Clinicians are failing to identify most cases of hypertension in children aged 3-18 years, a large study shows.Researchers at Case Western Reserve University in Cleveland assessed the records of 14,200 youngsters in this age group who had been examined at least three times for well-child care between June 1999 and September 2006 in outpatient clinics near Cleveland. Among other data from the visits that were electronically recorded were the children’s BPs.

Yet, of the 507 children (3.6%) with hypertension, only 131 (26%) had a diagnosis documented in their records. Part of the problem is there are no clear cutoffs for BP in children as there are in adults. BP in children is a function of age, sex, and height percentile, so clinicians have a hard time remembering the normal BP for the wide range of children seen in primary care.

“It’s not that clinicians are just missing a couple percent of hypertension cases. We’re missing a huge proportion (74%) of patients with this condition,” says David Kaelber, MD, PhD, of Children’s Hospital Boston.

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The researchers also discovered that children who were older, taller, and heavier were more likely to have their high BP diagnosed. “But those aren’t the only kids with hypertension,” Dr. Kaelber added.

“Identification of elevated BP in children is important because of the increasing prevalence of pediatric weight problems and because secondary hypertension is becoming more common in children than adults, requiring identification and workup,” the researchers write (JAMA. 2007; 298:874-879).