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Diagnosing Pediatric Hypertension: Missed Opportunities

Hypertension was missed in about 75% of children with persistently elevated BP readings.

The well-child visit is intended to detect potential threats to wellness and to provide appropriate interventions. To determine the incidence of undiagnosed hypertension in a pediatric population, investigators performed a review of electronic medical records for 14,187 children and adolescents (age range, 3–18 years) who attended at least three well-child care visits at community-based clinics of an academic medical center from 1999 to 2006. Stage 1 hypertension was defined as systolic or diastolic blood pressure (BP) readings at three visits at or above the 95th percentile for sex, age, and height; stage 2 hypertension was defined as three BP readings at or above the 99th percentile plus 5 mm Hg; prehypertension was defined as an average BP between the 90th and 95th percentile.

Overall, 507 patients (3.6%) met criteria for hypertension, but in only 131 (26.0%) was this diagnosis documented in the medical records, including only 10 of 17 patients with stage 2 hypertension. Of 485 patients (3.4%) who met criteria for prehypertension, only 11.0% had documented diagnoses. Hypertension was more common in Hispanics (odds ratio, 1.31) than in whites, and prehypertension was more common in blacks (OR, 1.20). Both hypertension and prehypertension were associated with family history of hypertension. Factors associated with a diagnosis of hypertension were older age, male sex, obesity, and stage 2 hypertension readings.

Comment: Hypertension in children often is not diagnosed, even when criteria suggestive of the diagnosis are present in electronic medical records. Electronic medical records give us the ability to evaluate important clinical epidemiology trends; however, such records must be programmed to display clinical-alert flags when abnormal values and important family history are present so diagnoses can be made and interventions can be provided.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine August 29, 2007

Citation(s):

Hansen ML et al. Underdiagnosis of hypertension in children and adolescents. JAMA 2007 Aug 22; 298:874-9.

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