Pediatric hypertension is a concern for all of us who see patients because of the role it likely plays as a harbinger of cardiovascular disease. Identifying hypertension in children can be complex because normal values change with age and body size, with differences between boys and girls. How good a job are we doing to treat high blood pressure in our patients? Kaelber et al. (10.1542/peds.2016-2195) have done their best to answer that question by looking at a “big data” set of over 1.2 million pediatric patients from 196 clinics in 27 states.
The authors looked at electronic health record data on these patients to determine if (1) 3 visits occurred for an elevated blood pressure to confirm the diagnosis; (2) the documentation suggests hypertension when the blood pressures meet that criteria in retrospect, and (3) whether antihypertensive medications have been prescribed. The results are concerning in that while guidelines from the AAP are available for appropriate diagnosis and treatment of hypertension, many of us are not identifying these patients as being hypertensive and even fewer of us are starting initial medication when warranted despite the evidence-based guidelines that help us know when such treatment is needed.
The seriousness of the findings in this study (that many of us are not diagnosing or managing hypertension according to the AAP guidelines) are captured as well in an accompanying commentary by Drs. Hill and Li (10.1542/peds.2016-2857). Their comments are more than just off the (blood-pressure) cuff, but a call for action for all of us to do a better job so as to improve our management to protect against long-term health problems.
Do you agree that we could do a better job of diagnosing and managing hypertension, or have electronic health records improved your screening and recognition of this health concern? Share with us your thoughts by responding to this blog, posting a comment on our website or sharing your ideas about how to improve recognition of hypertension by posting on our Facebook, Twitter, or Instagram sites.
