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Medical management of children with primary hypertension by pediatric subspecialists

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Abstract

Our aim was to characterize medical management of children with primary hypertension (HTN) by pediatric subspecialists. We performed a medical-record review of children ≤18 years with primary HTN seen at pediatric cardiology or pediatric nephrology clinics at an academic center. Main outcomes were whether treatment decision was in agreement with national guidelines, whether an antihypertensive medication was prescribed, and medication choice. One hundred and eighty children had ≥1 visit to a pediatric cardiology or nephrology clinic. The majority (83%) of children were pharmacologically managed according to national guidelines. However, only 1/3 children with stage 2 HTN received appropriate antihypertensive therapy from either subspecialty. Only 26 children were prescribed an antihypertensive drug. Children evaluated by pediatric nephrologists were fourfold more likely to receive an antihypertensive than children seen by pediatric cardiologists (29% vs. 7%; p < 0.001). However, all antihypertensive prescriptions were prescribed according to guidelines by both subspecialties. Medical management of children with primary HTN by pediatric cardiologists and pediatric nephrologists is largely consistent with guidelines. However, initiation of appropriate antihypertensive drugs for children with highest severity of HTN is equally poor for both subspecialties. Future studies should explore the factors underlying physicians’ reluctance to initiate recommended chronic pharmacologic therapy in children and its associated outcomes.

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Abbreviations

ACE:

Angiotensin-Converting Enzyme

ADHD:

Attention Deficit Hyperactivity Disorder

ARB:

Angiotensin Receptor Blocker

Ca2+ :

Calcium

ECG:

Electrocardiogram

ECHO:

Echocardiogram

HTN:

Hypertension

ICD-9:

International Classification of Diseases, 9th Revision

LVH:

Left Ventricular Hypertrophy

mmHg:

Millimeters of Mercury

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Authors and Affiliations

  1. Division of General Pediatrics, University of Michigan, 300 North Ingalls Building 6E07, Ann Arbor, MI, 48109-5456, USA

    Esther Y. Yoon, Matthew M. Davis & Gary L. Freed

  2. Division of General Internal Medicine and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA

    Matthew M. Davis

  3. Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA

    Albert Rocchini

  4. Division of Pediatric Nephrology, University of Michigan, Ann Arbor, MI, USA

    David Kershaw

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  1. Esther Y. Yoon
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  2. Matthew M. Davis
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  3. Albert Rocchini
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  4. David Kershaw
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  5. Gary L. Freed
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Correspondence to Esther Y. Yoon.

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Yoon, E.Y., Davis, M.M., Rocchini, A. et al. Medical management of children with primary hypertension by pediatric subspecialists. Pediatr Nephrol 24, 147–153 (2009). https://doi.org/10.1007/s00467-008-0970-3

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  • DOI: https://doi.org/10.1007/s00467-008-0970-3

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