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Wed 12 Sep 2007 04:00 AM

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Doctors miss high BP in kids

Only a quarter of hypertensive children and adolescents have a diagnosis or documentation of elevated blood pressure in their electronic medical records, US researchers have found.

Only a quarter of hypertensive children and adolescents have a diagnosis or documentation of elevated blood pressure in their electronic medical records, US researchers have found.

Even fewer prehypertensive children and adolescents had the condition noted in their records, Dr David Kaelber of Boston Children's Hospital and Harvard, and colleagues.

The findings were reported in the Journal of the American Medical Association.

"Based on the data in this study, these conditions appear to be frequently undiagnosed by pediatric clinicians," the authors concluded. "Early, appropriate diagnosis is important because established evaluation guidelines and effective treatment for abnormal blood pressure exist."

To assess the frequency of undiagnosed hypertension in children and adolescents, Kaelber and colleagues identified 14,187 patients ages three to 18 years who had at least three well-care visits from June 1999 to September 2006.

Analysis revealed 507 children and adolescents with hypertension and 485 who had prehypertension. Adolescents made up about 3.5% of the hypertensive and prehypertensive patients. Electronic medical records included a diagnosis of hypertension or documentation of elevated blood pressure in 131 (26%) of the hypertensive patients. Of the prehypertensive group, 55 (11%) had an appropriate diagnosis in their electronic medical records.

Factors that increased the likelihood of a hypertension diagnosis were:

• Each one-year increase in age beyond three.

• More than three elevated blood pressure readings.

• A 1% increase in height-for-age blood pressure percentile.

• An obesity-related diagnosis.

• Number of blood pressure readings in the stage 2 hypertension range.

The authors suggest a lack of knowledge of normal blood pressure ranges and a lack of awareness of a patient's previous BP readings may be behind the poor diagnosis rates. "Our study represents true underdiagnosis of hypertension as these patients' hypertension was not recognised by clinicians throughout our healthcare system," they concluded.

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