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Patterns of care and persistence after incident elevated blood pressure

Matthew F Daley1, Alan R Sinaiko, Liza M Reifler

  • 1Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado 80231, USA. matthew.f.daley@kp.org

Pediatrics
|July 4, 2013
PubMed

Insights

Most children with elevated blood pressure (BP) did not have a repeat BP measurement within one month. However, few children progressed to hypertension, indicating a need to review current screening guidelines for pediatric hypertension.

Area of Science:

  • Pediatric Cardiology
  • Public Health
  • Clinical Pediatrics

Background:

  • Hypertension screening in children is part of routine care.
  • Current guidelines recommend repeat blood pressure (BP) measurement within 1-2 weeks for elevated readings.
  • Patterns of care following incident elevated BP in pediatric populations require further investigation.

Purpose of the Study:

  • To assess follow-up care after an initial elevated blood pressure (BP) reading in children.
  • To determine the timing of repeat BP measurements and the incidence of persistently elevated BP.
  • To identify factors associated with timely follow-up BP measurement.

Main Methods:

  • Retrospective study of children aged 3-17 years with incident elevated BP from 2007-2010 across 3 healthcare organizations.
  • Assessed the proportion of children with repeat BP measurement within 1 month and those meeting hypertension definition.
  • Utilized multivariate analyses to identify factors associated with timely follow-up.

Main Results:

  • 8.4% of 72,625 children had an incident elevated BP.
  • Only 20.9% of these children had a repeat BP measurement within 1 month.
  • Obesity and stage 2 systolic elevation did not significantly increase the likelihood of timely follow-up; 1.4% had consecutive elevated readings within 12 months.

Conclusions:

  • Despite over 8% of children experiencing an incident elevated BP, most did not receive a repeat measurement within the recommended timeframe.
  • A low proportion of children with initial elevated BP subsequently met the definition of hypertension.
  • Findings suggest a potential need to re-evaluate current pediatric hypertension screening and follow-up protocols.
Abstract

Keywords:
adolescentblood pressurechildelectronic health recordshypertensionscreening

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