Hypertension was missed in approximately 75% of children with persistently elevated BP readings.
The prevalence of hypertension in U.S. children and adolescents appears to be increasing with the growing obesity epidemic. Ohio researchers sought to determine the rate of undiagnosed hypertension among 14,187 children and adolescents (age range, 3–18 years) who had at least three well visits at the community-based clinics of an academic medical center from 1999 to 2006. For their analysis, the investigators evaluated data from the network’s electronic medical record (EMR).
A total of 507 patients (3.6%) met criteria for hypertension, based on elevated BP readings during three or more visits. However, only 131 patients (26% of those with hypertension) had diagnoses of either hypertension (80 patients) or elevated blood pressure (51 patients) documented in the EMR. Seventeen patients met criteria for stage 2 hypertension, but only 10 had documented diagnoses. Factors associated with an increased likelihood of receiving a hypertension diagnosis included greater number or severity of elevated BP readings, older age, greater height, and having an obesity-related diagnosis.
Comment: These results document the prevalence of actual versus diagnosed hypertension in a practice-based population and the need for more aggressive and accurate diagnosis by pediatric clinicians. They also demonstrate the research value of electronic medical records in large healthcare systems.
Published in Journal Watch General Medicine August 23, 2007
Hansen ML et al. Underdiagnosis of hypertension in children and adolescents. JAMA 2007 Aug 22; 298:874-9.