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Evaluation and treatment of hypertension in general pediatric practice

Alexis Boneparth1, Joseph T Flynn

  • 1Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA.

Clinical Pediatrics
|October 4, 2008
PubMed

Insights

Pediatricians show varied approaches to childhood hypertension (HTN) diagnosis and treatment. Many feel uncomfortable managing HTN, highlighting a gap between current practice and consensus recommendations for hypertensive youth.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Health in Children
  • Public Health

Background:

  • Childhood hypertension (HTN) is a growing concern.
  • Current management practices among general pediatricians are not well understood.
  • Variability in care may impact long-term health outcomes for hypertensive youth.

Purpose of the Study:

  • To assess the variability in diagnostic and treatment approaches to pediatric hypertension among general pediatricians.
  • To identify barriers faced by pediatricians in managing hypertensive youth.
  • To compare current practices with established consensus guidelines.

Main Methods:

  • A survey was distributed to pediatricians referring to an urban children's hospital.
  • The survey focused on blood pressure measurement, diagnostic evaluation, and treatment initiation for hypertension.
  • Physician familiarity with The Fourth Report on pediatric hypertension was assessed.

Main Results:

  • Most pediatricians initiate blood pressure measurement at age 3, but diagnostic evaluation shows significant variability.
  • Only 7% of pediatricians routinely initiate antihypertensive drug treatment; 82% refer to specialists.
  • 40% of pediatricians reported discomfort in evaluating and treating pediatric HTN, particularly those unfamiliar with The Fourth Report.

Conclusions:

  • Pediatrician practices for hypertension management deviate from current consensus recommendations.
  • Lack of familiarity with guidelines and discomfort in management are key obstacles.
  • Targeted interventions are needed to improve the care of hypertensive children and adolescents.

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