pressure percentiles, however, should be routine in pediatric practice.
More research is needed, including head-to-head comparisons of drugs and assessments of lifestyle interventions, the editorialists said. However, “it is clear that childhood hypertension is a major public health concern. The clinical manifestations may be silent during childhood, but this should not deter early diagnosis and treatment.”
Dr. Hill and Dr. Li are with Duke University in Durham, N.C. They had no financial conflicts to disclose. Their work was supported in part by the National Institutes of Health.
“Childhood hypertension is associated with increased carotid intima media thickness, increased left ventricular mass, and increased arterial stiffness, all precursors to adverse cardiovascular outcomes in adulthood,” wrote Kevin D. Hill, MD, and Jennifer S. Li., MD, in an accompanying editorial (Pediatrics 2016 Nov 22;138:e20162857. doi: 10.1542/peds.2016-2857).
Although some may question the study findings, “there are compelling reasons to believe the results,” in part because the study’s definition of hypertension and reported 3.3% hypertension rate are consistent with current guidelines and previous studies, they noted.
“Hypertension is indeed more challenging to diagnose in children because of age, sex, and height-related variability in blood pressure norms,” they said. Evaluation of blood pressure percentiles, however, should be routine in pediatric practice.
More research is needed, including head-to-head comparisons of drugs and assessments of lifestyle interventions, the editorialists said. However, “it is clear that childhood hypertension is a major public health concern. The clinical manifestations may be silent during childhood, but this should not deter early diagnosis and treatment.”
Dr. Hill and Dr. Li are with Duke University in Durham, N.C. They had no financial conflicts to disclose. Their work was supported in part by the National Institutes of Health.
Twenty-three percent of children with hypertension and 10% of those with prehypertension were diagnosed by clinicians, based on data from a retrospective study of more than 398,000 children in the United States.
In addition, only 6% of children who met criteria for hypertension received treatment within a year of their diagnosis.
The researchers reviewed data from 398,079 children and adolescents aged 3-18 years who were part of the Comparative Effectiveness Research Through Collaborative Electronic Reporting Consortium. The patients had at least three visits with blood pressure and height measured.
The final study population included 12,138 children with hypertension at 44 sites and 38,874 children with prehypertension at 77 sites. Of the children with hypertension, 23% had hypertension or abnormal blood pressure diagnosis in their electronic health record (EHR). In addition, 32% of 4,996 children with stage 2 hypertension had an EHR diagnosis. A diagnosis was more likely in children who were male, taller, older, heavier, had at least one blood pressure measurement in the stage 2 range, or who had additional measurements beyond the three needed for a diagnosis.
Of the children with prehypertension, 10% had a diagnosis of hypertension or abnormal blood pressure in their EHRs. Diagnosis was more common among males and those who were older, heavier, taller, had more than one blood pressure measurement in the stage 2 range or had additional readings beyond those needed for diagnosis, the investigators said.
Of 2,813 pediatric patients who met criteria for hypertension and continued to have high blood pressure readings, only 6% were prescribed medication within 12 months of diagnosis. The average age for medication initiation was almost 14 years, and the most commonly prescribed medications were angiotensin-converting-enzyme inhibitors or angiotensin-II-receptor blockers for 35% of children, diuretics for 22%, calcium channel blockers for 17%, and beta blockers for 10%, Dr. Kaelber and his associates reported.
The study results were limited by several factors, among them the reliance on ICD-9 codes for identification of abnormal blood pressure and inclusion of all reasons (preventive care and nonpreventive care) for visits to primary care pediatric providers. The findings, however, suggest that “intervention is needed to help pediatric primary care clinicians recognize and treat hypertension and prehypertension,” they wrote.
Funding was provided by U.S. Department of Health & Human Services grants and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The researchers had no relevant financial disclosures.
Twenty-three percent of children with hypertension and 10% of those with prehypertension were diagnosed by clinicians, based on data from a retrospective study of more than 398,000 children in the United States.
In addition, only 6% of children who met criteria for hypertension received treatment within a year of their diagnosis.
The researchers reviewed data from 398,079 children and adolescents aged 3-18 years who were part of the Comparative Effectiveness Research Through Collaborative Electronic Reporting Consortium. The patients had at least three visits with blood pressure and height measured.
The final study population included 12,138 children with hypertension at 44 sites and 38,874 children with prehypertension at 77 sites. Of the children with hypertension, 23% had hypertension or abnormal blood pressure diagnosis in their electronic health record (EHR). In addition, 32% of 4,996 children with stage 2 hypertension had an EHR diagnosis. A diagnosis was more likely in children who were male, taller, older, heavier, had at least one blood pressure measurement in the stage 2 range, or who had additional measurements beyond the three needed for a diagnosis.
Of the children with prehypertension, 10% had a diagnosis of hypertension or abnormal blood pressure in their EHRs. Diagnosis was more common among males and those who were older, heavier, taller, had more than one blood pressure measurement in the stage 2 range or had additional readings beyond those needed for diagnosis, the investigators said.
Of 2,813 pediatric patients who met criteria for hypertension and continued to have high blood pressure readings, only 6% were prescribed medication within 12 months of diagnosis. The average age for medication initiation was almost 14 years, and the most commonly prescribed medications were angiotensin-converting-enzyme inhibitors or angiotensin-II-receptor blockers for 35% of children, diuretics for 22%, calcium channel blockers for 17%, and beta blockers for 10%, Dr. Kaelber and his associates reported.
The study results were limited by several factors, among them the reliance on ICD-9 codes for identification of abnormal blood pressure and inclusion of all reasons (preventive care and nonpreventive care) for visits to primary care pediatric providers. The findings, however, suggest that “intervention is needed to help pediatric primary care clinicians recognize and treat hypertension and prehypertension,” they wrote.
Funding was provided by U.S. Department of Health & Human Services grants and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The researchers had no relevant financial disclosures.
FROM PEDIATRICS
Key clinical point: Pediatric hypertension is underdiagnosed, and medication guidelines are inconsistently followed.
Major finding: Only 23% of children with hypertension and 10% of those with prehypertension were diagnosed by clinicians; 6% of those with hypertension were prescribed medication.
Data source: A retrospective cohort study including 398,079 pediatric patients from 196 clinics in 27 states.
Disclosures: Funding was provided by U.S. Department of Health & Human Services grants and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The researchers had no relevant financial disclosures.