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Patient-, provider-, and clinic-level predictors of unrecognized elevated blood pressure in children

Tammy M Brady1, Barry S Solomon, Alicia M Neu

  • 1MHS, Johns Hopkins University, David M. Rubenstein Child Health Building, 200 North Wolfe St, Room 3057, Baltimore, MD 21287, USA. tbrady8@jhmi.edu

Pediatrics
|May 5, 2010
PubMed

Insights

Most childhood elevated blood pressure (BP) cases go unrecognized. Factors like normal BP readings and provider experience influence recognition, highlighting a need for improved screening in pediatric care.

Area of Science:

  • Pediatric primary care
  • Cardiovascular health in children
  • Hypertension screening

Background:

  • Elevated blood pressure (BP) in children is a growing concern.
  • Early detection and management are crucial for preventing long-term cardiovascular disease.
  • Underrecognition of elevated BP in pediatric settings poses a significant public health challenge.

Purpose of the Study:

  • To identify patient, provider, and clinic factors predicting unrecognized elevated BP in children.
  • To test the hypothesis that healthy weight, lower BP readings, and less experienced providers are associated with decreased recognition.

Main Methods:

  • Cross-sectional study of pediatric primary care visits (2006).
  • Included children aged 3-20 years with elevated BP (≥90th percentile or ≥120/80 mmHg).
  • Multivariate logistic regression analyzed predictors of underrecognition, defined by lack of documented follow-up actions.

Main Results:

  • Elevated BP occurred in 39% of visits; 87% were unrecognized.
  • Underrecognition predictors: BP <120/80 mmHg, decreasing BMI z-score, male gender, older age, no family history of CVD, negative medical history.
  • Seeing a nurse practitioner or less experienced provider also predicted underrecognition.

Conclusions:

  • The majority of elevated BP in children is missed by providers.
  • Absence of obviously high BP, obesity, and lack of family history were key factors in poor recognition.
  • Improved screening protocols are needed to address underrecognition of pediatric hypertension.
Abstract

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