Hypertension in Children: Motivating Improvement in Clinical Practice
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INVITED COMMENTARY
Hypertension in Children: Motivating Improvement in Clinical Practice Goutham Rao 1
# Springer Science+Business Media New York 2016
Abstract Hypertension in children is a common and serious problem associated with target organ damage including left ventricular hypertrophy (LVH), increased carotid intima-media thickness (CIMT), and microalbuminuria. Unfortunately, there is ample evidence that the problem goes unrecognized in clinical practice. There are multiple reasons for this including the complexity of blood pressure standards in children, a lack of knowledge among clinicians, skepticism about the importance of hypertension in children, conflicting screening recommendations, and discomfort among clinicians, patients, and families with pharmacotherapy. Strategies to improve rates of diagnosis include clinical decision support systems, educational programs, and incorporating diagnosis and management of hypertension into a broader strategy to address weight and lifestyle among overweight and obese children. Furthermore, evidence about the long-term impact of hypertension in children is emerging and should motivate improved screening, diagnosis, and management according to established guidelines. Keywords Hypertension . Children . Diagnosis . Clinical practice
Low Rates of Diagnosis When I began studying how pediatric hypertension is diagnosed and managed in primary care settings more than 5 years ago, I recall a community-based pediatrician colleague telling * Goutham Rao [email protected] 1
Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106, USA
me candidly that, BIn my office we really don’t like taking blood pressure in kids. If it’s high, we’ve got to bring the kid back, and if it’s still high we’re not sure what to do.^ While for many types of cardiovascular problems, this might be an embarrassing admission, for pediatric hypertension and other cardiovascular risks in children, my colleague’s perspective was consistent with what is known about current practice. It has been nearly 40 years since the NIH published its first report on pediatric hypertension and declared that, BDetection and management of hypertension in children and the precursors of hypertension in adults are the next major frontier^ [1]. Most cases of hypertension in children, unfortunately, are still missed. Hansen and colleagues, for example, reported in 2007 that among 507 children seen in outpatient clinics, only 26 % of elevated blood pressure (BP) and hypertension was detected [2]. Others have reported that 87–92 % of elevated BP values among children go unrecognized in primary care settings [3, 4]. My own experience is consistent with these low rates of diagnosis. In a network of community health centers in which I am carrying out research and which serves nearly 50,000 primarily Latino and African American children, the overall recorded prevalence of hypertension among children in 2015 was just 0.75 %—despite pre
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