Documentations of Advanced Heath Care Directives Where Are They TAI_SEALE
Prevalence of Hypertension in Children Based on Task Force Guidelines vs Average BP
1. Prevalence of Hypertension in
Children:
Comparison Between Task Force
Recommendations and Average of Multiple
Measurements over 2 or 4 years
2. Authors
Kenneth F. Adams Emily D. Parker
Alan R. Sinaiko Louise C Greenspan
Joan C. Lo Karen L. Margolis
David J. Magid Nancy E. Sherwood
Elyse O. Kharbanda Nicole K. Schneider
Matthew F. Daley Patrick J. O’Connor
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3. Institutions
HealthPartners
Kaiser Permanente Colorado
Kaiser Permanente Northern California
University of Minnesota
Funding: NHLBI 1R01HL093345-01
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4. Background: Childhood Hypertension
Hypertension in adults is an asymptomatic
physiologic condition that predicts long term
adverse conditions
Hypertension may also be a sign of current
pathologic conditions (e.g., kidney disease)
Hypertension in children is associated with pre-
clinical cardiovascular disease in adulthood (carotid
intimal media thickness, left ventricular hypertrophy)
Tracking: Elevated BP in childhood is a risk factor
for hypertension in adulthood
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5. Background: Childhood Hypertension
NHBPEP 4th Working Group prescribed an approach
to assessing hypertension
Gender, age, & height-specific BP percentiles based
on normative data collected from school studies
Mimics adult hypertension guidelines
Measurement should be repeated on separate
occasions (Stage 1)
Various classifications
Pre-HTN, Stage 1, Stage 2
Providers should measure BP at all routine clinic visits
Prospective orientation
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6. Background: Current clinical
environment
Electronic medical records (EMR) allow provider to
track blood pressure over time
Several years of retrospective data may be available
Conversion from BP (as mm Hg) to age, gender, and
height-specific BP percentiles can be automated
But interpretation of retrospective BP data may not be
straight-forward
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7. Methods
Source population: Children and adolescents
(3-17 years); patient at one of 3 sites
Analysis cohort is a subset of the source population
Inclusion: Children having ≥ 3 BP measures (height
must be available)
Exclusion: Pregnant at any time during follow-up
Subjects are censored at time of HTN diagnosis or
claim for anti-HTN drug
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8. Results: Prevalence of hypertension
and other intermediate categories
By Working Group Classification Frequency
n %
HTN * 3,210 2.63
Pre-HTN and other intermediate categories † 36,285 29.63
Normal: All BP <90th % 82,832 67.74
Total 122,273 100.00
* Includes 3+ consecutive BP measures ≥ 95th % (Stage 1 HTN),
or 1+ BP measure >99th % + 5 mm Hg (Stage 2 HTN)
† Intermediate categories include BP 90th to 95th % (pre-HTN),
1-2 BP ≥ 95th %, or 3+ non-consecutively elevated BP measures
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9. Results: Cross-Tabulation of Working
Group Definitions with Avg BP ≥ 95th %
Average BP Percentile
Working Group Classification < 95th * ≥ 95th Total
n % % %
3+ consecutive BP measures ≥ 95th % 2,728 1.96 0.27 2.23
1+ BP measure >99th % + 5 mm Hg 477 0.29 0.10 0.39
Not hypertensive 119,068 97.20 0.18 97.38
Total 122,273 99.45 0.55 100.00
* cell percentages
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10. Results: Hypertension Prevalence By
Look-back Duration
HTN Prevalence Using 3 Definitions
Look-back Time Unique 3+ 1 or more Average
Period subjects consecutive BP >99th % BP ≥ 95th
BP ≥ 95th % + 5 mm Hg percentile
n % % %
Up to 4 years 122,273 2.63 1.00 0.55
Most recent 3 years 117,696 2.55 0.99 0.56
Most recent 2 years 98,648 2.45 0.97 0.58
Most recent 1 year 60,773 2.57 1.09 0.74
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11. Results: Hypertension Prevalence By
Number of BP Measures Available
HTN Prevalence Using 3 Definitions
Number of BP Unique 3+ 1 or more Average
Measures Available subjects consecutive BP >99th % BP ≥ 95th
BP ≥ 95th % + 5 mm Hg percentile
n % % %
3 41,139 1.28 0.18 0.92
4-5 39,648 1.63 0.28 0.49
≥6 41,486 3.75 0.72 0.24
Total 122,273 2.23 0.39 0.55
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12. Comments (1)
These preliminary data show
Prevalence of hypertension in overall pediatric
population is low by all 3 measures
4th Working Group definitions have only limited
correspondence with hypertension defined by
average BP percentile ≥ 95th percentile
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13. Comments (2)
These preliminary data show
Duration of follow-up (1-4 years) is not related to
prevalence of any of the 3 BP measures
Prevalence of Stage 1 and Stage 2 hypertension
increases with the number of BP measures available
Prevalence of average BP≥ 95th percentile
decreases with number of BP measures available
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14. Comments (3)
Potential significance
Differences in subjects identified by the 3
hypertension definitions suggests lack of persistence
and indicates further research is needed
Clinical usefulness of diagnosing hypertension in
pediatric patients using these criteria is unclear
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