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Undiagnosed High Blood Pressure in Children
Have you been hearing about high blood pressure being undiagnosed in children? According to a current article in JAMA, about a quarter of hypertensive children are going undiagnosed simply because we are not looking for it. That is not just a few children, but a million children! As healthcare providers, we need to be checking blood pressure (BP) on all children, not just obese children, big kids, and teenagers.
The study, which was done by Matthew L. Hansen, MD, and colleagues at Case Western Reserve University in Cleveland , involved more than 14,000 children between the ages of 3 and 18. The children were observed in ambulatory care at least three times for well checks between 1999 and 2007 .
Based on the criteria for hypertension, 507 children were hypertensive, but only 131 of them were given that diagnosis. That is an astonishing 376 who were undiagnosed! Of these kids, 485 met the criteria for prehypertension, but only 55 were assigned the diagnosis of elevated BP.
Some of the children were overweight, and secondary hypertension is more prevalent in children than adults. Secondary hypertension means hypertension due to another underlying cause, such as excess weight. The danger to these kids is that they may go years before being diagnosed, thus delaying treatment and risking serious organ damage and complications.
What can we, as medical assistants, do to help solve this problem? We can take BP readings of all children age 3 and above at every visit. Refer to our feature article in the Winter 2007 issue entitled “Are You Measuring Blood Pressure Correctly?” to review the proper technique and cuff sizes for accurate blood pressures.
Blood pressure cuffs are not standardized and can be difficult to fit properly. Currently it is recommended that the bladder (within the cuff) be wide enough to cover 40% of the mid upper arm circumference (UAC).
Along with careful attention to accuracy while measuring patient blood pressures , we should document the numbers and bring abnormally high readings to the attention of our physician employers. Documentation records will show a pattern over time if we continue to take BP readings with every visit. The electronic medical record (EMR) allows better access to this data.
This careful, consistent, and correct measuring of BP in our young patients will help our physician employers diagnose hypertension earlier, perform further testing as needed, treat the conditions, and educate our young patients and their parents. These measures could help avoid future healthcare crises for an entire generation of American youth.
What are considered healthy blood pressure readings for children and adolescents? Do not feel bad if you do not know the numbers. According to an article found at the website of the American Academy of Pediatrics, 44% of practitioners and 50% of nurses did not know the Task Force definition of hypertension. It is not easy to determine, and here are the reasons:
- Hypertension is defined as average systolic BP (SBP) and/or diastolic BP (DBP) that is
 95th percentile for gender, age, and height on  three occasions.
- Prehypertension in children is defined as average SBP or DBP levels that are
 90th percentile but < 95th percentile.
- As with adults, adolescents with BP levels
 120/80 mm Hg should be considered prehypertensive.
Fortunately, a table is available. Using the newly revised CDC growth charts (www.cdc.gov/growthcharts), the height percentage is determined. There are separate tables for boys and girls. These tables may be printed for reference. Instructions for using the tables can be found on the AAP Publications website at http://pediatrics.aappublications.org/cgi/content/full/114/2/S2/555.
The following websites have more information, which you can access by using key search words like “hypertension in children”:
Agency for Healthcare Research and Quality, www.ahrq.gov
American Academy of Pediatrics, www.aap.org
AAP Publications, http://pediatrics.aappublications.org
American Heart Association, www.americanheart.org
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