Blood Pressure Frequently Undiagnosed in Children, Adolescents

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Diagnosing Blood Pressure

In a study of children and adolescents with hypertension, only about one in four had been previously diagnosed with the condition, according to a study in the August 22/29 issue of JAMA.

Hypertension, with an estimated prevalence of between 2 percent and 5 percent, is a common chronic disease in children and 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, according to background information in the article.

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Matthew L. Hansen, M.D., of Case Western Reserve University, Cleveland, and colleagues conducted a study to determine the frequency of undiagnosed hypertension and prehypertension in 3- to 18-year-old children. The study included 14,187 children and adolescents who were observed at least three times for well-child care between June 1999 and September 2006 in outpatient clinics.

The researchers found that the criteria for hypertension were met by 507 children (3.6 percent). Of the children with hypertension, only 131 (26 percent) had a diagnosis of hypertension or elevated blood pressure documented in the electronic medical record; i.e., 376 of 507 participants (74 percent) had undiagnosed hypertension. Criteria for prehypertension were met by 485 children (3.4 percent). Of these children, 55 (11 percent) had a diagnosis of hypertension or elevated blood pressure documented in the electronic medical record.

Patient characteristics significantly associated with having a diagnosis of hypertension included a 1-year increase in age over age 3, number of elevated blood pressure readings beyond three, increase of 1 percent in height-for-age percentile, having an obesity-related diagnosis, and the number of blood pressure readings in the stage 2 hypertension range. Patient characteristics significantly associated with having a diagnosis of prehypertension included a 1-year increase in age over age 3 and number of elevated blood pressure readings beyond three.

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