Skip to main content
SpringerLink
Log in

Recognition and Management of Elevated Blood Pressure in Pediatric Patients: Challenges and Disparities in Community Health Centers

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

The prevalence of childhood elevated blood pressure (EBP)—a single blood pressure recording above the normal range—is increasing in the United States. Recognizing childhood EBP is difficult because classification is a function of age, sex, and height. We assessed the frequency of clinical recognition of EBP and follow-up care in a sample of pediatric patients seen in 2010 and followed up through September 2013 in a network of 8 urban health centers. Of 754 patients with BP measurements, 261 (35 %) had at least 1 EBP reading during the study period. Of those with an EBP reading, 52 (20 %) had at least 1 EBP reading noted in their medical record. Clinicians were more likely to recognize EBP in overweight/obese [OR 3.27 (95 % confidence interval (CI) 1.64–6.51)] and male [OR 2.83 (95 % CI 1.64–4.42)] children. Strategies to support routine monitoring of BP status could improve identification and management of pediatric EBP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention (CDC). (2011). Vital signs: Prevalence, treatment, and control of hypertension—United States, 1999–2002 and 2005–2008. MMWR Morbidity and Mortality Weekly Reports, 60(4), 103–108.

    Google Scholar 

  2. Rahimi, K., Emdin, C. A., & MacMahon, S. (2015). The epidemiology of blood pressure and its worldwide management. Circulation Research, 116(6), 925–936.

    Article  CAS  PubMed  Google Scholar 

  3. Cheng, S., Claggett, B., Correia, A. W., et al. (2014). Temporal trends in the population attributable risk for cardiovascular disease: The atherosclerosis risk in communities study. Circulation, 130(10), 820–828.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hajjar, I., Quach, L., Yang, F., et al. (2011). Hypertension, white matter hyperintensities, and concurrent impairments in mobility, cognition, and mood: The Cardiovascular Health Study. Circulation, 123(8), 858–865.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bramham, K., Parnell, B., Nelson-Piercy, C., Seed, P. T., Poston, L., & Chappell, L. C. (2014). Chronic hypertension and pregnancy outcomes: Systematic review and meta-analysis. BMJ, 348, g2301.

    Article  PubMed  PubMed Central  Google Scholar 

  6. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. (2004). The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics, 114(2 Suppl 4th Report), 555–576.

    Article  Google Scholar 

  7. Lande, M. B., & Kupferman, J. C. (2014). Pediatric hypertension: The year in review. Clinical Pediatrics (Phila), 53(4), 315–319.

    Article  Google Scholar 

  8. Din-Dzietham, R., Liu, Y., Bielo, M. V., & Shamsa, F. (2007). High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation, 116(13), 1488–1496.

    Article  PubMed  Google Scholar 

  9. Chen, X., & Wang, Y. (2008). Tracking of blood pressure from childhood to adulthood: A systematic review and meta-regression analysis. Circulation, 117(25), 3171–3180.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Vos L. E., Oren A., Uiterwaal C., Gorissen W. H., Grobbee D. E. & Bots M. L. (2003). Adolescent blood pressure and blood pressure tracking into young adulthood are related to subclinical atherosclerosis: The atherosclerosis risk in young adults (ARYA) study. American Journal of Hypertension, 16(7), 549–555.

    Article  PubMed  Google Scholar 

  11. Falkner, B. (2010). Hypertension in children and adolescents: Epidemiology and natural history. Pediatric Nephrology, 25(7), 1219–1224.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lande, M. B., Gerson, A. C., Hooper, S. R., et al. (2011). Casual blood pressure and neurocognitive function in children with chronic kidney disease: A report of the children with chronic kidney disease cohort study. Clinical Journal of the American Society of Nephrology, 6(8), 1831–1837.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Shapiro, D. J., Hersh, A. L., Cabana, M. D., Sutherland, S. M., & Patel, A. I. (2012). Hypertension screening during ambulatory pediatric visits in the United States, 2000–2009. Pediatrics, 130(4), 604–610.

    Article  PubMed  Google Scholar 

  14. Hansen, M. L., Gunn, P. W., & Kaelber, D. C. (2007). Underdiagnosis of hypertension in children and adolescents. JAMA, 298(8), 874–879.

