Sunday, January 20, 2019 | ePaper

Pediatric hypertension

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Life Desk  :
Children and teens showing high blood pressure readings on measuring for the first time should have a second measurement taken to correctly diagnose pediatric hypertension
Pediatric hypertension is on the rise and accurate diagnosis and treatment of the condition early is necessary to reduce risk of future complications
Children between 3 to 17 years showing high blood pressure readings on the first measurement should have it confirmed by a second measurement, according to a recent Kaiser Permanente study published in the Journal of Clinical Hypertension.
"Pediatricians don't diagnose hypertension in children very often, but if it is there, we want to find it," said, Robert James Riewerts, MD, regional chief of Pediatrics for the Southern California Permanente Medical Group. "This study is important because it demonstrates the best path to accurately diagnose hypertension in a child or teen. Taking a second blood pressure reading is something all clinicians must consider when the initial reading is elevated.
Blood pressure measurements in children and teens may be affected by factors such as anxiety. Also, definitions of hypertension in children vary based on the age, gender and height making it more difficult with unwieldy reference tables.
'Approximately 25 percent of children showing elevated blood pressure values in the first measurement does not reproduce the results during the second reading.'
"Because an elevated first blood pressure in youth is common, correct identification of truly elevated blood pressure may be the first step to improve the recognition of hypertension in pediatric care," said Corinna Koebnick, PhD, MSc, of the Kaiser Permanente Southern California Department of Research & Evaluation. "If hypertension is missed, children and teens may not receive the counseling they need for lifestyle changes or medication."
The current study included children and teens between the ages of 2 to 19 years in Southern California who are members of the Kaiser Permanente. The cohort follow-up study was done through passive surveillance of clinical care data using the electronic health record system.
The final group of 755,795 children was monitored during a 4-year period, from January 2012 to December 2015.
Less than half of the children who had their blood pressure screened would be correctly diagnosed taking into account only the first blood pressure reading during the visit
The findings suggest that at least two blood pressure readings should be taken (if initial measurement is high) to precisely diagnose hypertension.
Following this study, Kaiser Permanente in Southern California has placed 'flags' on its electronic health records alerting clinicians to when a second blood pressure reading is advised. Additionally, decision-support tools were also put in to help doctors decide if and when further evaluation would be needed.
The findings of the current study are in addition to earlier studies that aimed to improve hypertension diagnosis and treatment in the population
Children having an initial increased blood pressure at the doctor's office are unlikely to receive the suggested recommendations regarding monitoring of blood pressure values
In a separate study, it was found that allowing blood pressure screenings to be done in non-primary care settings might be useful in identifying more adults with hypertension
Educating parents on the risk factors of pediatric hypertension - family history of hypertension, obesity, certain endocrine disorders, renal disease, and some heart diseases
Lifestyle changes should be the first line of management; only if these fail should blood pressure lowering medications be considered
Involving the entire family in lifestyle changes such as healthy diet and exercise to improve compliance in the child
Recently, the American Academy of Pediatrics (AAP) has also brought newer, simpler and improved guidelines to accurately diagnose and treat pediatric hypertension.
Source: Medindia

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