Kids' High Blood Pressure Often Missed

High blood pressure in children and teens appears
increasingly common, but it frequently goes undiagnosed, according to new
research.

Three out of four children in the study who were found to have high blood
pressure also had no previous diagnosis of the disorder. Only one in 10
children with borderline high blood pressure, or pre-hypertension, had a prior
diagnosis.

The study is published in the Aug. 22/29 edition of The Journal of the
American Medical Association.

Children who were not obese, not tall for their age, or were younger were
most likely to have their high blood pressure missed during previous medical
visits.

Diagnosing high blood pressure in children and adolescents is more
complicated than in adults. It involves an evaluation that takes into account
the child's age, sex, and height -- and at least three high readings during
separate visits.

Researcher Matthew L. Hansen, MD, tells WebMD that pediatricians and family
doctors often have a very low suspicion of high blood pressure in children who
do not have obvious risk factors like obesity.

"High blood pressure isn't necessarily on the minds of pediatric
clinicians," he says. "It is also much more difficult to know if a
child's blood pressure is abnormal because there is not a set cutoff like there
is with adults."

Kids With High Blood Pressure

It is estimated that between 2% and 5% of children and adolescents have high
blood pressure, but this figure may climb higher as obesity becomes more
prevalent in this age group.

In addition to obesity, conditions such as kidney disease can increase a
child's risk for high blood pressure.

In an effort to better understand the incidence of undiagnosed high blood
pressure among children and teens, Hansen and colleagues from Cleveland's Case
Western Reserve University reviewed the medical records of 14,187 patients
between the ages of 3 and 18 enrolled in an Ohio-based health plan.

All of the children saw their doctor for well-child visits at least three
separate times between the summer of 1999 and the fall of 2006, and all had
electronically accessible medical records.

Of the 507 cases of high blood pressure identified by the researchers
through examination of the electronic data, only 131 (26%) had been previously
identified. And just 55 (11%) of the 485 children and teens with
pre-hypertension had a previous diagnosis of higher-than-normal blood
pressure.

Obese children were less likely to have their high blood pressure go
undiagnosed than normal-weight children, presumably because doctors had a
higher suspicion of the disorder in overweight patients, Hansen says.

Underdiagnosis was also less of an issue among the oldest and tallest kids
in the study because their normal and high blood pressure readings were more
likely to mirror those of adults.

An Electronic Solution

The Case Western Reserve study highlights the problem of underdiagnosed high
blood pressure in children and teens, and it also offers a solution, Hansen
says.

The researchers used a computer program designed to automatically identify
high blood pressure and pre-hypertension based on previous blood pressure
readings and patient age, height, and sex.

They say the program could be used in any medical practice where patient
records are stored electronically.

American Heart Association President Daniel W. Jones, MD, says simplifying
the diagnosis of high blood pressure in children could have a big clinical
impact.

"The current approach to the diagnosis of hypertension in children is so
complex, it is no surprise we miss it so often," he says. "That means
missing opportunities to identify diseases that may be causing the high blood
pressure and missing the chance to manage high blood pressure through
treatment."

By Salynn Boyles
Reviewed by Louise Chang
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