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Pediatricians May Not Recognize High Blood Pressure

Providers at urban clinic missed 87 percent of cases; lack of obvious risk factors may be cause

TUESDAY, May 4 (HealthDay News) -- At some pediatric practices, many cases of elevated blood pressure go unrecognized, and the most important factors associated with under-recognition are an absence of cardiovascular disease risk factors such as obviously elevated blood pressure, obesity, and family history of cardiovascular disease, according to a study published online May 3 in Pediatrics.

Tammy M. Brady, M.D., of the Johns Hopkins University in Baltimore, and colleagues performed a cross-sectional study of 2,000 clinic visits for children aged 3 to 20 years at an urban, pediatric primary care practice in 2006.

The researchers found that elevated blood pressure was present in 779 (39 percent) of the visits, and included 726 cases in their analysis. Among these cases, they found that 87 percent were unrecognized by providers, and that the most important patient-level predictors of under-recognition included systolic blood pressure of less than 120 mm/Hg (odds ratio, 7.7), diastolic blood pressure of less than 80 mm/Hg (odds ratio, 2.4), decreasing BMI z score, older age, male gender, negative medical history findings, and lack of family history of cardiovascular disease. They also found that significant predictors of under-recognition included being seen by a nurse practitioner or a less-experienced provider.

"To improve recognition and ultimately to increase early diagnosis and treatment of children with hypertension, it is imperative that systems such as computerized alerts be put into place to help improve provider recognition of elevated blood pressure," the authors conclude. "In addition, enhanced provider education is needed to ensure that providers are practicing in the context of current guidelines and to improve our ability to detect elevated blood pressure in children who may seem to be at low risk."

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