High blood pressure is vastly underdiagnosed in children, new study says

A new national study that looked at 15 years of health records for thousands of pediatric patients suggests that hypertension in children is a greatly underdiagnosed condition.

Only 23 percent of the children who had elevated blood pressure readings in the hypertension range and about 10 percent of the patients with prehypertensive readings were actually diagnosed with the conditions, according to the study to be reported online Tuesday in the medical journal Pediatrics.

Of the children actually diagnosed with hypertension, fewer than 6 percent were prescribed medication for their condition. 

“I think what this highlights is that children with high blood pressure are really slipping through unrecognized,” said Alexander Fiks, a Children’s Hospital of Philadelphia pediatrician and researcher with the hospital’s PolicyLab, a research center focused on health policy.

Fiks worked on the study with researchers from several other institutions, including the University of Pennsylvania.

"Although over 95 percent of children and adolescents are checked for high blood pressure, doctors taking care of children are not putting all the pieces of the puzzle together in terms of interpreting the results and following the appropriate guidelines for treatment," lead  author David Kaelber said in a statement.

Kaelber, a Case Western Reserve University medical professor and chief medical informatics officer of the MetroHealth System, is co-chair of the American Academy of Pediatrics task force rewriting pediatric blood pressure guidelines. 

The study includes records of nearly 400,000 patients age 3 to 18 who had three or more blood pressure readings measured at nearly 200 primary-care sites in 27 states.

More than 12,000 children had at least three hypertension-range readings, but only about 2,800 were given a hypertension diagnosis. Of nearly 39,000 children with prehypertension-range readings, fewer than 4,000 were officially diagnosed with prehypertension.

Out of the 2,813 patients diagnosed with hypertension, only 5.6 percent were prescribed an antihypertensive medication within 12 months of diagnosis. Just as with adults, not all children with high blood pressure should immediately be started on medicine, but researchers said the prescription rate they found clearly is low.

Pediatric high blood pressure is known to predispose children to adult hypertension and can be a precursor to cardiovascular disease.

Fiks said the data suggested that too many pediatricians may be discounting children's elevated blood pressure readings, attributing it to anxiety or being upset.

With so many children now overweight or obese,  doctors should be attentive to potential signs of trouble such as elevated blood pressure, he said.

Many medical practices now have electronic record keeping, Fiks noted. More of them should incorporate ways to flag repeated elevated pressure readings, he said.

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