    Article  CAS  PubMed  Google Scholar 

  15. Daley, M. F., Sinaiko, A. R., Reifler, L. M., Tavel, H. M., et al. (2013). Patterns of care and persistence after incident elevated blood pressure. Pediatrics, 132(2), e349–e355.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Brady, T. M., Solomon, B. S., Neu, A. M., Siberry, G. K., & Parekh, R. S. (2010). Patient-, provider-, and clinic-level predictors of unrecognized elevated blood pressure in children. Pediatrics, 125(6), 1286–1293.

    Article  Google Scholar 

  17. Zaheer, S., Watson, L., & Webb, N. J. (2014). Unmet needs in the measurement of blood pressure in primary care. Archives of Disease in Childhood, 99(5), 463–464.

    Article  CAS  PubMed  Google Scholar 

  18. Philadelphia Department of Public Health (PDPH).(2009). Health center service areas: Examining population health in Philadelphia. http://www.phila.gov/health/pdfs/2009_Health_Center_Service_Area_Report.pdf. Accessed 12 June 2015.

  19. Nguyen, J. V., Robbins, J. M., Houck, K. L., et al. (2014). Severe obesity and high blood pressure among children, Philadelphia health centers, 2010. Journal of Primary Care and Community Health, 5(2), 149–152.

    Article  Google Scholar 

  20. Sorof, J. M., Poffenbarger, T., Franco, K., Bernard, L., & Portman, R. J. (2002). Isolated systolic hypertension, obesity, and hyperkinetic hemodynamic states in children. Journal of Pediatrics, 140(6), 660–666.

    Article  PubMed  Google Scholar 

  21. Riley, M., Dobson, M., Sen, A., & Green, L. (2013). Recognizing elevated BP in children and adolescents: How are we doing? Journal of Family Practice, 62(6), 294–299.

    PubMed  Google Scholar 

  22. Gillman, M. W. (2009). Childhood prevention of hypertensive cardiovascular disease. Journal of Pediatrics, 155(2), 159–161.

    Article  PubMed  Google Scholar 

  23. Andrews, J. C., DeWill, B., Czerwien, T. E., Bijelic, M., & Latman, N. S. (2011). Inaccuracies introduced by single width blood pressure cuffs. Hypertension Research, 34(2), 209–211.

    Article  PubMed  Google Scholar 

  24. Brady, T. M., & Feld, L. G. (2009). Pediatric approach to hypertension. Seminars in Nephrology, 29(4), 379–388.

    Article  PubMed  Google Scholar 

  25. Lo, J. C., Sinaiko, A., Chandra, M., Daley, M. F., et al. (2013). Prehypertension and hypertension in community-based pediatric practice. Pediatrics, 131(2), 415–424.

    Article  Google Scholar 

Download references

Acknowledgments

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. It was carried out under the guidance of the Pediatric and Adolescent Continuous Quality Improvement Committee of the Philadelphia Health Centers, and could not have been completed without the active support of Committee members, including Dr. Louise Lisi, Dr. Karen Trabulsi, and Lisa Hart, who provided training for the research staff. We would also like to thank Amy H. Auchincloss, Drexel University School of Public Health, for critical scientific advice and assistance, and Mingie Kang, Sumaiya Khan, Geoffrey Kip, Jinggaofu Shi, Nicholas Thompson, Emily Zammitti, and Aran Zouela, who assisted with data collection.

Author information

Authors and Affiliations

  1. Health Care for the Homeless, 421 Fallsway, Baltimore, MD, 21202, USA

    Rikki L. Ward

  2. Philadelphia Department of Public Health, 500 South Broad Street, Philadelphia, PA, 19146, USA

    Jessica M. Robbins

  3. Human Care Systems, Inc.,, 429 E. 9th St Apartment #3, New York, NY, 10009, USA

    Rebecca N. Haden

  4. UBC-An Express Scripts Company, 920 Harvest Drive Suite 200, Blue Bell, PA, 19422, USA

    Brittany J. Benson

  5. Philadelphia Department of Public Health, Health Center #2, 1930 South Broad Street, Unit #14, Philadelphia, PA, 19145, USA

    Issy C. Esangbedo

Authors
  1. Rikki L. Ward
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jessica M. Robbins
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rebecca N. Haden
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brittany J. Benson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Issy C. Esangbedo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jessica M. Robbins.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ward, R.L., Robbins, J.M., Haden, R.N. et al. Recognition and Management of Elevated Blood Pressure in Pediatric Patients: Challenges and Disparities in Community Health Centers. J Community Health 41, 258–264 (2016). https://doi.org/10.1007/s10900-015-0091-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-015-0091-4

Keywords

Search

Navigation