Recognizing elevated BP in children and adolescents: how are we doing?

Hypertension is increasing in incidence in children and adolescents, but may go unrecognized by health care providers. This study assessed rates of recognition of abnormal blood pressure (BP) values in patients ages 3 to 18 years by family medicine attending physicians, resident physicians, and nurse practitioners/physician assistants. The study also explored provider knowledge and comfort with diagnosing hypertension in children.

We conducted a chart review of pediatric patient visits in family medicine outpatient clinics, in addition to a survey of family medicine providers.

Providers recognized only 8% of elevated BP values during pediatric clinic visits. They were more likely to recognize BP values in the hypertensive range than in the pre­hypertensive range (P<.001). Providers were no more likely to recognize abnormal values during a health maintenance exam than during a routine office visit (P=.091). Rates of recognition differed by provider type (P=.002), with resident physicians being most likely to recognize an abnormal value. Anonymously surveyed providers answered less than half of the knowledge-based questions correctly (mean, 45%). The number of knowledge questions answered correctly was not associated with either the provider’s level of training or comfort with diagnosing hypertension in children.

Elevated BP values in children and adolescents are going unrecognized by family medicine providers most of the time. Providers additionally demonstrated knowledge gaps in how hypertension is defined in this age group. Evaluation of interventions to improve rates of hypertension diagnosis in children and adolescents is needed.