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Paediatric hypertension often goes unrecognised

BMJ 2007; 335 doi: (Published 30 August 2007) Cite this as: BMJ 2007;335:421

Hypertension in children and adolescents is an independent risk factor for adult hypertension and is associated with early markers of cardiovascular disease. Most of the children have primary hypertension, but the proportion of those with secondary hypertension will be higher than in the adults. Early diagnosis should lead to appropriate diagnostic investigation and treatment, thereby preventing long term sequelae.

A US cohort study of more than 14 000 children and adolescents aged 3-18 years shows that the diagnosis is often missed. While 507 children (3.6%) met the criteria for hypertension, only one in four had the diagnosis recorded in their electronic health records. Similarly, only 11% (55 of 485) of children with prehypertension (prevalence in this sample 3.4%) were diagnosed, even though most records contained the data on which to base the diagnoses.

Older and taller children were more likely to be diagnosed, perhaps because criteria in these children are closer to those for adults. Children with a diagnosis related to obesity were also more likely to have their hypertension documented (odds ratio 2.61, 95% CI 1.49 to 4.55). The authors call for incorporation of clinical decision support algorithms into electronic medical records, which would help clinicians to recognise when a child fulfils the criteria for prehypertension or hypertension.


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