The importance of recognizing hypertension is well ingrained in all of us who care for children and teenagers—but recognizing when a blood pressure is high is sometimes more difficult for us to do, given how the normal ranges can vary with age. For that reason, electronic health records are striving to add clinical decision support (CDS) tools to help flag for us abnormalities that may escape our clinical review of a patient’s vital signs, anthropometric data, or even laboratory studies. Will use of a CDS tool enhance our ability to recognize and even manage hypertension in our patients? Kharbanda et al. (10.1542/peds.2017-2954) opted to answer that question by analyzing data gathered in a randomized trial involving 20 primary care clinics in one integrated health system some of whom received a CDS tool (designed by the authors) for hypertension recognition and management or usual care. The study involved more than 31,000 patients ages 10-17 over a 2-year period.
The good news is that the CDS tool made a significant difference in picking up on recognition of hypertension in these adolescents or pre-adolescents. The CDS tool did not do quite as well but still made a significant difference in prompting management adherence to recommended NIH guidelines for diagnosing and managing hypertension. The bad news is that not every patient with the clinical diagnosis of hypertension on review of the records got recognized for it by clinicians despite access to the CDS tool and a clinician’s examination of that patient. Why not? We asked pediatric nephrologists Ari Pollack and Joseph Flynn from Seattle Children’s Hospital to address that question in an accompanying commentary (10.1542/peds.2017-3756). They remind us that a CDS tool is not the answer if we are not even thinking about recognizing hypertension and measuring blood pressures in the first place. The authors of the study and commentary offer a number of suggestions to further boost the reliability of a CDS tool to help clinicians do their job in the prevention and screening of hypertension. We won’t pressure you, but encourage you to check out both these important articles and learn more.
